bluuebunny/crossref_metadata_2025 huggingface dataset:
Tools and Methodologies for Investigating the Mental Health Needs of Indigenous Patients: It's about Communication
Authors: Eley Diann , Hunter Keith , Young Louise , Baker Peter , Hunter Ernest , Hannah Dominique
Published: December 2009

Objective: To undertake a needs analysis to determine the quality and effectiveness of current mental health services to Indigenous patients within a health district of Southern Queensland. The present study focused on identifying gaps in the service provision for Indigenous patients. Tools and methodologies were developed to achieve this.

Method: Before commencement of the needs analysis, a review of related national projects was completed. The needs analysis entailed the develop ment and distribution of two separate questionnaires. A major priority of the questionnaire for Indigenous patients was ensuring that effective com munication and cultural respect was achieved. A steering committee of both Indigenous and non-Indigenous experts collaborated on this. The second questionnaire was for employees of the mental health service. Both questionnaires were designed to provide a balanced perspective of current mental health service needs for Indigenous people within the mental health service.

Results: The predominant issue that emerged and underpinned all the results was communication.

Conclusions: The present study has developed and used procedures for undertaking research involving Indigenous people. It has shown the impor tance of involving Indigenous people to help ensure successful communication, compliance and cooperation by Indigenous mental health patients.
Video-Linked Court Liaison Services: Forging New Frontiers in Psychiatry in Western Australia
Authors: Brett Adam , Blumberg Lawrence
Published: December 2009

Objective: To describe the use of videoconferencing that is providing a specialist forensic service to remote parts of Western Australia.

Conclusions: Court liaison has been shown to be an effective intervention for people with mental illness within the justice system. Most such programmes occur within metropolitan areas in Australia. Videoconferencing facilitates the provision of specialized forensic services to courts in remote parts of Australia.
The RANZCP Australian Private Practitioners' Network
Authors: Middleton Warwick , Lammersma Johanna
Published: December 2009

Objective: To provide an overview of the challenges and opportunities afforded by the practice of psychiatry in the private sector, and in so doing build a rationale for the formation of a formally established network of Australian psychiatrists who meet to advance constructive proposals concerning the private practice of psychiatry, encourage mutual support, and promote this area of psychiatric endeavour.

Conclusions: Private psychiatry has dangers, challenges and many responsibilities, but it also has the potential for relative independence and creative fulfilment. It is desirable that its practitioners support each other and work constructively together in addressing the sorts of issues delineated in the Private Practitioners’ Network's mission statement and objectives.
Selecting Patients for Long-acting Novel Antipsychotic Therapy
Authors: Lambert Tim
Published: December 2009

Objective: As new psychopharmacological agents for the management of schizophrenia are introduced into clinical practice, inappropriate patient selection may often lead to disappointing outcomes for the patient, the family and services. Recently, the first and only long-acting novel antipsy chotic was made available in Australia. Based on criteria used in a large clinical network in Victoria, this paper sets out to present six selection profiles for patients with schizophrenia who may be suitable candidates for treatment with this class of medication.

Conclusions: Optimizing outcome for patients with enduring psychotic disorders involves enabling a stable psychopharmacological platform upon which to build a psychosocial therapies programme. Too often, problems with adherence undermine the recovery process. Long-acting novel anti psychotics ensure adherence, with all the advantages inherent in second generation antipsychotics. Identifying patients a priori who might best respond to the long-acting novel antipsychotics may lead to improving the efficiency of the recovery process.
Evaluation of a Short Course in Psychiatry for General Practitioners
Authors: Clarke David , Smith Graeme , Peake Julie-Anne , Trauer Tom , McCall Louise , Blashki Grant , Piterman Leon
Published: December 2009

Objective: To assess the acceptability and benefits to general practitioners (GPs) of a short course on the management of depression and anxiety.

Method: One hundred and twenty-two GPs from southeast metropolitan Melbourne participated in a five-session short course. Pre- and postmeasures of knowledge, attitude and self-evaluated clinical practice and a post-measure of participant satisfaction were completed.

Results: The course was overwhelmingly appreciated by participating GPs. In the group as a whole, knowledge, attitude and certain elements of clinical practice changed in a positive and predicted direction. General practitioners affirmed the use of an interpersonal and problem-solving framework for patients more commonly than a cognitive-behavioural one.

Conclusions: Brief educational interventions are useful and, through improving GP knowledge, attitude and clinical practice, have an important role to play in enhancing the capacity of GPs to assist people with depression and anxiety.
Education System Discrimination Against Children with Mental Disorders
Authors: Bor William , Dakin Jean
Published: December 2009

Objective: To describe the conceptual confusion, inconsistency and discrimination within some state and territory education systems towards children with mental disorders.

Conclusions: Reforms are required to achieve a consistent Australia wide framework for the classification of childhood mental disorders as disabilities. The mental health diagnostic assessment to qualify for disability status needs to be simplified when participation in complex evaluation procedures is not possible.
Working with Families of Patients within an Adult Mental Health Service: Development of a Programme Model
Authors: Mottaghipour Yasaman , Woodland Lisa , Bickerton Annemaree , Sara Grant
Published: December 2009

Objective: In order to implement and sustain family intervention programmes in clinical settings, there is a need for an organizational change within routine clinical practice. The objective of this paper is to outline the idea behind the development of a programme for working with families of patients within an adult mental health service.

