bluuebunny/crossref_metadata_2025 huggingface dataset:
Health-related quality of life and mental health in the medium-term aftermath of the Prestige oil spill in Galiza (Spain): a cross-sectional study
Authors: Carrasco José Miguel , Pérez-Gómez Beatriz , García-Mendizábal Maria José , Lope Virginia , Aragonés Nuria , Forjaz Maria João , Guallar-Castillón Pilar , López-Abente Gonzalo , Rodríguez-Artalejo Fernando , Pollán Marina
Published: September 2007

Background

In 2002 the oil-tanker Prestige sank off the Galician coast. This study analyzes the effect of this accident on health-related quality of life (HRQoL) and mental health in the affected population.

Methods

Using random sampling stratified by age and sex, 2700 residents were selected from 7 coastal and 7 inland Galician towns. Two exposure criteria were considered: a) residential exposure, i.e., coast versus interior; and b) individual exposure-unaffected, slightly affected, or seriously affected-according to degree of personal affectation. SF-36, GHQ-28, HADS and GADS questionnaires were used to assess HRQoL and mental health. Association of exposure with suboptimal scores was summarized using adjusted odds ratios (OR) obtained from logistic regression.

Results

For residential exposure, the SF-36 showed coastal residents as having a lower likelihood of registering suboptimal HRQoL values in physical functioning (OR:0.69; 95%CI:0.54–0.89) and bodily pain (OR:0.74; 95%CI:0.62–0.91), and a higher frequency of suboptimal scores in mental health (OR:1.28; 95%CI:1.02–1.58). None of the dimensions of the other questionnaires displayed statistically significant differences.

For individual exposure, no substantial differences were observed, though the SF-36 physical functioning dimension rose (showed better scores) with level of exposure (91.51 unaffected, 93.86 slightly affected, 95.28 seriously affected, p < 0.001).

Conclusion

Almost one and a half years after the accident, worse HRQoL and mental health levels were not in evidence among subjects exposed to the oil-spill. Nevertheless, some of the scales suggest the possibility of slight impact on the mental health of residents in the affected areas.
Scarless and site-directed mutagenesis in Salmonella enteritidischromosome
Authors: Cox Mandy M , Layton Sherryll L , Jiang Tieshan , Cole Kim , Hargis Billy M , Berghman Luc R , Bottje Walter G , Kwon Young Min
Published: September 2007

Background

A variety of techniques have been described which introduce scarless, site-specific chromosomal mutations. These techniques can be applied to make point mutations or gene deletions as well as insert heterologous DNA into bacterial vectors for vaccine development. Most methods use a multi-step approach that requires cloning and/or designing repeat sequences to facilitate homologous recombination. We have modified previously published techniques to develop a simple, efficient PCR-based method for scarless insertion of DNA into Salmonella enteritidis chromosome.

Results

The final product of this mutation strategy is the insertion of DNA encoding a foreign epitope into the S. enteritidis genome without the addition of any unwanted sequence. This experiment was performed by a two-step mutation process via PCR fragments, Red recombinase and counter-selection with the I-SceI enzyme site. First, the I-SceI site and kanamycin resistance gene were introduced into the genome of cells expressing Red recombinase enzymes. Next, this sequence was replaced by a chosen insertion sequence. DNA fragments used for recombination were linear PCR products which consisted of the foreign insertion sequence flanked by homologous sequences of the target gene. Described herein is the insertion of a section of the M2e epitope (LM2) of Influenza A virus, a domain of CD154 (CD154s) or a combination of both into the outer membrane protein LamB of S. enteritidis.

Conclusion

We have successfully used this method to produce multiple mutants with no antibiotic gene on the genome or extra sequence except those nucleotides required for expression of epitope regions. This method is advantageous over other protocols in that it does not require cloning or creating extra duplicate regions to facilitate homologous recombination, contains a universal construct in which an epitope of choice can be placed to check for cell surface expression, and shows high efficiency when screening for positive mutants. Other opportunities of this mutational strategy include creating attenuated mutants and site-specific, chromosomal deletion mutations. Furthermore, this method should be applicable in other gram-negative bacterial species where Red recombinase enzymes can be functionally expressed.
An evaluation of a model for the systematic documentation of hospital based health promotion activities: results from a multicentre study
Authors: Tønnesen Hanne , Christensen Mette E , Groene Oliver , O'Riordan Ann , Simonelli Fabrizio , Suurorg Lagle , Morris Denise , Vibe Peder , Himel Susan , Hansen Poul Erik
Published: September 2007

Background

The first step of handling health promotion (HP) in Diagnosis Related Groups (DRGs) is a systematic documentation and registration of the activities in the medical records. So far the possibility and tradition for systematic registration of clinical HP activities in the medical records and in patient administrative systems have been sparse. Therefore, the activities are mostly invisible in the registers of hospital services as well as in budgets and balances.

