bluuebunny/crossref_metadata_2025 huggingface dataset:
Gender difference with the use of percutaneous left ventricular assist device in patients undergoing complex high-risk percutaneous coronary intervention: From pVAD Working Group
Authors: Doshi Rajkumar , Singh Avneet , Jauhar Rajiv , Meraj Perwaiz M
Published: January 2018

Background:

The interventional treatment of complex high-risk indicated patients is technically difficult and can result in poor outcomes. Thus, percutaneous left ventricular assist devices are being increasingly used to provide hemodynamic support. No data is available comparing male and female for Complex High-risk Indicated Patients treated with percutaneous left ventricular assist devices. Our goal was to evaluate in-hospital as well as short term outcomes comparing males and females.

Methods:

There were 160 complex high-risk indicated patients with percutaneous left ventricular assist device use who were not in cardiogenic shock. A total of 132 male and 28 female patients were included. Ejection fraction below 35% with one additional criterion such as use of atherectomy device or treatment on unprotected left main disease or multi-vessel disease were our inclusion criteria. An Impella 2.5 or Impella CP (Abiomed Inc.) device was used as a left ventricular support device.

Results:

There was no difference in in-hospital mortality between the genders after performing a propensity score matched analysis (8.3% vs. 12.5%, p=0.54). Secondary outcomes of myocardial infarction, cardiogenic shock, congestive heart failure, dysrhythmia, major adverse cardiac events and composite of all complications were higher in males. Furthermore, 30-day survival was similar in males and females (88.9% vs. 87.5%, p=0.31). In addition, worse complications rates and survival were noted in patients with incomplete revascularization compared with those patients with complete revascularization in both gender.

Conclusion:

This study demonstrated no gender difference in clinical outcomes when using percutaneous left ventricular assist device support for the treatment of complex high-risk indicated patients. Overall, males had higher secondary outcomes compared with females with no difference in in-hospital mortality or 30-day survival rates.
Results of surveillance in individuals at high‐risk of pancreatic cancer: A systematic review and meta‐analysis
Authors: Signoretti Marianna , Bruno Marco J , Zerboni Giulia , Poley Jan-Werner , Delle Fave Gianfranco , Capurso Gabriele
Published: January 2018

Background

Data on surveillance for pancreatic ductal adenocarcinoma (PDAC) in high‐risk individuals (HRIs) with “familial pancreatic cancer” (FPC) and specific syndromes are limited and heterogeneous.

Objective

We conducted a systematic review and meta‐analysis of PDAC surveillance studies in HRIs.

Methods

Prevalence of solid/cystic pancreatic lesions and of lesions considered a successful target of surveillance (proven resectable PDAC and high‐grade precursors) was pooled across studies. The rate of lesions diagnosed by endoscopic ultrasonography (EUS)/magnetic resonance imaging (MRI) and across different HRI groups was calculated.

Results

Sixteen studies incorporating 1588 HRIs were included. The pooled prevalence of pancreatic solid and cystic lesions was 5.8% and 20.2%, respectively. The pooled prevalence of patients with lesions considered a successful target of surveillance was 3.3%, being similar to EUS or MRI and varying across subgroups, being 3% in FPC, 4% in hereditary pancreatitis, 5% in familial melanoma, 6.3% in hereditary breast/ovarian cancer, and 12.2% in Peutz‐Jeghers syndrome. The pooled estimated rate of lesions considered a successful target of surveillance during follow‐up was 5/1000 person‐years.

Conclusion

Surveillance programs identify successful target lesions in 3.3% of HRIs with a similar yield of EUS and MRI and an annual risk of 0.5%. A higher rate of target lesions was reported in HRIs with specific DNA mutations.
Algorithms as fetish: Faith and possibility in algorithmic work
Authors: Thomas Suzanne L , Nafus Dawn , Sherman Jamie
Published: January 2018

Algorithms are powerful because we invest in them the power to do things. With such promise, they can transform the ordinary, say snapshots along a robotic vacuum cleaner’s route, into something much more, such as a clean home. Echoing David Graeber’s revision of fetishism, we argue that this easy slip from technical capabilities to broader claims betrays not the “magic” of algorithms but rather the dynamics of their exchange. Fetishes are not indicators of false thinking, but social contracts in material form. They mediate emerging distributions of power often too nascent, too slippery or too disconcerting to directly acknowledge. Drawing primarily on 2016 ethnographic research with computer vision professionals, we show how faith in what algorithms can do shapes the social encounters and exchanges of their production. By analyzing algorithms through the lens of fetishism, we can see the social and economic investment in some people’s labor over others. We also see everyday opportunities for social creativity and change. We conclude that what is problematic about algorithms is not their fetishization but instead their stabilization into full-fledged gods and demons – the more deserving objects of critique.
Mechanical Circulatory Support for the Failing Fontan: Conversion to Assisted Single Ventricle Circulation—Preliminary Observations
Authors: Peer Syed M. , Deatrick Kristopher B. , Johnson Thomas J. , Haft Jonathan W. , Pagani Francis D. , Ohye Richard G. , Bove Edward L. , Rojas-Peña Alvaro , Si Ming-Sing
Published: January 2018

Background:

Mechanical circulatory support (MCS) of a failing Fontan circulation remains challenging. We hypothesized that MCS can be provided by converting the Fontan circulation into a mechanically assisted single ventricle parallel circulation (MASVC).