Methods: Capacity building, project management and action research frameworks were the three theoretical frameworks used to inform the implementation of the programme within the mental health service. Extensive literature in the area of working with families informed the programme's content. Sutherland Mental Health Service in New South Wales is used as a model to show that organizational changes are needed to implement a ‘family friendly’ service.

Results: The programme included two main components: (i) a service development component, (ii) a family engagement and support component. Description of the programme plan has been based on key objectives, strategies and activities for implementation at the service delivery level. Individual activities within the programme have achieved their goals. The rate of family contact within the service has doubled.

Conclusions: Issues regarding the effectiveness of such a programme, its limitations, as well as the nature of examining and evaluating such work were discussed. Becoming more ‘family friendly’ is a realistic goal for adult mental health services.
Patients with Deliberate Self-Harm Seen by a Consultation-Liaison Service
Authors: Brakoulias Vlasios , Ryan Christopher , Byth Karen
Published: December 2009

Objective: To examine Australian trends in deliberate self-harm in order to explore aetiological factors and improve clinical practice.

Method: A database recording 5 years of activity of a consultation-liaison service from a large tertiary referral hospital in Sydney was analysed to discover trends in types of self-harm, sex, age, marital status, repetition rates, diagnoses and follow up.

Results: 1295 patients with deliberate self-harm were referred to the Service over the 5 years. Of these patients, women exceeded men (ratio of 1.48:1). Self-poisoning constituted 79.5% of the referrals. Rates of selfharm referrals increased from 1999 to 2001, but appeared to plateau in 2002 and 2003. Eighty-eight per cent of referrals were first presentations of self-harm. Most referrals received the diagnosis of adjustment disorder with depressed mood, but a significant proportion was diagnosed with major depressive disorder and schizophrenia, particularly in those that violently self-harmed. There was a significant decline in the rate of admission to hospital over the study period.

Conclusions: While patient characteristics did not change significantly, there was a decline in admission rates to hospital. Many patients had serious mental illnesses, highlighting the importance of a thorough psychiatric assessment of people who self-harm.
Using Mental Health Outcome Measures in Everyday Clinical Practice
Authors: Patterson Pandora , Matthey Stephen , Baker Martin
Published: December 2009

Objective: To examine clinicians’ use of Mental Health Outcomes and Assessment Tools (MH-OAT), standardized clinical measures that have been introduced in NSW.

Method: Two separate studies are described, which examined the use of MH-OAT within two community child and family mental health service teams in Sydney.

Results: It appears that clinicians are often not completing the clinicianrated measures and rarely were they requesting and/or following up clients to complete the Strengths and Difficulties Questionnaire. Further, while clinicians are reviewing the progress of their clients, they rarely use the MH-OAT data for this purpose.

Conclusions: Clinicians’ lack of adherence to MH-OAT and use of MHOAT data are discussed in terms of passive resistance and their possible perception that the process is largely irrelevant to the care of their clients.
A Clinical Monitoring System for Clozapine
Authors: Castle David , Lambert Tim , Melbourne Sue , Cox Andrew , Boardman Gaylene , Fairest Katherine , Davy Martin , Goh Joyce , Kuluris Bill , Berk Michael
Published: December 2009

Objective: To describe a framework for the initiation and ongoing monitoring of patients on clozapine, and detail support materials that can be used in clinical settings, including general practice, to support this process.

Conclusions: A framework is described. Clozapine has a special place in the management of treatment-resistant schizophrenia. However, it has certain side-effects that require its use to be carefully evaluated on an individual patient basis, and encompass excellent documentation and discussion with all relevant parties. Comprehensive longitudinal monitoring is required.
Reconsidering the Attention Deficit Paradigm
Authors: Rosenman Stephen
Published: December 2009

Objective: To examine the inadequacies and criticisms of the current categorical paradigm of Attention Deficit Disorder both in children and adults.

Conclusions: An alternative, more dimensional paradigm linking executive functions is described and its advantage over categorical diagnostic paradigms is argued. Consideration of a more discriminating and dimensional behavioural model would help psychiatrists operating in this area.
Outcome Measures in Mental Health Services: Humpty Dumpty is Alive and Well
Authors: Mellsop Graham , Wilson Janice
Published: December 2009

Objective: To reflect on the surge of interest in ‘outcomes’ in mental health services.

Conclusions: Reliable assessments underpin the ability to measure change in clinically relevant health status, and no single measure can represent all relevant variables. The measure of change should be regarded as only one part of a larger and dynamic process. Consumer management and service quality improvement activities may be better enhanced by placing emphasis on assessing those domains, which will inform the development of potential clinical management plans, in a quantitative fashion. Where indicated, repeated assessment will provide information which will inform individual patient care, and by grouping data, service planning and continuous improvement activities.
Addressing the Health and Lifestyle Issues of People with a Mental Illness: The Healthy Living Programme
Authors: O'sullivan Julie , Gilbert Jillian , Ward Warren
Published: December 2009

Objective: The physical health and well-being of mental health patients have been a concern to health professionals for many years. However, very few positive gains have been made to address this problem. This paper outlines the efforts of the Inner North Brisbane Mental Health Service, Royal Brisbane and Women's Hospital, to design and implement a structured educational programme, aimed at addressing and encouraging healthy lifestyle behaviours in its community mental health service recipients.