A simple model has been described to structure the registration of the HP procedures performed by the clinical staff. The model consists of two parts; first part includes motivational counselling (7 codes) and the second part comprehends intervention, rehabilitation and after treatment (8 codes).

The objective was to evaluate in an international study the usefulness, applicability and sufficiency of a simple model for the systematic registration of clinical HP procedures in day life.

Methods

The multi centre project was carried out in 19 departments/hospitals in 6 countries in a clinical setup. The study consisted of three parts in accordance with the objectives.

A: Individual test. 20 consecutive medical records from each participating department/hospital were coded by the (coding) specialists at local department/hospital, exclusively (n = 5,529 of 5,700 possible tests in total).

B: Common test. 14 standardized medical records were coded by all the specialists from 17 departments/hospitals, who returned 3,046 of 3,570 tests.

C: Specialist evaluation. The specialists from the 19 departments/hospitals evaluated if the codes were useful, applicable and sufficient for the registration in their own department/hospital (239 of 285).

Results

A: In 97 to100% of the local patient pathways the specialists were able to evaluate if there was documentation of HP activities in the medical record to be coded.

B: Inter rater reliability on the use of the codes were 93% (57 to 100%) and 71% (31 to 100%), respectively.

C: The majority of the study participants found the codes to be useful (71%), applicable (92%) and sufficient (92%).

Conclusion

Systematic registration of HP activities is relevant in clinical day life and the suggested codes proved to be applicable for international use. HP is an essential part of the clinical pathway or the value chain. This model promises to improve the documentation and thereby facilitate analysis of records for evidence based medicine as well as cost and policy analyses.
Dosimetric comparison between coplanar and non coplanar field radiotherapy for ethmoid sinus cancer
Authors: Serre Antoine , Idri Katia , Fenoglietto Pascal , Ailleres Norbert , Santoro Lore , Lemanski Claire , Garrel Renaud , Makeieff Marc , Allaw Ali , Dubois Jean-Bernard , Azria David
Published: September 2007

Background

To compare non coplanar field (NCF) with coplanar field (CF) -intensity-modulated radiotherapy (IMRT) planning for ethmoid cancer.

Methods

Seven patients treated with NCF IMRT for ethmoid cancer were studied. A CF IMRT optimization was prepared with the same constraints as for the NCF treatment. The maximum point doses (D max) obtained for the different optic pathway structures (OPS) should differ no more than 3% from those achieved with the NCF IMRT plan. The distribution of the dose in the target volume and in the critical structures was compared between the two techniques, as well as the Conformity (CI) and the Homogeneity Indexes (HI) in the target volume.

Results

We noted no difference between the two techniques in the OPS for the D1, D2, and D5%, in the inner ear and controlateral lens for the average Dmax, in the temporo-mandibular joints for the average mean dose, in the cord and brainstem for the average D1%. The dose-volume histograms were slightly better with the NCF treatment plan for the planning target volume (PTV) with a marginally better HI but no impact on CI. We found a great improvement in the PTV coverage with the CF treatment plan for two patients with T4 tumors.

Conclusion

IMRT is one of the treatment options for ethmoid cancer. The PTV coverage is optimal without compromising the protection of the OPS. The impact of non coplanar versus coplanar set up is very slight.
Making care programming work
Authors: Kingdon David
Published: September 2007

It is hard to disagree with the principles of the care programme approach (SPCR, 1993; Kingdon, 1994) but it has been much harder to agree how to put them into practice. What should be ‘just good practice’ becomes more complex the more it is discussed by clinical teams.
Anxiety Control Training
Authors: Snaith Philip
Published: September 2007

Anxiety pervades every aspect of human activity and experience. It is a normal state and a spur to action, but readily exceeds normal limits in intensity, duration and appropriateness to the stimulus or situation. Anxiety is manifest by the mood of fearfulness, behaviour marked by restlessness and avoidance of situations, increased arousal with insomnia, excessive preoccupation with thoughts on the theme of insecurity, and a wide range of somatic symptoms which are based on muscular tension, hyperventilation leading to paraesthesiae and faintness, and symptoms based on overactivity of the autonomic nervous system. Excessive anxiety and situational avoidance leads to diminution of performance and limitation of endeavour. In the context of physical illness, anxiety increases the distress of symptoms, may confuse diagnostic procedure, prolong recovery time from acute illness, cause failure to comply with effective treatment and promote destructive habits such as reliance on alcohol or excessive use of sedative drugs.
Management of jealousy in couples
Authors: Crowe Michael
Published: September 2007