Methods:

A porcine model of functionally univentricular circulation was created under cardiopulmonary bypass (CPB) by performing an atrial septectomy, tricuspid valvectomy, and interrupting antegrade pulmonary blood flow. A centrifugal flow pump was placed with inflow from the common atrium. Eight millimeter Dacron grafts anastomosed to the ascending aorta and main pulmonary artery supplied systemic (Qs) and pulmonary (Qp) blood flow. Ultrasonic flow probes were used to measure Qs and Qp after weaning from CPB. The Qp/Qs ratio was regulated using an adjustable clamp. Hemodynamic and laboratory data were recorded.

Results:

All four animals were successfully weaned from CPB onto the MASVC for a duration of two hours. Mechanically assisted single ventricle parallel circulation achieved satisfactory hemodynamics. As anticipated, the arterial oxygen saturation and partial pressure of oxygen in arterial blood were lower in the MASVC compared to baseline biventricular circulation. At the conclusion of the study, there was a trend towards a decrease in the mixed venous saturation with increasing oxygen extraction compared to the baseline. Serum lactate levels increased after weaning from CPB and did not return to baseline after two hours of support.

Conclusion:

Mechanically assisted single ventricle parallel circulation can be established in a single ventricle animal model. This strategy could potentially provide MCS of a single ventricle circulation. Studies with longer duration of support are required to assess adequacy of support and long-term sustainability.
Evaluation of Factors Associated With Achievement of Biventricular Repair After Bilateral Pulmonary Artery Banding in Patients With Interrupted Aortic Arch
Authors: Hirano Yasuhiro , Inamura Noboru , Kawazu Yukiko , Aoki Hisaaki , Kayatani Futoshi , Iwai Shigemitsu , Kawata Hiroaki
Published: January 2018

Background:

At our institution, we perform bilateral pulmonary artery banding (BPAB) as the first-stage palliation for interrupted aortic arch (IAA) with low birth weight or severe subaortic stenosis (SAS). The present study aimed to identify factors that may influence the decision regarding the type of second-stage operation, that is, univentricular palliation or biventricular repair, in these patients.

Methods:

Cardiac catheterization and angiographic data of nine patients with IAA who underwent initial BPAB and subsequent univentricular or biventricular repair were retrospectively analyzed.

Results:

Between 2004 and 2014, of nine patients with IAA who underwent initial BPAB, biventricular repair was subsequently performed in six patients (group B) and univentricular repair in three patients (group U). All patients survived. There was no significant intergroup difference in IAA classification, location of ventricular septal defect, presence of 22q11.2 deletion, presence of aberrant right subclavian artery, band diameter, or post-BPAB pulmonary artery pressure and index. Timing of BPAB and the body weight at the time of BPAB, however, differed significantly between the groups ( P = .02). Catheter data before BPAB were not significantly different between the groups, with the exception of the degree of subaortic stenosis (or hypoplasia of the left ventricular outflow tract) expressed as percentage of the normal end-systolic aortic valve annular diameter for patient body surface area. This metric (%SAS before BPAB) was significantly higher in group B (60%-68%) than in group U (47%-60%; P = .04). Among patients for whom baseline %SAS was < 60%, the %SAS did not increase after BPAB.

Conclusion:

The most important factor that allowed biventricular repair was not the pulmonary artery pressure or diameter but the degree of SAS. Patients who initially had more severe SAS ultimately underwent univentricular repair due to lack of substantial improvement in dimensions of the left ventricular outflow tract after BPAB.
Endotoxin Activity in Neonates Undergoing Cardiac Surgery: Cohort Study
Authors: Ricci Zaccaria , Benegni Simona , Garisto Cristiana , Favia Isabella , Haiberger Roberta , Di Chiara Luca
Published: January 2018

Background:

Endotoxemia in pediatric cardiac surgical patients is poorly understood. The endotoxin activity assay (EAA) levels were examined in neonates undergoing cardiac surgery in order to assess their reference levels and their association with other pre-, intra-, and postoperative risk factors for gut hypoperfusion. We finally observed if refeeding was associated with modification of endotoxin levels.

Methods:

In a prospective cohort study, neonates undergoing surgery for correction or palliation were enrolled. Preterm birth, weight below 1.5 kg, the need for extracorporeal membrane oxygenation, and urgent surgery were exclusion criteria.