Methods: Three programme modules were designed, addressing the topics of Nutrition and Healthy Eating, Physical Health, and Community Based Activities and Interests. Referral of patients to the programme was by their case manager or doctor. At the conclusion of each module, participants were asked to complete a satisfaction survey evaluating the programmes. The survey also gathered feedback regarding any suggestions and/or recommendations to improve content suitability and relevance.

Results: Since commencing the Healthy Living Program, each module has been conducted at least twice, the topic of Healthy Eating receiving the most referrals and therefore conducted most frequently. To date, 35 satisfaction surveys have been evaluated. The overwhelming majority of respondents offered very positive feedback about the programme, most being able to identify some healthy lifestyle changes they planned to make in response to programme attendance.

Conclusions: This paper highlights the importance of incorporating healthy lifestyle programmes into mental health service delivery. The majority of patients who have attended the Healthy Living Program have indicated satisfaction with the content, but as yet information pertaining to long-term lifestyle change has not been collated. The next phase aims to examine whether the programme attendance has more long-term outcomes in improving health and well-being and promoting healthy behaviour change of mental health service recipients.
Consultation-Liaison to General Practitioners Coming of Age: The South Australian Psychiatrists' Experience
Authors: Sved Williams Anne , Dodding Jane , Wilson Ian , Fuller Jeffrey , Wade Victoria
Published: December 2009

Objective: To evaluate outcomes and satisfaction with a consultationliaison service to general practitioners (GPs), provided by a cohort of private and public psychiatrists.

Methods: All SA psychiatrists were invited to participate in a project, funded by the Australian Government Department of Health and Ageing, which was operational for 9 months. Participating psychiatrists provided telephone advice in urgent cases to GPs, and where agreed by GP, patient and psychiatrist, a one-off assessment with rapid feedback to the GP. Evaluation was carried out by external evaluators on satisfaction rates of psychiatrists, and barriers to the use of such a service, and the project officers collected information on usage and satisfaction rates by GPs.

Results: Thirty-one of the 203 SA psychiatrists undertook a 2 hour training package, with 27 joining the project and 100% of those completing the project. Both GPs and psychiatrists expressed high rates of satisfaction with this mode of service, the GPs reported increases in knowledge and confidence, and the psychiatrists enjoyed the consultant role.

Conclusions: A shift towards a consultation-liaison mode with GPs has produced positive benefits for GPs and psychiatrists, and ways to sustain this should be explored. Effects on outcomes for consumers using this approach need evaluation.
Let's Get Physical: An Audit of Medical Practice in First Episode Psychosis
Authors: Mckay Diana , Gorrell Jo , Cornish Alison , Tennant Chris , Rosen Alan , Moss Beverley , Nash Louise
Published: December 2009

Objectives: To assess aspects of medical examination, diagnosis and side-effect monitoring, and to consider the role of routine investigations in this group as recommended by national guidelines.

Method: A retrospective file audit was performed on young people presenting with first episode psychosis (n = 117) over 12 months of treatment contact.

Results: Diagnoses were: first episode psychosis (43%), schizophrenia (16%), drug-induced psychosis (12%), affective psychosis (13%) and brief reactive psychosis (2%). Only four of the 52 (8%) subjects undergoing neuroimaging had any abnormality, with only two of these requiring referral. Three of the 33 (9%) electroencephalograms were obviously abnormal, but without epileptiform activity. There was little documentation of the assessment of involuntary movements (4% of sample) or weight (15% of sample).

Conclusions: The low rates of clinically important abnormal findings in computed tomography/magnetic resonance imaging and electroencephalogram re-open debate about the need for routine neuroimaging and electrophysiology in this population.
Ethnic Minority Community Patients and the Better Outcomes in Mental Health Care Initiative
Authors: Klimidis Steven , Minas Harry , Kokanovic Renata
Published: December 2009

Objective: To compare general practitioners registered under the Better Outcomes in Mental Health Care initiative (BOiMHC) and those not registered, in addressing mental disorders in members of ethnic minority communities (EMCs).

Methods: We conducted a cross-sectional survey of 597 Melbourne metropolitan general practitioners, leading to 311 meeting criteria for having seen EMC patients with a mental disorder in the last 3 months. Comparisons were made between those registered (n = 61) and those not registered (n = 205) within the BOiMHC on measures of difficulties in: accessing bilingual allied health, accessing interpreters, accessing translated materials, patient compliance, accessing guidelines for working effectively with interpreters, accessing guidelines on cultural and migration factors affecting mental health.

Results: Significantly less of those registered in the BOiMHC endorsed problems of access to bilingual allied health, interpreters and translated materials compared with those not registered. No differences between groups were observed in relation to access to guidelines and patient compliance. Those registered with the BOiMHC reported significantly less problems than those not registered. The most prevalent problems of the full sample included lack of access to bilingual allied health (70%), access to translated materials (58%) and low EMC patient compliance with mental health assessment and treatment (64%).