Jealousy has traditionally been treated by offering medication, support, or various forms of individual psychotherapy or counselling. However, jealousy is usually a condition which has a profound effect on the sexual partner of the jealous person, and they may actually suffer more from the condition than the person him/herself. While accepting that medication and other individual approaches have their place in the management of jealousy, there seem to be several advantages in seeing the problem from the standpoint of the couple relationship. Firstly, couple therapy reduces the almost inevitable labelling of the jealous person as a psychiatric case. Secondly, one might argue a priori that any changes which take place as a result of two people changing their behaviour are likely to be more stable and long-lasting than if just one person changes. There is another consideration, namely that, since the relationship is bound to be affected by the jealousy, it will need attention regardless of the means used to treat the jealousy itself.
Setting up a psychiatric case register
Authors: Bloor Roger N.
Published: September 2007

Case registers have very little to do with computers or any other form of mechanical calculating machine. To write an article on case registers which concentrated on information technology would be as logical as an article on open heart surgery which confined itself to the finer points of scalpel technology. The creation of a case register is as simple or as complicated as the clinician wishes it to be; a case register at its purest is simply a list of contacts with patients, organised to a predetermined format, which allows the clinician to gain information from the list for education, research, planning or administration. The work needed to establish a case register, however, should not be underestimated, and the time spent in thinking through reasons for development of a register is a worthwhile investment. An understanding of the history of the development of psychiatric case registers may help those wishing to develop new registers to avoid treading well worn cul-de-sacs, while reviewing some of the work which has resulted from case registers may demonstrate the enormous potential of a well-designed register in facilitating the extension of knowledge about treatment and provision of services.
The new genetics in psychiatry
Authors: Feldman Eleanor
Published: September 2007

Advances in the understanding of the genetic causes of some neuropsychiatric disorders are having an impact on clinical practice as direct mutation analysis becomes possible. Mutation analysis is now available in UK Health Service diagnostic laboratories for Huntington's disease (HD) and the fragile X syndrome (FRAXA). Psychiatrists need to be familiar with issues surrounding presymptomatic and diagnostic testing in HD and diagnostic and carrier testing in FRAXA. They may be asked to assist clinical geneticists in the assessment of candidates for HD presymptomatic testing and a suggested mode of assessment is described here. The procedure for HD will provide the model for use with other familial neuropsychiatric disorders of late onset, notably familial Alzheimer's disease (FAD). Testing for FAD is already possible in conjunction with research laboratories in the few families where a mutation has been discovered and we shall have more tests for FAD within a few years.
Treating tobacco dependence
Authors: Foulds Jonathan , Ghodse Hamid
Published: September 2007

The 1988 US Surgeon General's Report entitled Nicotine Addiction reviewed the mass of evidence on the role of nicotine in tobacco consumption and came to three main conclusions, shown in Box 1.
Information systems for mental health care: uses, shapes and rhythms
Authors: Glover Gyles R.
Published: September 2007

Mental health care is a complex undertaking. It involves care providers of many disciplines, administrative support staff, managers, funding bodies and of course carers and patients themselves. Each group has their own information needs; each, however, is primarily concerned with other things, and the importance of minimising the effort involved in amassing and accessing dependably accurate information cannot be stressed too highly.
Environmental quality for patients with dementia
Authors: Bowie Peter
Published: September 2007

For centuries the conditions existing in institutions have been a cause of concern. Accompanying this has been a drive to improve the quality of care in such places. Until the second half of this century younger patients constituted the majority of the mentally ill residing in institutions. Now the balance has shifted and considerable numbers of elderly people, particularly those suffering from dementia, are residing in institutions (hospitals, nursing and residential homes). Perhaps never before has the question “What makes a good environment for the demented?” been so important.
Management of the sexually abused child
Authors: Jones David
Published: September 2007

This review considers the place of psychiatry in the complex area of management of the sexually abused child. A model is described in order to guide psychiatric perspectives in the field of child sexual abuse, before describing an approach to management in mental health teams.
Mental health nursing: issues and roles
Authors: Gournay Kevin
Published: September 2007

1994 saw the publication of the report of the Mental Health Nursing Review Team (Department of Health, 1994). This report signified the end of a three year process where mental health nursing was examined from the perspectives of practice, education, research and management. The last review of mental health nursing took place in 1968, but since that time there have been enormous changes in our thinking about mental illness, in the delivery of services and a number of very exciting developments in treatment. The review process included the widest possible consultation with other professionals, user organisations, patients, relatives and carers. It also co-opted expert advisers and took written and oral evidence, and visited clinical services across England. There were altogether 42 recommendations and during this article reference will be made to a number of the most important of these.
Working effectively with clinical psychologists
Authors: Hall John N.
Published: September 2007

Most clinical psychologists and psychiatrists already work together constructively and cooperatively, although guerrilla warfare may descibe the situation in some areas. This outline of issues affecting work with clinical psychologists, looking not only at a mutual awareness of each others' profession-specific knowledge and clinical skills, but also at an understanding of mind-sets and value systems, is aimed at further improving working effectively together, while not glossing over actual and potential areas of role-confusion and conflict between the professions.
Fit to be interviewed by the police?
Authors: Rix Keith J. B.
Published: September 2007