Results:

Among the 26 enrolled neonates, 12 underwent on-pump and 14 off-pump surgery, 22 received a preoperative infusion of prostaglandin E2. Overall, 11 patients were surgically corrected and 15 received a palliation. Endotoxin activity assay baseline levels were inversely correlated with age at surgery ( r = −.50, P = .006) and they increased to postoperative day2 ( P = .002). On-pump versus off-pump surgery ( P =.36) and surgical palliation with a Blalock-Taussig shunt versus correction ( P = .45) did not predict increase in EAA levels. Aortic clamping for coarctation repair was associated with the lowest levels ( P = .04). Systolic, mean, and diastolic pressures were associated with EAA levels ( r = −.55, P = .01; r = −.45, P = .02; r = −.37, P = .04, respectively). Endotoxin activity assay levels after refeeding were similar to baseline levels. Patients with abdominal distension and feeding intolerance showed higher median peak EAA levels (0.7, 0.66-1.11) than asymptomatic patients (0.53, 0.35-0.64; P = .01).

Conclusions:

Endotoxin activity assay levels increase after elective neonatal surgery and are not modified by refeeding. High postoperative levels may predict feeding intolerance.
A Medium-Term Venous Access Alternative for Infants Undergoing Congenital Heart Surgery
Authors: Raees Muhammad Aanish , Dubar Paul V. , Bichell David P.
Published: January 2018

We describe a strategy aimed at maximizing the safety and minimizing the thrombogenicity of central venous lines for neonates with congenital heart defects. Our method involves the use of a tunneled technique to place a 4.2 Fr single-lumen (Broviac) catheter in the subpericardial space, with minimal intravascular course and a tip placed in the lower right atrium. Using this technique, we potentially eliminated the requirement for percutaneous placement of central venous lines postoperatively as well as potentially decreased the risk of intrapericardial bleeding associated with transthoracic lines.
Prognostic factors in pontine haemorrhage: A systematic review
Authors: Behrouz Réza
Published: January 2018

Background

Pontine haemorrhage comprises approximately 10% of intracerebral haemorrhages. There is a common presumption that pontine haemorrhage is inherently associated with poor outcome.

Purpose

The aim of the review was to identify chief predictors of prognosis in (pontine haemorrhage) through systematic review of published literature.

Methods

A query of PubMed/MEDLINE was conducted in search of studies in English language since, 1980 focusing specifically on outcome in pontine haemorrhage. References for each publication were reviewed for additional studies not detected by the PubMed/MEDLINE probe. Surgical outcome studies were excluded from the review.

Findings

The query identified 7867 titles, after removal of duplicates and irrelevant studies, 20 titles were included in the review. In a total of 1437 pontine haemorrhage patients included in the 20 studies, the overall rate for early all-cause mortality was 48.1%. Level of consciousness on admission and haemorrhage size were the most consistent predictors of mortality in patients with pontine haemorrhage. Haemorrhage localisation within the pons was also a prognostic factor, but not consistently. Age and intraventricular extension were not found to be powerful prognostic predictors.

Discussion/Conclusion

Based on this review, level of consciousness on admission and haemorrhage size were the most influential prognostic factors in pontine haemorrhage, whereas age, haemorrhage localisation, and intraventricular haemorrhage did not consistently predict prognosis.
Casein kinase 1 is a therapeutic target in chronic lymphocytic leukemia
Authors: Janovska Pavlina , Verner Jan , Kohoutek Jiri , Bryjova Lenka , Gregorova Michaela , Dzimkova Marta , Skabrahova Hana , Radaszkiewicz Tomasz , Ovesna Petra , Vondalova Blanarova Olga , Nemcova Tereza , Hoferova Zuzana , Vasickova Katerina , Smyckova Lucie , Egle Alexander , Pavlova Sarka , Poppova Lucie , Plevova Karla , Pospisilova Sarka , Bryja Vitezslav
Published: January 2018

Key Points

CK1 inhibition significantly blocks microenvironmental interactions of CLL cells. CK1 inhibition slows down development of CLL-like disease in the Eμ-TCL1 mouse model.
Elastic 3D PS converted-wave Gaussian beam migration
Authors: Li Xuelei , Mao Weijian , Shi Xingchen , Yue Yubo
Published: January 2018

Elastic-wave migration is a desirable technique because it can image the structure of the earth more accurately. We develop a new elastic Gaussian beam migration method with 3D three component (3D-3C) seismic data that focuses on a complex PS-converted wave. Based on the elastic-wave equations and complete boundary conditions, we derive effective work formulas for an accurate multimode wave downward continuation for the free-space, ocean-bottom, and free-surface models. We separate the PS-wave into linear-polarized P-S1 and P-S2 waves to simplify the expression and derivation of the migration. To image the vectorial wave directly and solve the reverse-polarity issue, we use the crosscorrelations of P-wave divergence and PS-wave curl operators as the 3D P- and PS-imaging conditions, and we develop a unit vector to define the rotation direction of the PS-wave. With our approach, 3D-3C multimode waves are automatically decomposed to P- and PS-waves during the migration without the need for prior data separation, which not only reduces the crosstalk noise caused by inaccurate multimode wave decomposition but also decreases the processing cost. Applications of this method to two 3D-3C synthetic examples indicate successful PS-wave migration. Also, confirming that the PS-image can be constructed by summing the P-S1 and P-S2 images and is independent of the choice of the ray-centered local coordinates validates this method.
3D geostatistical inversion of induced polarization data and its application to coal seam fires
Authors: Soueid Ahmed Abdellahi , Revil André , Jardani Abdel , Chen Rujun
Published: January 2018