Conclusions: Possible impacts of the BOiMHC appear to be modest in relation to EMC patients with mental disorders. The BOiMHC may require additional strategies for its application to EMCs, especially for patient engagement in mental health assessment and treatment. There is a need for a more comprehensive evaluation of EMC issues within the BOiMHC.
Liability of Psychiatrists and Mental Health Services for Failing to Admit or Detain Patients with Mental Illness
Authors: Scott Russ
Published: December 2009

Objectives: To discuss the findings and the various judgements of the courts in the case of Presland v Hunter Area Health Service and to consider the liability of psychiatrists and mental health services for failing to admit or detain patients with mental illness.

Conclusion: In a highly controversial and sometimes misreported decision, the NSW Supreme Court on 21 August 2003 entered judgement for Presland against the Hunter Area Health Service and a third year psychiatry registrar for injury suffered by reason of their negligent failure to care for Presland and, in particular, to detain him in hospital under provisions of the Mental Health Act (NSW). By a majority, the NSW Court of Appeal overturned the decision on 21 April 2005. Judgements in the appeal decision explored the duty of care owed by a psychiatrist to a patient. The decision confirmed that a successful litigant suing for negligence will not recover damages for pain and suffering and economic loss caused as a result of not being admitted for treatment of a mental illness before committing a violent offence.
Dual roles for the Drosophila PI 4-kinase Four wheel drive in localizing Rab11 during cytokinesis
Authors: Polevoy Gordon , Wei Ho-Chun , Wong Raymond , Szentpetery Zsofia , Kim Yeun Ju , Goldbach Philip , Steinbach Sarah K. , Balla Tamas , Brill Julie A.
Published: December 2009

Successful completion of cytokinesis relies on addition of new membrane, and requires the recycling endosome regulator Rab11, which localizes to the midzone. Despite the critical role of Rab11 in this process, little is known about the formation and composition of Rab11-containing organelles. Here, we identify the phosphatidylinositol (PI) 4-kinase III β Four wheel drive (Fwd) as a key regulator of Rab11 during cytokinesis in Drosophila melanogaster spermatocytes. We show Fwd is required for synthesis of PI 4-phosphate (PI4P) on Golgi membranes and for formation of PI4P-containing secretory organelles that localize to the midzone. Fwd binds and colocalizes with Rab11 on Golgi membranes, and is required for localization of Rab11 in dividing cells. A kinase-dead version of Fwd also binds Rab11 and partially restores cytokinesis to fwd mutant flies. Moreover, activated Rab11 partially suppresses loss of fwd. Our data suggest Fwd plays catalytic and noncatalytic roles in regulating Rab11 during cytokinesis.
Bone marrow mesenchymal stem cells from infants with MLL-AF4+ acute leukemia harbor and express the MLL-AF4 fusion gene
Authors: Menendez Pablo , Catalina Purificación , Rodríguez René , Melen Gustavo J. , Bueno Clara , Arriero Mar , García-Sánchez Félix , Lassaletta Alvaro , García-Sanz Ramón , García-Castro Javier
Published: December 2009

MLL-AF4 fusion is a hallmark genetic abnormality in infant B-acute lymphoblastic leukemia (B-ALL) known to arise in utero. The cellular origin of leukemic fusion genes during human development is difficult to ascertain. The bone marrow (BM) microenvironment plays an important role in the pathogenesis of several hematological malignances. BM mesenchymal stem cells (BM-MSC) from 38 children diagnosed with cytogenetically different acute leukemias were screened for leukemic fusion genes. Fusion genes were absent in BM-MSCs of childhood leukemias carrying TEL-AML1, BCR-ABL, AML1-ETO, MLL-AF9, MLL-AF10, MLL-ENL or hyperdiploidy. However, MLL-AF4 was detected and expressed in BM-MSCs from all cases of MLL-AF4+ B-ALL. Unlike leukemic blasts, MLL-AF4+ BM-MSCs did not display monoclonal Ig gene rearrangements. Endogenous or ectopic expression of MLL-AF4 exerted no effect on MSC culture homeostasis. These findings suggest that MSCs may be in part tumor-related, highlighting an unrecognized role of the BM milieu on the pathogenesis of MLL-AF4+ B-ALL. MLL-AF4 itself is not sufficient for MSC transformation and the expression of MLL-AF4 in MSCs is compatible with a mesenchymal phenotype, suggesting a differential impact in the hematopoietic system and mesenchyme. The absence of monoclonal rearrangements in MLL-AF4+ BM-MSCs precludes the possibility of cellular plasticity or de-differentiation of B-ALL blasts and suggests that MLL-AF4 might arise in a population of prehematopoietic precursors.
Nfil3/E4bp4 is required for the development and maturation of NK cells in vivo
Authors: Kamizono Shintaro , Duncan Gordon S. , Seidel Markus G. , Morimoto Akira , Hamada Koichi , Grosveld Gerard , Akashi Koichi , Lind Evan F. , Haight Jillian P. , Ohashi Pamela S. , Look A. Thomas , Mak Tak W.
Published: December 2009