Although police surgeons (or forensic medical examiners; FMEs) usually assess fitness to be interviewed by the police (Norfolk, 1996), psychiatrists may also be asked for an opinion (Protheroe & Roney, 1996).
Lessons to be learnt from meta-analyses of newer versus older antidepressants
Authors: Anderson Ian
Published: September 2007

Meta-analysis is the use of statistical techniques to analyse the findings of many individual analyses (Glass, 1977). It covers all aspects of the review process involving formulating relevant research questions, searching the literature, assessing the quality of studies and choosing relevant ones, extracting and combining the data (for review see Henry & Wilson, 1992; Wilson & Henry, 1992). Meta-analysis as part of a systematic review has advantages over a narrative review but there are problems in applying it in practice (Box 1).
What a patient can expect from a consultant psychiatrist
Authors: Shooter Michael
Published: September 2007

This half-joking remark from the Specialist Adviser to a national mental health charity, sums up the dilemma every consultant faces from time to time: how to be all things to all people. What is more, it tunes in to our own sense of omnipotence. A recent review of ethics in psychiatry (Adshead, 1995) urged consultants to follow the four principles in practice: respect for the autonomy of the patient; beneficence (actively doing good); non-maleficence (avoiding doing harm); and the pursuit of justice – an incontestable but formidable remit.
Practical pharmacotherapy for anxiety
Authors: Nutt David , Bell Caroline
Published: September 2007

Anxiety is a very common and disabling condition which has serious consequences for patients, their families and society in general. The past decade has witnessed an increase in the recognition and understanding of the problem but considerable confusion and debate remains over attitudes towards treatment. The background to this controversy dates from the late 1980s when widespread and vehement criticism of doctors and drug companies over the use of benzodiazepines began. Although the litigation was unsuccessful, it resulted in a pervading feeling of uncertainty (both within the medical profession and among patients) about prescribing or taking any drug as a treatment for anxiety. The situation has been further confounded by the split that has occurred between the proponents of pharmacological and psychological approaches to management. These controversies have left the practising clinician in an unenviable position, with few practical or relevant guidelines to follow. Developments over recent years, however, should put an end to this confusion; new pharmacotherapies such as the selective serotonin reuptake inhibitors (SSRIs) and buspirone, and older ones such as the tricyclic antidepressants (TCAs), have emerged as effective alternatives to the benzodiazepines and have been paralleled by a similar growth in effective and available psychological treatments, particularly cognitive and cognitive–behavioural therapy. This progress seems set to continue with the rapid expansion of knowledge about the brain circuits and transmitters regulating anxiety that is now emerging from imaging studies.
Establishing a mental health liaison attachment with primary care
Authors: Burns Tom , Bale Rob
Published: September 2007

The role of the general practitioner (GP) in the care of individuals with mental health problems has long been recognised. Goldberg & Huxleys' (1980) pioneering work on the pathways to mental health care demonstrated that only a fraction of identified mental health problems are referred on to psychiatrists. Goldberg & Bridges (1987) estimated that between 20 and 25% of a GP's workload concerns mental health, with only about 5% referred on to psychiatrists. Shepherd (1991) insisted that the only real hope for significant improvement in mental health care lay in the improvement of GP provision – there will simply never be enough psychiatrists.
Child psychoanalytic psychotherapy
Authors: Fitzgerald M.
Published: September 2007

The goal of psychoanalytic psychotherapy with a distressed child is to alter the child's psychic structure and function. The technique is based on the same theory as adult psychoanalytic psychotherapy (see Box 1). The unconscious is central, as is the interpretation of defence, resistance, transference, working through and the reconstruction of earlier life. It differs from adult psychotherapy in that the child's age and level of development are at all times central to the work. In young children the focus of interpretation is on free play, while with adults it is free association of ideas. In the treatment of adolescents a combination of techniques, both adult and pre-adolescent, are used, while for late adolescents the technique is basically adult technique with attention to issues relevant to that stage of the life cycle.
Commentary
Authors: Vizard Eileen
Published: September 2007

The key messages emerging from this paper are the need for early intervention in all cases of known or suspected child abuse, and the necessity for practitioners to remain alert to the possible early traumatic origins of adult symptomatology. These clear messages are amply supported by research (Lindberg & Distad, 1985; Browne & Finklehor, 1986; Briere, 1992; Mendel, 1995; Styron & Janoff-Bulman, 1997). The paper suggests that services for both victims and perpetrators could be identified and provided much sooner if the process is started with an ‘overall statement of risk’ or risk assessment. Given the connections between child abuse, family violence and various physical, psychosomatic and emotional problems presenting to doctors in all specialities, it is clear that “The likelihood of a clinician encountering past or current abuse is overwhelming” (p. 109). The message here is that all doctors, not just psychiatrists, should be alert to the possibility of abuse in the past history or present symptomatology of their patients.
Occupational factors and unexplained physical symptoms
Authors: Hotopf Matthew
Published: September 2007