We applied the principal component geostatistical approach (PCGA) to the inversion of time-domain induced polarization data in terms of resistivity and chargeability distributions. The PCGA presents two major advantages over standard methods: (1) It avoids the storage of the usually large covariance matrix, which contains the geostatistical information, by factorizing it in a product of low-rank matrices. (2) It does not assemble the Jacobian matrix per se. We determine the robustness of this approach with three examples. We first reconstruct the electrical conductivity and chargeability fields of two synthetic models generated using the geostatistical software Stanford Geostatistical Modeling Software. The PCGA approach performs better than the Tikhonov-based regularization approach when the true fields are very heterogeneous and the amount of data is limited. The third example is devoted to a field study over the former Lewis coal mine in Colorado (USA). We perform a 3D localization of the burning front of this coal seam fire by applying our geostatistical inverse methodology to a time-domain induced-polarization data set. In this case, the horizontal components of the semivariogram are determined from a self-potential map and the correlation length scale for the vertical component is determined from the known thickness of the coal bed. The tomogram presents a high normalized chargeability associated with the burning front. We evaluate the high normalized chargeability of the burning front in terms of the physical mechanism associated with the cation exchange capacity of the coal and the effect of temperature. This demonstrates the potential of the geostatistical inversion and its suitability for inverting geophysical data, especially when the data density is sparse. In the case of coal seam fires, we determine the suitability of the induced polarization method to localize the burning front and the effect of temperature on the normalized chargeability.
Fast salt boundary interpretation with optimal path picking
Authors: Wu Xinming , Fomel Sergey , Hudec Michael
Published: January 2018

Salt boundary interpretation is a crucial step for velocity-model building in seismic migration, but it remains a highly labor-intensive task for manual interpretation and a big challenge for automatic methods. We have developed a semiautomatic method to efficiently and accurately extract 2D and 3D complicated salt boundaries from a seismic attribute image that highlights salt boundaries. In 2D salt boundary extraction, we first pick a few points to interpolate an initial curve that is close to the true salt boundary. These points are picked near the salt boundary but are not required to be exactly on the boundary, which makes human interactions convenient and efficient. We then resample the salt boundary attribute image in a band area centered at the initial curve to obtain a new image in which the true salt boundary is an open curve extending laterally. We then extract the salt boundary in the new image using an optimal-path picking algorithm, which is robust enough to track a stable salt boundary from highly discontinuous attribute values by solving a global maximization problem. We finally map the picked path back to the original image to obtain a final salt boundary. In 3D salt boundary extraction, we apply the 2D method to recursively pick 2D salt boundaries in a sequence of inline or crossline slices and then use these 2D boundaries to fit an implicit (level-set) surface of the 3D salt boundary. In our recursive picking, human interactions are greatly reduced by using a salt boundary picked in the previous slice as an initial curve for picking in a followed slice. The effectiveness of our method is confirmed with 2D and 3D real seismic images.
Psychotherapeutic interventions and contemporary developments: common and specific factors
Authors: Burbridge-James William , Iwanowicz Maciej
Published: January 2018

In this article we start with the effectiveness paradox between different psychotherapeutic modalities, considering common factors, before moving on to give a brief overview of the three main psychotherapeutic approaches – psychoanalytic, cognitive–behavioural and humanistic – and their developments. We conclude that it is the therapeutic relationship – considered in the context of the above – that is core to all therapeutic engagement, medical or otherwise.

LEARNING OBJECTIVES

•

Refresh knowledge of three main psychotherapies

•

Understand the equivalence paradox: common and specific factors

•

Understand the development of contemporary psychotherapeutic approaches

DECLARATION OF INTEREST

None
Psychodynamic approaches to suicide and self-harm
Authors: Yakeley Jessica , Burbridge-James William
Published: January 2018

Rates of suicide and self-harm are rising in many countries, and it is therapeutically important to explore the personal stories and relationships that underlie this behaviour. In this article psychoanalytic and psychodynamic principles and concepts in relation to violence towards the self are introduced and the various unconscious meanings of suicide and self-harm are explored within a relational context and attachment framework. We describe how a psychodynamic approach may enhance the risk assessment and treatment of patients presenting with self-harm and suicidality, particularly examining the role of transference and countertransference within the therapeutic relationship.

LEARNING OBJECTIVES

•

Understand historical and contemporary psychoanalytic theories and concepts regarding the aetiology of suicide and self-harm

•

Understand the different meanings and expressions of acts of suicide and self-harm

•

Understand the use of countertransference in the risk assessment and management of self-harm and suicide attempts

DECLARATION OF INTEREST

None.
Chaining, culture and values: ethical issues in research in middle- and low-income countries
Authors: Hughes Julian C.
Published: January 2018

A paper in this month'sBritish Journal of Psychiatryreports on research from Ghana where some participants were exposed to chaining, which raises ethical concerns. Strict boundaries need to exist between researchers and cruel, inhuman or degrading treatment. Nevertheless, there may be things we can learn from other cultures about our own values.