Nuclear factor interleukin-3 (Nfil3; also known as E4-binding protein 4) is a basic region leucine zipper transcription factor that has antiapoptotic activity in vitro under conditions of growth factor withdrawal. To study the role of Nfil3 in vivo, we generated gene-targeted Nfil3-deficient (Nfil3−/−) mice. Nfil3−/− mice were born at normal Mendelian frequency and were grossly normal and fertile. Although numbers of T cells, B cells, and natural killer (NK) T cells were normal in Nfil3−/− mice, a specific disruption in NK cell development resulted in severely reduced numbers of mature NK cells in the periphery. This defect was NK cell intrinsic in nature, leading to a failure to reject MHC class I–deficient cells in vivo and reductions in both interferon γ production and cytolytic activity in vitro. Our results confirm the specific and essential requirement of Nfil3 for the development of cells of the NK lineage.
Micropipe-induced birefringence in 6H silicon carbide
Authors: Ouisse T. , Chaussende D. , Auvray L.
Published: December 2009

The micropipe-induced birefringence of 6H silicon carbide (SiC) is measured and quantitatively modelled. A good agreement can be obtained between theory and experiment, provided that background residual stress is added to the local dislocation-induced stress. Observations are compatible with or predictable from the Burgers vector values, and birefringence is shown to be an interesting tool for probing the nature of the dislocations associated withe.g.micropipes; it is also faster than and complementary to the more involved techniques of transmission electron microscopy or X-ray topography.
A novel model for the interpretation of small-angle scattering experiments of self-affine structures
Authors: Schneider Gerald J. , Göritz D.
Published: December 2009

A novel theory is presented which allows, for the first time, the analytical description of small-angle scattering experiments on anisotropic shaped clusters of nanoparticles. Experimentally, silica-filled rubber which is deformed is used as an example. The silica can be modelled by solid spheres which form clusters. The experiments demonstrate that the clusters become anisotropic as a result of the deformation whereas the spheres are not affected. A comparison of the newly derived model function and the experiments provides, for the first time, microscopic evidence of the inhomogeneous deformation of clusters in the rubbery matrix.
Genome‐wide identification of chemosensitive single nucleotide polymorphism markers in colorectal cancers
Authors: Kim Jin C. , Kim Seon Y. , Cho Dong H. , Roh Seon A. , Choi Eun Y. , Jo Yoon K. , Jung Sang H. , Na Young S. , Kim Tae W. , Kim Yong S.
Published: December 2009

Improved methods for predicting chemoresponsiveness involving the identification of polymorphic markers is highly desirable, considering narrow therapeutic index and frequent resistance to anti‐cancer regimens. The genome‐wide screening of chemosensitive single nucleotide polymorphisms (SNPs) was undertaken in association with in vitro chemosensitivity assays in 104 colorectal cancer patients for the initial screening step. Allele frequency, linkage disequilibrium, potential function, and Hardy–Weinberg equilibrium of the candidate SNPs were then determined for the identifying step. Finally, clinical association analysis in the other 260 evaluable patients or cell viability assays of transfected RKO cells was used to verify candidate SNPs for the validation step. In total, 12 SNPs to six regimens were initially chosen during the screening and identifying steps. In patients receiving fluoropyrimidine‐based adjuvant chemotherapy, the substitution alleles of GPC5 rs553717 (AA) correlated significantly with tumor recurrence and shorter disease‐free survival (P = 0.019 and 0.023, respectively). Interestingly, RKO cells expressing mutant GPC5 showed enhanced cell death in response to 5‐FU in cytotoxicity assays. Patients that were homozygous for the reference alleles SSTR4 rs2567608 (AA) and EPHA7 rs2278107 (TT) showed lower disease control rates in response to irinotecan and oxaliplatin regimens, respectively, than those with substitution alleles (P = 0.022 and 0.014, respectively). Thus, we identified chemosensitive SNP markers using a novel three step process of genome‐wide analysis consisting of in vitro screening, identification, and validation. The candidate chemosensitive SNP markers identified in our study, including those identified in vitro, can now be further verified in a large cohort study.

(Cancer Sci 2010; 101: 1007–1013)
Activated protein C action in inflammation
Authors: Sarangi Pranita P. , Lee Hyun‐wook , Kim Minsoo
Published: December 2009

Activated protein C (APC) is a natural anticoagulant that plays an important role in coagulation homeostasis by inactivating the procoagulation factor Va and VIIIa. In addition to its anticoagulation functions, APC also has cytoprotective effects such as anti‐inflammatory, anti‐apoptotic, and endothelial barrier protection. Recently, a recombinant form of human APC (rhAPC or drotrecogin alfa activated; known commercially as ‘Xigris’) was approved by the US Federal Drug Administration for treatment of severe sepsis associated with a high risk of mortality. Sepsis, also known as systemic inflammatory response syndrome (SIRS) resulting from infection, is a serious medical condition in critical care patients. In sepsis, hyperactive and dysregulated inflammatory responses lead to secretion of pro‐ and anti‐inflammatory cytokines, activation and migration of leucocytes, activation of coagulation, inhibition of fibrinolysis, and increased apoptosis. Although initial hypotheses focused on antithrombotic and profibrinolytic functions of APC in sepsis, other agents with more potent anticoagulation functions were not effective in treating severe sepsis. Furthermore, APC therapy is also associated with the risk of severe bleeding in treated patients. Therefore, the cytoprotective effects, rather than the anticoagulant effect of APC are postulated to be responsible for the therapeutic benefit of APC in the treatment of severe sepsis.
Numerical simulation of the migration and distribution of diamond squid (Thysanoteuthis rhombus) in the southwest Sea of Japan
Authors: ONITSUKA G. , HIROSE N. , MIYAHARA K. , OTA T. , HATAYAMA J. , MITSUNAGA Y. , GOTO T.
Published: December 2009