Liaison psychiatrists are frequently asked to see people with chronic, debilitating and unexplained physical symptoms, in particular chronic pain and chronic fatigue. People with these conditions have often seen many doctors and received multiple medical investigations, but rarely have had any effective treatment or even explanation for their symptoms. There are many reasons for focusing on occupational factors in this patient group. First, many people may attribute their symptoms to workplace exposures. For example, back pain may commonly be put down to accidents; upper limb disorders to use of keyboards or repetitive manual tasks; and headaches and fatigue to visual display units or air conditioning. These attributions have prognostic and legal implications, and are likely to affect the course of treatment. Second, for those who have had prolonged sickness absence, it is often necessary to make decisions regarding return to work or to help them negotiate the often lengthy and complex medical retirement process. This may be a major stumbling block in managing such people. Finally, psychiatrists are frequently invited to write medico-legal reports regarding the role of occupational factors in causing unexplained physical symptoms. This article aims to address these issues and provide some practical guidance to clinicians.
Teaching psychiatry to medical undergraduates
Authors: Curran Stephen , Bowie Peter C. W.
Published: September 2007

There is now a greater awareness among academics that teaching skills, like clinical and research skills, must be acquired and practised, usually over an extended period of time. In addition, teachers have a great responsibility in ensuring that medical students develop the knowledge, skills and attitudes to enable them to become competent and effective doctors. Although teaching theory is complex, attention to a few simple techniques and careful planning of teaching sessions and courses can greatly improve the experience for both students and teachers. This article discusses some of the theoretical aspects of teaching medical students and is followed by three articles which specifically address the teaching of child and adolescent, general and old age psychiatry to medical undergraduates.
Witnessing adults' violence: the effects on children and adolescents
Authors: Black Dora
Published: September 2007

Children, like adults, can directly experience or be witness to interpersonal violence either within or outside the family, on one or repeated occasions. Intra-familial violence may result in the death or serious disablement of a parent or child, or may be experienced as child sexual abuse or chronic domestic violence. Non-familial violence includes urban violence now endemic in some communities, war and civil conflict, and vicarious violence such as in films and on television. Traumatic events can also occur by natural forces, for example, earthquakes, volcanic eruptions, hurricanes. This review will focus mainly on the effects on children of witnessing severe or repeated violence, sometimes resulting in death, occurring to a member of their family, perpetrated either by a parent, step-parent or cohabitee or by a person or persons unrelated to them, although it will draw on studies of other traumatic experiences where relevant.
Commentary
Authors: Neal Leigh A.
Published: September 2007

It is a sobering fact that the average age of the surviving veterans of the Second World War is now close to 80 years. The available information indicates that the prevalence of post-traumatic stress disorder (PTSD) in all Second World War veterans is slightly higher than the 15% lifetime prevalence found in Vietnam War veterans, although there are few reliable studies on which to base this conclusion. It is, however, consistent with the finding that combat stress, based on casualty rates, during periods of the Vietnam War was equivalent to the severity of combat stress in the Second World War. There are several epidemiological studies (Beebe, 1975; Tennant et al, 1986) of more specific Second World War veteran groups such as Far East prisoners of war and, predictably, they show higher PTSD prevalence rates, ranging between 30 and 50%.
Diagnosis of mental illness in elderly people from ethnic minorities
Authors: Lindesay James
Published: September 2007

From the 1991 census (Office of Population Censuses and Surveys, 1993) it is estimated that 5.9% of the total population of England and Wales belong to an ethnic minority, and that 3% of this ethnic minority population are aged 65 years and older. This compares with 17% aged 65 years and older in the indigenous population. Although the numbers of elderly people from ethnic minorities are small in absolute terms, these groups are growing rapidly, and mental health professionals working with elderly patients will increasingly need to be equipped with the necessary services and skills to meet their specific needs. The elderly ethnic minority population of the UK is extremely diverse; the largest groups originate from the Indian subcontinent and the Caribbean, but there are also significant communities of Chinese, Somali, Vietnamese, Eastern European, Mediterranean and Irish origin, all of which require consideration when planning and providing services, whatever their numbers. This diversity is also important when considering the various factors that influence the presentation and diagnosis of mental disorders in these groups.
Emergency treatment of depression
Authors: Porter Richard , Ferrier Nicol
Published: September 2007

Psychiatric emergencies are common and each case presents particular problems and difficulties. This article focuses on one subset of psychiatric emergencies, that of severe depression, and on the role of and use of antidepressant treatments in these conditions. The clinical situations to be discussed in this article include active suicidality, severe psychomotor retardation (with associated problems of hydration and nutrition), affective psychosis, bipolar depression and behavioural disturbance.
Attention-deficit hyperactivity disorder in adults
Authors: Toone Brian , Clarke Maria , Young Susan
Published: September 2007