Declaration of interest

None.
Guardianship under the Mental Health Act 1983
Authors: Shaw Jenny , Hatfield Barbara , Evans Sherrill
Published: January 2018

Aims and Method

To describe the extent and variation in the use of Guardianship nationally. The Directors of Social Services were asked to provide details about Guardianship cases on two separate occasions one year apart.

Results

There were 428 new Guardianship cases in 12 months. At the second enumeration, 73% of cases were within the mental illness category and 47% of these had serious mental illness.

Clinical Implications

There is much variation in the use of Guardianship. Further developments of this study will explore the reasons for this variation and will ascertain clinicians' views on Guardianship, supervised discharge and other community treatment orders.
Pressure on adult acute psychiatric beds
Authors: Greengross Peter , Hollander Doris , Stanton Richard
Published: January 2018

Aims And Method

To quantify perceived problems with psychiatric bed availability nationally using a questionnaire survey of all 210 UK mental health trusts.

Results

One hundred and seventy-three (82%) trusts replied. Thirty (17%) are often over-occupied, 21 (15%) often have problems with bed availability. Ten (7%) often use extra-contractual referrals (ECRs). Frequent over-occupancy is associated with deprivation. Frequent use of ECRs is associated with relatively few beds.

Clinical Implications

Problems with bed availability are found nationwide, but outside southern England are relatively infrequent. Such problems are less pronounced than in Greater London.
An audit of anti-muscarinic drug use at the State Hospital
Authors: Steele Jonathan , Duncan Janice , Short Angela
Published: January 2018

Aims and Method

This paper is based on two audits carried out in 1996 and 1998 atThe State Hospital, Carstairs. Each audit looked at anti-muscarinic drug use within the hospital, in relation to approved prescribing standards issued in 1996. All patients within the hospital on anti-muscarinic drugs were identified at the timeof each audit. These prescriptions were compared with the approved prescribing standards. In the 1998 audit additional information was obtained from the case notes and the consultants, when the approved standards were not met.

Results

The percentage of patients on regular anti-muscarinic drugs, falling outwith the prescribing standards, reduced between the two audits. However, in 1998 a small number of patients were still outwith the approved prescribing standards set in 1996.

Conclusions

An improvement in the prescribing practice of anti-muscarinics occurred following the introduction of prescribing guidelines. However, the guidelines were not fully met in the 1998 audit. This demonstrates the need for further audit and continued monitoring of anti-muscarinic prescription at the State Hospital.
Observations on the mental health of a civilian population living under long-term hostilities
Authors: Tobin John P.
Published: January 2018

The civilian population of southern Lebanon has endured military conflict, civil war, and two invasions since the foundation of the State of Israel in 1948. Currently part of the south is under Israeli occupation forming a buffer zone between Israel and the hostile forces of the Hizbollah and Amal militias. The Israeli Defence Forces are aided by the South Lebanese Army which is the remnants of a Christian militia. The Hizbollah is supported by Iran and Syria and is the dominant force outside the occupation zone. In the south of Lebanon there is a United Nations mandate force which is attempting to return Lebanese government control over the south, decrease hostilities, protect the civilian population and provide humanitarian aid. This is part of the humanitarian mandate of the United Nations Interim Force in Lebanon (UNIFIL) that I had the opportunity to observe and to treat the mental health problems of the civilian population who were living under long-term artillery bombardment and living with continuous fluctuating conflict. Under such circumstances, rigorous scientific methodology in assessing the mental health of the population is extremely difficult. In order to operate effectively, as well as my own rudimentary Arabic, a translator was required. A translator does more than just translate language they also translate custom, culture and provide a valuable source of local information. Utilising my own observations and those of my valued translator, Basima, I did my best to assess how the civilian population coped with what was difficult circumstances. These assessments are value laden and I suppose are in many ways personal. My position as a military psychiatrist in the United Nations allowed me access to both the occupation zone and unoccupied Lebanon.
Do patients who receive electroconvulsive therapy in Scotland get better?
Authors: Fergusson Grace , Hendry James , Freeman Chris
Published: January 2018

Aims and Method

We aimed to compare the practice of electroconvulsive therapy (ECT) in Scotland with the recommendations of the Royal College of Psychiatrists, to determine the characteristics of patients who receive ECT, to assess the outcome of ECT given in a routine clinical setting and to develop a system of quality assurance for ECT. Between February 1997 and March 2000, an audit of ECT measured the quality of treatment given at all clinics in Scotland. Audit tools were designed and standards set for the process, and outcome of treatment and interventions were identified to address any variance prior to each audit cycle. An electronic data collection system was developed and a website produced for the purpose of continued audit and information sharing.

Results

The annual rate of ECT in Scotland was 142 individual treatments per 100 000 of the total population. Electroconvulsive therapy was given mainly to White adult patients with a depressive illness who had consented to treatment. Clinical improvement, as measured by at least a 50% reduction in the Montgomery–Åsberg Rating Scale for Depression (MADRS) score, was evident in 71.2% of patients with a depressive episode.