To elucidate the effects of hydrographic conditions on the migration and distribution of diamond squid (Thysanoteuthis rhombus) in the Sea of Japan, two numerical experiments were conducted using a Lagrangian particle‐tracking model. First, Lagrangian simulations with different horizontal swimming speeds were conducted in the area off the San‐in coast, the southwest Sea of Japan. The comparison results of simulations and experimental tagging records from 2003 suggest that horizontal movement of diamond squid over a few days is influenced by individual swimming, but long‐term migration over more than about 10 days is dependent on the ambient current field. Secondly, further Lagrangian simulations with biological processes, forced by different hydrographic conditions in 2003–2005, were conducted. Temporal variations in distributions and sizes calculated by the model corresponded approximately to those of catch data. A large number of particles simulating squid were distributed over the nearshore region from the San‐in coast to the Noto Peninsula during September–November every year. Differences in the migration route and distribution of particles among years were closely related to differences in hydrographic conditions such as the position of the main stream of the Tsushima Warm Current. Prediction of the catch off the San‐in coast might be improved by considering hydrographic conditions in the southwest Sea of Japan.
The extensive polymorphism of KIR genes
Authors: Middleton Derek , Gonzelez Faviel
Published: December 2009

The functions of human natural killer (NK) cells are controlled by diverse families of antigen receptors. Prominent among these are the killer cell immunoglobulin‐like receptors (KIR), a family of genes clustered in one of the most variable regions of the human genome. Within this review we discuss the vast polymorphism of the KIR gene complex which rivals that of the human leucocyte antigen (HLA) complex. There are several aspects to this polymorphism. Initially there is presence/absence of individual KIR genes, with four of these genes, termed framework genes, being present in all individuals tested to date, except on those very occasional instances when the gene has been deleted. Within each gene, alleles are present at different frequencies. We provide details of a new website that enables convenient searching for data on KIR gene, allele and genotype frequencies in different populations and show how these frequencies vary in different worldwide populations and the high probability of individuals differing in their KIR repertoire when both gene and allele polymorphism is considered. The KIR genes present in an individual may be classified into A and/or B haplotypes, which respectively have a more inhibitory role or a more activating role on the function of the NK cell. Family studies have been used to ascertain the make‐up of these haplotypes, inclusion of allele typing enabling determination of whether one or two copies of a particular gene is present. In addition to genetic diversification the KIR gene complex shows differences at the functional level with different alleles having different protein expression levels and different avidity with their HLA ligand.
Genetic diversity of Melon necrotic spot virus and Olpidium isolates from different origins
Authors: Herrera‐Vásquez J. A. , Córdoba‐Sellés M. C. , Cebrián M. C. , Rosselló J. A. , Alfaro‐Fernández A. , Jordá C.
Published: December 2009

The geographic incidence, genetic diversity and phylogenetic relationships of Melon necrotic spot virus (MNSV) and Olpidium isolates were studied in three cucurbit species from several Latin American and European countries on different collecting dates. Of the 112 cucurbit samples analysed, 69 from Guatemala, Honduras, Mexico, Panama and Spain were DAS‐ELISA‐positive for MNSV. Olpidium bornovanus and O. virulentus infections, and MNSV infections mixed with these Olpidium species, were observed for all these countries. Twenty‐nine MNSV isolates from all the origins where the virus was detected were selected and amplified by RT‐PCR. The resulting RT‐PCR of the p29, p89, p7A, p7B and p42 proteins was used to estimate the genetic diversity and the phylogenetic relationships of the MNSV population. The sequences obtained in this study were compared with the MNSV sequences of the NCBI database, and three groups were recovered by nucleotide composition according to geographical origins: the EU‐LA genotype group (with two subgroups: EU and LA, European and Latin American isolates, respectively), the JP melon genotype group (Japanese melon reference isolates) and the JP watermelon genotype group (Japanese watermelon reference isolates). The genetic diversity in the entire p7A and p7B proteins of MNSV suggests that these coding regions are under strong selective pressure. Additionally, the rDNA‐ITS region was analysed in 40 O. bornovanus and O. virulentus isolates associated with each geographical location and host examined. Phylogenetic analysis showed two groups for each Olpidium species, and these groupings were related to the host from which they were originally isolated.
The Richmond Agitation‐Sedation Scale: translation and reliability testing in a Swedish intensive care unit
Authors: ALMGREN M. , LUNDMARK M. , SAMUELSON K.
Published: December 2009

Background: Awareness about adequate sedation in mechanically ventilated patients has increased in recent years. The use of a sedation scale to continually evaluate the patient's response to sedation may promote earlier extubation and may subsequently have a positive effect on the length of stay in the intensive care unit (ICU). The Richmond Agitation‐Sedation Scale (RASS) provides 10 well‐defined levels divided into two different segments, including criteria for levels of sedation and agitation. Previous studies of the RASS have shown it to have strong reliability and validity. The aim of this study was to translate the RASS into Swedish and to test the inter‐rater reliability of the scale in a Swedish ICU.