Attention-deficit hyperactivity disorder (ADHD) and hyperkinetic disorder are well-established diagnoses in children, with estimates of prevalence in pre-adolescent children from 3 to 5%. Until recently ADHD was not thought to persist beyond adolescence, but results from long-term prospective outcome studies indicate that 30–70% of children with ADHD exhibit some symptoms as adults. Recognition of this disorder is important as the persistence of ADHD symptoms has been shown to be associated with academic and occupational failure and high rates of psychiatric comorbidity. With the establishment of a UK support group (LADDER) and increasing media attention highlighting this problem it is likely that there will be an increased demand for psychiatric assessment of adult ADHD in the next few years.
Psychodynamic interpersonal therapy
Authors: Guthrie Elspeth
Published: September 2007

The dramatic development of cognitive–behavioural therapy (CBT) over the past 30 years, with associated high-quality research into the evaluation of its treatment effects, is to be welcomed and applauded. This form of therapy is now a recognised psychological treatment of choice for a wide variety of psychological disorders. The role of cognitive processes in the development and prolongation of psychological symptoms has been studied, and resulted in the development of coherent and effective treatment models.
Anticonvulsants as mood stabilisers
Authors: Porter Richard , Ferrier Nicol , Ashton Heather
Published: September 2007

Recent research has highlighted the fact that a significant number of patients with bipolar affective disorder have a poor outcome (Cole et al, 1993). The most common poor outcome is the development of rapid or ultra-rapid cycling, but mixed states, prolonged depression and severe mania are also associated with poor outcome. It is estimated that approximately one-third of patients with bipolar affective disorder do not respond fully to lithium and a significant number of patients discontinue lithium (Post, 1990) which may itself cause further problems.
Insight and major mental illness: an update for clinicians
Authors: Surguladze Simon , David Anthony
Published: September 2007

This article will concentrate on insight into serious mental disorder. Not psychoanalytic insight – nor indeed, the insight all of us have, to a greater or lesser extent, into our own attitudes, motives and behaviour – but the insight which patients with psychosis have into their mental pathology. This is no longer considered an all-or-none phenomenon, but rather a dimensional one, so that subjects can have different levels of awareness into their illness. The suggestion was first mooted by Aubrey Lewis (1934) in his seminal work on insight. Conceptual exploration of insight has been activated in the past decade and is proceeding in parallel with the construction of special scales to measure insight and research into its cognitive, biological, social and cultural basis.
Use of an adolescent in-patient unit
Authors: Cotgrove A. J. , Gowers S. G.
Published: September 2007

Adolescence is a transitional stage of development between childhood and adulthood. The physical changes of puberty are generally seen as the starting point of adolescence, while the end is less clearly delineated. Adolescence ends with attainment of ‘full maturity’, and a range of social and cultural influences, including the legal age of majority, may influence this. In developed societies, these tend to delay progression to adulthood. The extension of compulsory schooling and development of further education, with its economic consequences, generally contribute to a delay in reaching full independence. This may, in turn, lead to difficulties in adjusting to the responsibilities of the next stage of life.
Psychiatric sequelae of acquired brain injury
Authors: Barrett Ken
Published: September 2007

Improvements over recent decades in acute care of the brain-injured now ensure that all but the most severely injured survive. The legacy of that survival is an increasing number of people with enduring organic mental disorders. Here, I will focus upon the psychiatric sequelae of five types of severe single-insult brain injury: head trauma, subarachnoid haemorrhage, and hypoxic, hypoglycaemic and postencephalitic injury. Thrombotic stroke is a common and important cause of brain injury but the psychiatric consequences have been more extensively studied and are fairly well-known (Robinson & Price, 1982; Starkstein et al, 1987). Damage due to alcohol and associated malnutrition is also well-documented (Jacobson & Lishman, 1987, 1990). Neither will be specifically addressed here, though some of the consequences of brain injury are similar, regardless of cause.
Running an assertive community treatment team
Authors: Burns Tom , Guest Louise
Published: September 2007

In the 1960s, most people with severe mental illness were treated in large mental hospitals, receiving all their care under one roof, ensuring its continuity and accountability. Deinstitutionalisation resulted in discharge into the community, where care was fragmented between many agencies, making continuity and accountability very difficult. Countless individual programs were developed with few links between them. Not surprisingly, deinstitutionalised patients, in an unfamiliar environment and with poor coping skills to navigate services, did not receive the care they needed.
Multimedia computer-based learning: a developing role in teaching, CPD and patient care
Authors: Williams Christopher , Harkin Patrick
Published: September 2007

Since the 1970s, there has been a progressive increase in the use of computers as a teaching resource. The purpose of this article is to summarise the current uses of computer-based learning (CBL) packages and to highlight how to assess whether a particular multimedia package meets your own requirements for training.
Clinical governance in practice
Authors: Oyebode Femi , Brown Nick , Parry Elizabeth
Published: September 2007

Clinical governance is defined by the government as:

“a framework through which [National Health Service (NHS)] organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish'’ (emphasis not in original) (Department of Health (DOH), 1998).
ZBP1 enhances cell polarity and reduces chemotaxis
Authors: Lapidus Kyle , Wyckoff Jeffrey , Mouneimne Ghassan , Lorenz Mike , Soon Lillian , Condeelis John S. , Singer Robert H.
Published: September 2007

The interaction of β-actin mRNA with zipcode-binding protein 1 (ZBP1) is necessary for its localization to the lamellipod of fibroblasts and plays a crucial role in cell polarity and motility. Recently, we have shown that low ZBP1 levels correlate with tumor-cell invasion and metastasis. In order to establish a cause and effect relationship, we expressed ZBP1 in a metastatic rat mammary adenocarcinoma cell line (MTLn3) that has low endogenous ZBP1 levels and delocalized β-actin mRNA. This leads to localization of β-actin mRNA, and eventually reduces the chemotactic potential of the cells as well as their ability to move and orient towards vessels in tumors. To determine how ZBP1 leads to these two apparently contradictory aspects of cell behavior – increased cell motility but decreased chemotaxis – we examined cell motility in detail, both in cell culture and in vivo in tumors. We found that ZBP1 expression resulted in tumor cells with a stable polarized phenotype, and reduced their ability to move in response to a gradient in culture. To connect these results on cultured cells to the reduced metastatic ability of these cells, we used multiphoton imaging in vivo to examine tumor cell behavior in primary tumors. We found that ZBP1 expression actually reduced tumor cell motility and chemotaxis, presumably mediating their decreased metastatic potential by reducing their ability to respond to signals necessary for invasion.
Mizrahi Subaltern Counterpoints: Sderot's Alternative Bands
Authors: Saada-Ophir Galit
Published: September 2007

This article addresses Mizrahi (or Oriental) identity in Israel by focusing on a well-known musical scene in the town of Sderot, in the south of Israel, populated largely by low-income Mizrahim. This group has undergone a unique Orientalization process in Israel. This process triggered the crystallization of a diverse musical scene in Sderot that exposed three practices of molding Mizrahi identity. By engaging with a dialectic model that appears in the later writing of Edward Said, I argue that the Mizrahi subversion of Israeli Orientalism encompasses a re-creation of it in different degrees of intensity.
Money and Merit in French Renaissance Comedy*
Authors: Parsons Jotham
Published: September 2007

Pierre Corneille’sMélite(1629) resonated in part due to a social critique with deep roots in the French Renaissance. Corneille’s characters live by the canons of a (notionally) natural system of merit, divorced from money, implicitly noble, but open to upwardly-mobile commoners. Reconciling the traditional social order with the purchase of status and power by venal office-holders had preoccupied French comedy since the 1550s. While early playwrights hesitated to comment on this phenomenon (in which they took part), by about 1580 Odet de Turnèbe had already dramatized an educated elite’s transcendence of the economic, which Corneille would then go on to perfect. The biographies of these playwrights show that their plays’ ideological functions suited their own social situations.
Dancing the Righoletto
Authors: NOSOW ROBERT
Published: September 2007

The righoletto was a type of round dance current in Florence and its surrounding countryside in the late 14th and 15th centuries. It was above all a dance accompanied by song, one in which all the dancers sang the refrain, and a soloist sang the stanzas. Twelve canzone a righoletto have been identified in literary sources, together with three closely related works also appropriate to accompany the dance. The lyrics occupy a medium or lower poetic register; they range from moralizing texts to ribald narratives. Despite its country origins, the righoletto and its canzone were shared across social classes, largely via oral transmission. One canzona a righoletto survives with its music, the lauda “In su quell'alto monte.” Another, the satiric “Non ti fidare che oggi è sì pocha fé,” has been reconstructed from its model in the Squarcialupi Codex. The righoletto thus offers valuable glimpses of a vanished form of vernacular culture in late medieval Italy.
Centralised or decentralised sanitation in Swedish summerhouse areas in transition to permanent living?
Authors: Kärrman E. , Erlandsson Å. , Hellström D. , Björlenius B. , Tidåker P.
Published: September 2007

The standard of wastewater management is high in Sweden. Around 90% of the population is connected to central wastewater treatment plants with high requirements of nutrients removal; however, still the problem with algae blooms in the Baltic Sea exists. The aim of the VeVa project was to develop a simple and user-friendly Excel-based model to support environmental decisions of how to select wastewater systems for housing areas where no central sewer system exists. The VeVa model deals with two types of environmental issues: substance flow analysis and energy analysis. Six system structures were studied for the transition area Lillängsdal in Värmdö municipality sorted in three categories: 1) on-site systems for single households; 2) local collective systems; 3) connection to central systems. All studied system structures, except for a Sand filter system, fulfilled the goals of reducing phosphorus and BOD7 according to Swedish guidelines for on-site systems in sensitive areas. All studied systems, except for the Sand filter system, have the potential to fulfil the Swedish National Environmental goal to recycle 60% phosphorus to productive land.