Clinical Implications

The audit of ECT is achievable at a national level, ECT is effective in a routine clinical setting and the standards at ECT in Scotland are higher than the UK average.
Providing a community mental handicap service
Authors: Hall D. J. , Pieri L. F.
Published: January 2018

It is acknowledged that assessing ‘consumer satisfaction’ is an important part of medical audit (The Royal College of Psychiatrists, 1991). For the mentally handicapped, it can be argued that ‘carer satisfaction’ is particularly relevant. This is particularly so at a time when the ‘community’ is being advocated as the preferred setting for the long-term care of the mentally handicapped, the families and neighbours of the handicapped being the main providers of this ‘community care’ (Griffiths, 1988).
The United Kingdom Standing Conference for Psychotherapy: The Psychotherapy Register
Authors: Pokorny Michael R.
Published: January 2018

UKSCP was inaugurated in January 1989 as a sequel to the “Rugby” Psychotherapy Conference, itself a sequel to the Sieghart Committee. In 1990 UKSCP resolved to establish psychotherapy as a separate profession and to seek to establish itself as the competent authority in relation to EC regulations, present and impending, which regulate the freedom of movement of professional people in the EC. The key to being a competent authority lies mainly in holding a register for the profession.
Senior registrar in psychotherapy
Authors: Ryle A.
Published: January 2018

Higher professional training is designed to produce consultants and in general this aim is achieved by combining the increasing practice of consultant-like activities (clinical, teaching, administration) with the opportunity to consolidate basic skills and knowledge and to undertake research. This combination of the practical and the intellectual is regulated by clinically and academically responsible professional bodies. While the same principles apply in psychotherapy, there are a number of special features.
Equality in a child and adolescent psychiatry multidisciplinary team
Authors: Mathai John
Published: January 2018

The multidisciplinary team and its functioning have been much debated. Such teams have been encouraged as a basis for good clinical practice. However, exactly how these teams should function has gone through various phases. With the advent of family therapy, some teams have experienced a process of crisis and the dismantling of more traditional ways of working. This has brought about a lot of disillusionment within teams and also a challenge to medical authority in the team. Unfortunately, it seems that family therapy as a treatment approach has been confused with the organisation of a multidisciplinary team. Considerable stress has been produced in the process as each professional has vied for a position and role in the team.
Lunacy Acts: 8 & 9 Vict. a 100; 16 & 17 Vict. C. 96, 97.: Instructions for the Guidance of Superintendents, Proprietors, Medical Practitioners, and Others
Authors: Lutwidge R. W. S.
Published: January 2018

RECEPTION OF PATIENTS.

Orders.—In the case of a private patient, the order may be dated before or after the medical certificates, or either of them.
Suicide of Dr. Grahamsley, Medical Superintendent of the Worcester County and City Pauper Lunatic Asylum
Authors: Lectures Winslow's
Published: January 2018

Our readers will learn with deep grief the melancholy end of this promising physician. The following brief summary we condense from the Worcester Herald.
Observations on Sanguineous Tumours of the External Ear,
Authors: Fischer Francis , Arlidge J. T. , J. T. A.
Published: January 2018

Causes. Opinions are divided respecting the causes of this condition of the external ear. The one most in vogue refers it to mechanical injuries, such as blows, bruises, and the effects of polling or of robbing the ear. F. Bird has not recognised the operation of external violence, and when such has happened he has regarded it as only an accelerating cause? for he considers necessary a peculiar condition consisting in persistent congestion about the head and enlargement of the vessels. Flemming, on the contrary, believes an external hurt to be always the cause, mostly self-inflicted by the patient, who, from severe and painful feelings about the head, strikes it against hard objects. He would, however, not deny the existence of a predisposition to the morbid condition resulting from a cachectic state. Ferrus discovers the cause in the I long continued pressure and robbing, &c., to which the ear is submitted. Friedreich concurs with Bird, and adduces in illustration two cases of dementia in which an inflammatory swelling of the ear manifested itself along with evident signs of congestion, occurring after maniacal paroxysms. Belhomme believes it to spontaneously originate from the feeble, retarded, circulation, the consequence of paralysis, and from the proneness to stagnation in extreme parts. Again, Wallis, Leubuscher, and Schmalz, assume the presence of cachexia as necessary to the production of the swollen ear; whilst Riedel and Rupp are of opinion that external violence is in itself a sufficient cause.
On Prolonged Fasting, with reference to a particular Class of Insane Persons,
Authors: Manley John
Published: January 2018

Most of the well-authenticated instances of long-continued fasting on record are such as have arisen from physical incapacity to take food into the stomach, or to retain it for the support of the system when taken, —from a peculiar condition of the mind, which induces in the individual a disregard or disinclination for food,—or, lastly, from accidental circumstances, as shipwreck, burial in mines, and such like. Those cases which have their origin in either of the two former causes, or in a combination of them, are important to the medical attendant on the insane, inasmuch as they not unfrequently occur in persons under treatment in lunatic asylums, are sources to him of great trouble and anxiety, and are fraught with considerable danger to the life of the patient under his care.
On the Non-Restraint System,
Authors: Hill Robert Gardiner
Published: January 2018