Methods: A translation of the RASS from English into Swedish was carried out, including back‐translation, critical review and pilot testing. The inter‐rater reliability testing was conducted in a general ICU at a university hospital in the south of Sweden, including 15 patients mechanically ventilated and sedated. Forty in‐pair assessments using the Swedish version of the RASS were performed and the inter‐rater reliability was tested using weighted κ statistics (linear weighting).

Result: The translation of the RASS was successful and the Swedish version was found to be satisfactory and applicable in the ICU. When tested for inter‐rater reliability, the weighed κ value was 0.86.

Conclusion: This study indicates that the Swedish version of the RASS is applicable with good inter‐rater reliability, suggesting that the RASS can be useful for sedation assessment of patients mechanically ventilated in Swedish general ICUs.
Functional intravascular volume deficit in patients before surgery
Authors: BUNDGAARD‐NIELSEN M. , JØRGENSEN C. C. , SECHER N. H. , KEHLET H.
Published: December 2009

Background: Stroke volume (SV) maximization with a colloid infusion, referred to as individualized goal‐directed therapy, improves outcome in high‐risk surgery. The fraction of patients who need intravascular volume to establish a maximal SV has, however, not been evaluated, and there are only limited data on the volume required to establish a maximal SV before the start of surgery. Therefore, we estimated the occurrence and size of the potential functional intravascular volume deficit in surgical patients.

Methods: Patients scheduled for mastectomy (n=20), open radical prostatectomy (n=20), or open major abdominal surgery (n=20) were anaesthetized, and before the start of surgery, a 200 ml colloid fluid challenge was provided and repeated if a ≥10% increment in SV estimated by oesophageal Doppler was established. The volume needed for SV maximization defined the intravascular volume deficit.

Results: Forty‐two (70%) of the patients needed volume to establish a maximal SV. For the patients needing volume, the required amount was median 200 ml (range 200–600 ml), with no significant difference between the three groups of patients. The required volume was ≥400 ml in nine patients (15%).

Conclusion: The majority of anaesthetized patients present with a functional intravascular volume deficit before surgery. Although the deficit in general was minor, a fraction of patients presented with a deficit that may be of clinical relevance, emphasizing the importance of the individual approach of goal‐directed fluid therapy.
The 2008 Okuda lecture: Management of hepatocellular carcinoma: From surveillance to molecular targeted therapy
Authors: Kudo Masatoshi
Published: December 2009

Hepatocellular carcinoma (HCC) is responsible for approximately 600 000–700 000 deaths worldwide. It is highly prevalent in the Asia‐Pacific region and Africa, and is increasing in Western countries. Alpha fetoprotein (AFP) alone is insufficient for HCC screening. A combination with other tumor markers, such as PIVKA‐II and AFP‐L3, and periodical ultrasound surveillance is necessary. Sensitivity of AFP in depicting HCC is highest, followed by PIVKA‐II and AFP‐L3, but the order of the specificity is inverse, AFP‐L3, PIVKA‐II, and AFP. Sonazoid‐enhanced ultrasound (US) is extremely useful to characterize hepatic tumors equal to or more than multidetector row computed tomography (MDCT). Sonazoid‐enhanced US with defect re‐perfusion imaging is a breakthrough technique in the treatment of HCC. Defect re‐perfusion imaging will markedly change the therapeutic strategy for liver cancer. Gd‐EOB‐DTPA‐magnetic resonance imaging is a newly developed imaging technique in the detection and diagnosis of HCC. It is the most sensitive tool in the differentiation of early HCC from dysplastic nodules. Regarding the treatment strategy, there has been no established systemic chemotherapy for advanced HCC, except for Sorafenib. Empirically, intrahepatic arterial infusion chemotherapy using implanted reservoir port is known to be effective in response rate and overall survival for advanced HCC with vascular invasion. Sorafenib in combination with transcatheter arterial chemoembolization or adjuvant use after ablation or resection will significantly prolong the life expectancy if ongoing clinical trials provide positive results. In conclusion, it is expected that readers will gain deeper insight into the latest progress and updated diagnosis and treatment of HCC described in this review.
Protoperidinium tricingulatumsp. nov. (Dinophyceae), a new motile form of a round, brown, and spiny dinoflagellate cyst
Authors: Kawami Hisae , Van Wezel René , Koeman Reinoud P.T. , Matsuoka Kazumi
Published: December 2009

A small, broadly ovoidal and heterotrophic dinoflagellate containing round, brownish, and spiny cyst was found in the water column of Huibertsplaat in the Wadden Sea off the coast of the Netherlands. This dinoflagellate had these conspicuous morphological characters: a five‐sided first apical plate (1′), only three cingular plates, and an extremely small first antapical plate. Based on these morphological features,Protoperidinium tricingulatumKawami, vanWezel, Koeman et Matsuoka is described as a new species. The flagellar pore ofP. tricingulatumis covered with a small fin, which rises from the left side of the right sulcal plate to the large V‐shaped posterior sulcal plate. This feature suggests thatP. tricingulatumis assigned to the Abé's Monovela Group. The cyst stage ofP. tricingulatumwas positively linked to the vegetative stage by comparison of the ribosomal 5.8S rDNA, internal transcribed spacers (ITS1 and ITS2). Living cysts ofP. tricingulatumare round, brownish, and covered with many slender spines bearing capitate or cauliforate distal ends. The cyst also possesses a theropylic archeopyle formed by a slit corresponding to parasutures between three apical and two apical intercaraly plates. These morphological characters indicate that this species is morphologically related to two dinoflagellate cyst‐generaIslandiniumandEchinidinium.
Fine structure of two Hygropetra species, Hygropetra gelasina sp. nov. and Hygropetra balfouriana (Bacillariophyceae), and the taxonomic position of the genus with special reference to Frankophila
Authors: Mayama Shigeki , Idei Masahiko
Published: December 2009