The systems with central wastewater treatment plant and local wastewater treatment are the most energy efficient alternatives that also fulfil the requirements of discharges and environmental goals regarding phosphorus recycling.
An intelligent visualisation and decision support system for decentralised wastewater treatment plants
Authors: Wölle J. , Steinmetz H. , Hansen J. , Einsfeld K. , Ebert A.
Published: September 2007

Current sanitation concepts of decentralised wastewater treatment and reuse raise the issue of monitoring and maintenance of such systems. To guarantee high quality of the recycled water, systems with high requirements concerning process technology are essential. With increasing numbers of decentralised treatment systems spread over far distances it will become more and more impossible and uneconomic to have expert personnel on site. Therefore, new visualisation and intelligent information systems are necessary. The paper describes the structure and 3D-demonstrations as a base for information visualisation. Up-to-date visualisation techniques, facilitating the cognition of context-adapted information, make it possible to maximise the amount of information presented to the user without overwhelming her or him. Concerning diagnosis and decision support systems in the domain of wastewater treatment, several interesting approaches are presented, estimating their applicability for decentralised wastewater treatment systems. The intelligent decision support system presented here consists of a combined ontology- and case-based reasoning system in addition to a process monitoring system. It is responsible for plausibility checks, error diagnosis, solution proposals, and optimisation suggestions.
Conformational study on the structures and energies of the weakly bound complexes of AlCl3 with diatomic molecules
Authors: Jimenez-Fabian Issac , Jalbout Abraham , Boutalib Abderahim
Published: September 2007

In this work we present the results of high level ab initio calculations on weakly bound complexes of aluminium trichloride and hydrogen halides, HX, halogens, X2 and diatomic interhalogens, XY (where X, Y = F, Cl, Br). Based upon these calculations we have predicted that all structures in the staggered conformation (except for Cl3AlFH and Cl3AlClH) are stable minima while those in the eclipsed configurations are transition state structures. In the XH complexes the strength of interaction with the Cl3Al group is FH > ClH > BrH. In the case of X2 species it is Br2 > F2 > Cl2, and finally in the XY (YX) group it is: FBr > ClBr > FCl > BrCl > BrF > ClF.
Moisture sensitivity of polyester and acrylic polymer concretes with metallic monomer powders
Authors: Ahn Namshik
Published: September 2007

To evaluate the moisture sensitivity of polyester and acrylic polymer concretes with commercial metallic monomer powders, polymer concretes containing different levels of these powders were investigated with respect to the properties of hardened polymer concrete. The mix design was made and optimized for workability, strength, and economy, which depended on the resin viscosity, the intended use, and the additional quantities of the polymeric materials. The investigated properties included the compressive and flexural strengths of hardened polymer concrete. These polymeric materials offer the possibility of using wet aggregates in polyester and acrylic polymer concrete construction. © 2007 Wiley Periodicals, Inc. J Appl Polym Sci, 2008
Parasite suppression of the oxidations of eumelanin precursors in Drosophila melanogaster
Authors: Kohler Lara J. , Carton Yves , Mastore Maristella , Nappi Anthony J.
Published: September 2007

In insects, eukaryotic endoparasites encounter a series of innate immune effector responses mediated in large part by circulating blood cells (hemocytes) that rapidly form multilayer capsules around foreign organisms. Critical components of the encapsulation response are chemical and enzyme‐catalyzed oxidations involving phenolic and catecholic substrates that lead to synthesis of eumelanin. These responses are initiated immediately upon infection and are very site‐specific, provoking no undesirable systemic responses in the host. In this study, we were interested to learn if the principal oxidation pathways leading to the synthesis of eumelanin in larvae of Drosophila melanogaster were targets for inhibition by immune suppressive factors (ISF) derived from a virulent strain of the endoparasitic wasp Leptopilina boulardi. Comparative in vitro assays monitored by sensitive electrochemical detection methods showed that ISF derived from female reproductive tissues significantly diminished the oxidations of the two diphenol eumelanin precursors, dopamine and 5,6‐dihydroxyindole (DHI). The oxidations of the monophenol tyrosine, and two other related diphenols, dopa and 5,6‐dihydroxyindole‐2‐carboxylic acid (DHICA), were not significantly inhibited by ISF. The data suggest that melanogenesis represents at least one of the host responses suppressed by L. boulardi ISF, and that the oxidation pathways selectively targeted for inhibition are those synthesizing decarboxylated pigment precursors derived from DHI. These observations, together with previous reports of adverse effects of ISF on the ability of hemocytes to adhere to foreign surfaces, suggest a multifaceted approach by the parasitoid to circumvent the innate immune response of D. melanogaster. Arch. Insect Biochem. Physiol. 66:64–75, 2007. © 2007 Wiley‐Liss, Inc.