In a recent review of the answers of the medical officers of asylums, published in the Eighth Report of the Commissioners in Lunacy, it is objected that “many of the gentlemen who have forwarded replies to the Commissioners, and who have expressed an unqualified opinion in favor of non-restraint are men of but limited experience, having but for a short time been practically engaged in the treatment of the insane Again, a few of the medical men who answered the circular of the Commissioners, are in the habit of admitting into these houses a limited number of ‘nervous invalids,’ a quiet class of patients, not at all likely to require the application of mechanical restraint in their treatment. The evidence of these gentlemen is not, therefore, of much value quoad the question at issue.'’
Third Notice of the Eighth Report of the Commissioners in Lunacy,
Authors: Conolly John
Published: January 2018

Among the most miserable asylums for the insane, the asylums for boroughs were until lately conspicuous. Inconvenient buildings, unfavorably situated, and regarded as only inferior appendages to hospitals for the sick, were assigned to the insane poor both of boroughs and some of our largest towns, and presented examples of every evil that could be accumulated on mental affliction. In some instances, as at Birmingham, Liverpool, and Manchester, new asylums have now been erected, better situated, superintended by medical men devoting their whole time to them, and ranking among the most improved asylums in the country. A few of the old examples, however, yet remain.
On the Association and Classification of Patients at Colney Hatch, and appropriation of the Recreation Room as a Dining Hall
Authors: Tyerman D. F.
Published: January 2018

Encouraged by the success of the system, commenced in the year 1850, of associating at the dinner meal the male pauper patients of the Cornwall Lunatic Asylum, then under my superintendence, I ventured soon after my appointment at Colney Hatch, in September, 1852, to recommend here a far more extended association of the patients of both sexes in the hall hitherto used for occasional recreation, and which, from its dimensions and contiguity with the kitchen, appeared to offer especial advantages for carrying out such an experiment upon a large scale. After consultation with my colleagues upon the subject, I urged upon the Visiting Justices the following arguments in favour of the measure:—

1.

The moral, social, and curative results likely to accrue.

2.

Relief to the patients from the usual monotony and routine of the establishment.

3.

Increased facilities afforded both to magistrates and officers for inspecting the patients.

4.

Improved ventilation in the wards, especially in hot weather.

5.

Removal of the knives, &c., from the store-rooms and sculleries of the wards.

6.

The more rapid conveyance of the provisions, whilst hot; and the better working of the establishment generally.
An Address to the Trustees and Governors of the Warnford Lunatic Asylum, and the Gentry interested in the distribution of the Warnford Gifts
Authors: Ley William , J. C. B.
Published: January 2018

Mr. Lee has done good service, in calling attention to the noble charity provided by Dr. Warnford, for the insane poor of those classes whose education and position in society, would render the acceptance of relief from parochial funds, a painful degradation, and whose habits would render their residence in the wards of a pauper lunatic asylum, humiliating to themselves, and the source of difficulty and embarrassment in the arrangements of the institution. He says, with perfect truth, that the provisions for health and comfort supplied to the inmates of county asylums, are such as would not be deemed inadequate to the wants of the insane gentry. But the amalgamation of the two classes has been tried in several county asylums, with indifferent success; and public opinion, guided by experience, has now set strongly in the direction of providing for the educated and the uneducated classes in distinct institutions.
On the various Forms of Mental Disorder, (being the Substance of Lectures Delivered at the York School of Medicine,)
Authors: Tuke Daniel H.
Published: January 2018

In describing the symptoms arising from the derangement of the group of faculties last under consideration, namely, those termed moral, and with which man is specially endowed, as contrasted with the lower animals, it might have seemed natural to detail those morbid mental phenomena, which Prichard and others have so much dwelt upon when treating of moral insanity. But such a perverted condition of the moral sense is so almost invariably indicated, and often only discovered by the activity of the animal propensities, that it is more convenient to treat of it under the third class of mental disorders. It is likewise more consistent with our adopted principle of classification, which consists in referring each mental disorder to that group of faculties, the affection of which is essential to its manifestations. In homicidal mania, the animal propensities are of necessity called into action, whether the homicidal act be the result of their diseased action, in association with a healthy condition of the higher sentiments, or of their normal action when associated with, and therefore uncontrolled by, a state of the moral sense rendered powerless or feeble by disease; be it congenital or acquired, or the result of functional disorder or structural changes. We usually become cognizant of diseased mental conditions by positive, not by negative, symptoms; some overt act or explosion of passion will, in general, be the first proof of such disease of the moral sentiments, as involves their occlusion or inertness, when they ought to be in exercise. Should the disease be of such a nature as to increase the activity of these faculties, then we have an exhibition of religious excitement or ecstasy, a morbid condition already treated of.
On the Establishment of a State Asylum
Authors: Wood Wm.
Published: January 2018