A small diatom, Hygropetra gelasina sp. nov., obtained from wet moss is described. This diatom is similar to Hygropetra balfouriana (Grunow ex Cleve) Krammer & Lange‐Bertalot, which was found in the same moss sample. Fine structural observations revealed that H. gelasina has a reduced raphe slit and depressions along the margin of the axial area, at the proximal ends of the striae. Both species are characterized by multiple rows of areolae in each stria and a hexagonal pattern of sub‐pores similar to that in Pinnularia, but differing in the position of the areola occlusions or hymenes, which are internal in Hygropetra. Comparison with Frankophila, which shares the characteristics of reduced raphe slits and areola structure with Hygropetra, provides a reference for future taxonomic study of these related genera.
Effect of fluid intake on the outcome of constipation in children: PEG 4000 versus lactulose
Authors: Bae Sun Hwan , Son Jae Sung , Lee Ran
Published: December 2009

Background:  The aim of the present study was to evaluate the effect of fluid intake on the outcome of treatment with osmotic laxatives, PEG 4000 and lactulose, in children with chronic constipation.

Methods:  Medical records were reviewed, and 27 children with chronic constipation satisfying the following criteria were enrolled: (i) on stable maintenance medication for ≥3 months; (ii) no dosage modification or drug change between the two periods compared; (iii) no clinical events during the investigation that could affect intake or the clinical outcomes; (iv) good compliance regarding inclusion in the diaries of the frequency of bowel movements, the consistency of stools, and the amount of fluid intake. The diary covered >25 days per visit; and (v) interval of <3 months between the two periods compared. A scoring system was developed for bowel movements and for stool consistency. The score during a period of better fluid intake was compared to that during a period of worse fluid intake, for the same patient. Wilcoxon signed‐rank test was used for the analysis.

Results:  On polyethylene glycol 4000 (PEG 4000; n= 14), the bowel movement score on good fluid intake was 21.43–30.00 (median, 27.78), while that on poor fluid intake was 19.00–30.00 (median, 25.13; P= 0.009). For stool consistency, the score on good fluid intake was 11.79–20.00 (median, 20.00), while that on poor fluid intake was 11.00–25.00 (median, 15.91; P= 0.002). On lactulose (n= 13) there was no statistical difference with respect to the two categories of defecation.

Conclusions:  Children who are already on PEG 4000 still benefit from additional fluid intake.
SURGICAL MANAGEMENT OF CONGENITAL NYSTAGMUS
Authors: TAYLOR J. NORTON , JESSE K.
Published: December 2009

Forty‐three patients with congenital nystagmus who underwent surgery in the Ocular Motility Clinic at The Royal Victorian Eye and Ear Hospitar Melbourne, are analysed to assess the effect of different surgical approaches on the abnormal head posture and binocular visual performance. There were 38 patients with a horizontal head turn, and five with a vertical abnormal head posture.

In those undergoing horizontal nystagmus surgery the different surgical procedures have been classified as

(4 Anderson procedure, which involves large bilateral augmented recessions only; (ii) Kestenbaum and augmented Kestenbaum bilateral recess/resect surgery in which the recess:resect ratio is less than 1; and (iii) a modified Anderson‐Kestenbaum procedure with the emphasis on large recessions. so that the bilateral recess/resect ratio is greater than 1. In this series the augmented recessions of the Anderson and Anderson‐Kestenbaum procedures appeared to produce a more favourable result of improved binocular vision.

The five patients with vertical abnormal head posture with nystagmus had various surgical procedures with very encouraging results, both in terms of reduction of the abnormal head posture and an even greater improvement of binocular vision than with the horizontal cases. The surgical techniques in these cases are presented and discussed.
A survey of local anaesthesia use in cataract surgery in Australia
Authors: Sindhu Kiran , Colrain Ian , Buttery Robert , Wise Gordon
Published: December 2009

A survey of the use of local anaesthesia in cataract surgery by ophthalmologists in Australia is presented. The main conclusions drawn from the survey were:

1. A marked trend towards the use of local anaesthesia in cataract surgery during the years 1983–88 throughout Australia. A less marked trend in country areas and in Western Australia.

2. The use of local anaesthesia did not correlate with the number of cataract operations performed by an ophthalmologist.

3. Day case cataract surgery was more often performed under local anaesthesia in private than in public hospitals.

4. Throughout Australia retrobulbar local anaesthesia was preferred to the peribulbar technique.

5. The most commonly used local anaesthetic mixture was 2% lignocaine and 0.5% marcaine with or without adrenaline and/or hyalase.