The revision of the criminal law which has been so wisely conceived, and thus far so ably executed, has yet left one very important part of the subject untouched; although it is one very nearly affecting the administration of justice and the safety of society. It is to be feared that the unwillingness to meddle with a question avowedly beset with difficulties, as this is, may be, to some extent at least, owing to the fact that such widely different opinions have been expressed by those whose judgment must necessarily guide our lawgivers on the subject of criminal lunacy, as it is called. But the difficulty of the subject, and the differences of opinion among those best informed, offer no sufficient reason why the attempt to apply a remedy should be indefinitely postponed, at the cost of so much accumulated cruelty and injustice.
Asylum Architecture and Arrangements
Authors: Bucknill
Published: January 2018

A commodious and conveniently arranged asylum is the first requisite for the skilful care and treatment of the insane. Without this no alienist physician can deal successfully with any number of patients. It is, indeed, the bad workman who complains of his tools; and it will be found in practice that a superintendent fertile in resources, and skilful in their application, will do more with a bad building than another can effect with the newest, the most expensive, and the most commodious asylum that ever was constructed. It is not the bricks and mortar which cure patients, but the living spirit which, as it were, animates them. Nelson, in his old tubs, effected deeds at which the world grew pale; his braggadocio and vituperative successor has exhibited the gigantic masterpieces of naval architecture in an useless and ridiculous parade. In like manner it has happened that some of the worst asylums have been the best conducted, and some of the largest and most costly have. brought more disgrace than honour upon the psychiatric branch of the profession.
On the Present Condition and Future Prospects of Idiot Education
Authors: Kern Ferdinand , Tr J. C. B.
Published: January 2018

The author is unable to determine to whom belongs the credit of having first attempted the education of idiot children. Saegert, of Berlin, believed that be had demonstrated scientifically the curability of idiocy in 1846. Seguin, of Paris had made known his efforts in the cause about the same period. Guggenbiihl opened his institution upon the Abendberg in 1836; but Voisin in Paris had preceded him, and even Voisin was not the first labourer in the field. The Government of Saxony has been the first to found an idiot institution, at the cost of the State. The Government of Wurtemburg has given its support to the institutions of Mariaburg and Winterbach, The Government of the kingdom of Sardinia has proved its lively interest in this question by issuing in 1848 a Royal Commission to inquire into the nature and the causes of cretinism, and it has thus set an example to other Governments.
The Pathology of Insanity
Authors: Bucknill John Charles
Published: January 2018

It has been unfortunate for the cause of cerebral pathology, that those writers who have devoted much care and attention to the observation of cerebral changes presented in post-mortem examinations, have either lacked the desire or the opportunity to make themselves acquainted with the mental phenomena which had preceded death. The careful and minute detail of appearances observed in the brains of persons supposed to have died insane, disconnected from any account of the symptoms which existed during life, are of comparatively little value in the present imperfect state of pathological science. A few fossil teeth and bones enable Professor Owen to reconstruct the probable similitude of an extinct animal; but the science of pathological anatomy has attained far less certitude than that of comparative anatomy; and even the able descriptions of the post-mortem examinations made in Bethlem by Dr. Webster, have their practical value diminished from the want of some account of the symptoms which in each case preceded death. The descriptions of the older anatomists, Morgagni, Bonetus, and others, have the same defect; a defect, indeed, of which Morgagni was fully sensible, and of which he offers an explanation, or rather an excuse, in the fact that the medical men who had observed the cases during life frequently did not know whether to call the patients melancholics or maniacs; and that, indeed, “melancholia is so nearly allied to mania that the diseases frequently alternate, and pass into one another, so that you frequently see physicians in doubt whether they should call a patient a melancholic or a maniac, taciturnity and fear alternating with audacity in the same patient; on which account, when I have asked under what kind of delirium the insane people have laboured whose heads I was about to dissect, I have had the more patience in receiving answers which were frequently ambiguous, and sometimes antagonistic to each other, yet which were, perhaps, true in the long course of the insanity.” (De Sedibus et Causis Morborum, Epist. VIII.)
ERECTA-family genes coordinate stem cell functions between the epidermal and internal layers of the shoot apical meristem
Authors: Kimura Yuka , Tasaka Masao , Torii Keiko U. , Uchida Naoyuki
Published: January 2018

The epidermal cell layer and the tissues that lie underneath have different intrinsic functions during plant development. The stem cells within the shoot apical meristem (SAM) that give rise to aerial structures are located in the epidermal and internal tissue layers. However, our understanding of how the functions of these stem cells are coordinated across tissue layers so stem cells can behave as a single population remains limited. WUSCHEL (WUS) functions as a master regulator of stem cell activity. Here, we show that loss of function in the ERECTA (ER)-family receptor kinase genes can rescue the mutant phenotype of wus plants (loss of stem cells), as demonstrated by the reinstated expression of a stem cell marker gene in the SAM epidermis. Localized ER expression in the epidermis can suppress the SAM phenotype caused by loss of ER-family activity. Furthermore, the CLAVATA3- and cytokinin-induced outputs, which contribute to stem cell homeostasis, are dysfunctional in a tissue layer-specific manner in ER-family mutants. Collectively, our findings suggest that the ER family plays a role in the coordination of stem cell behavior between different SAM tissue layers.