bluuebunny/crossref_metadata_2025 huggingface dataset:
Polymerase Chain Reaction (
PCR
)
Authors: Ruddock Campbell A.
Published: March 2016

The polymerase chain reaction (PCR) is a very useful method for increasing the amount of DNA present in a sample to a larger amount accessible for analysis. PCR is modified in a wide range of methods for a large number of biomedical and forensic uses. The general method is described and its application to forensic biological science as well commonly encountered challenges with the PCR assay.
Familial Searching
Authors: Slooten Klaas , Meester Ronald
Published: March 2016

Familial searching is the act of deliberately searching a DNA database with the purpose of identifying biological relatives of the unknown donor of a DNA profile. In this article, we discuss the statistical and probabilistic issues arising from such a search. We first discuss the genetic background of familial searching and observe that some DNA profiles are more suitable for familial searching than others. We discuss various strategies for finding relatives and discuss weak and strong points of each strategy in terms of false positive and false negative rates, workload, and efficiency. We also discuss statistical issues in the context of familial searching arising from the fact that databases and populations are both heterogeneous. Finally, we briefly discuss some ethical issues.
Validation
Authors: Ruddock Campbell A.
Published: March 2016

Validation of any new method is a critical component of a forensic DNA laboratory's quality assurance program. Validation exists to substantiate and test the integrity of scientific processes utilized during DNA testing to allow for development of detection thresholds, operating parameters and protocols prior to casework applications. Successful validation of a DNA testing method will include both developmental and internal validation to support good practice and adheres to established quality standards and guidelines as dictated by testing standardization bodies. The purpose of validation is to test and document through specific experiment categories the reliability, reproducibility, and robustness of a testing method. It is an important process in substantiating scientific methods and general confidence in their reliability as testing methods. As validation is a core process to DNA testing method establishment within a laboratory the validation data is an important aspect to admissibility and defining testimony scope also.
DNAin theUKCourts
Authors: Wheate Rhonda M.
Published: March 2016

DNA‐profiling evidence has become ubiquitous in the UK criminal prosecutions since its first use in forensic casework in 1987. It has been lauded as a gold standard in court because the frequency of DNA types in the population is measurable; the results of DNA‐profiling techniques were highly reproducible; and the forensic significance of any “match” between two profiles could be calculated by reference to the population data. More recently, however, jurisprudence from the United Kingdom indicates that the courts are willing to admit DNA‐profiling results into evidence without statistics and without the level of reproducibility, reliability, and transparency for which DNA evidence has been lauded in the past. This article traces the trajectory of DNA evidence in the UK courts from its statistical origins, to its most recent manifestation based on the “experience” of the expert witness.
Legal Issues with Forensic
DNA
in the
USA
Authors: Flood Christopher A.
Published: March 2016

Forensic DNA is widely considered to be the “gold standard” of forensic technologies. Yet recent developments in the way forensic DNA technology is used in the American criminal justice system call for renewed attention to the standards and practices by which forensic laboratories and law enforcement develop DNA evidence. This article identifies three areas of concern with American forensic DNA : Database governance, including private and custom housing of DNA profiles; increasing utilization of highly sensitive techniques of questionable accuracy; and persistent resistance to transparency, including limitations on open disclosure of lab work. Examining the case of
United States v. Morgan
, this article poses a critique of prevailing conceptions of American forensic DNA technology, and concludes that DNA technology is in danger of serious misuse. Finally, the article proposes that the most appropriate and effective method for ensuring the responsible use of forensic DNA technology in the American criminal justice system lies in strengthening systems providing representation to indigent people charged with criminal offenses.
Introduction to Forensic
DNA
Profiling — The Electropherogram (
epg
)
Authors: Jamieson Allan
Published: March 2016

The DNA analyst, in order to decide which alleles are present in a sample, uses a graph called the
electropherogram
(or
electrophoretogram
), usually referred to simply as the
epg
The epg represents the separated DNA molecules that are produced after the amplification process of the original sample. It is not necessary here to detail all of the issues affecting the production of the epg as it most rarely materially affects the profile result. However, it is important to understand the general manner in which an epg is produced and how steps can be taken to verify a profiling result.
Drug trafficking
Authors: Pasko Lisa
Published: March 2016

Drug trafficking is another term for the illegal drug trade and refers to the unlawful process by which narcotic drugs (cocaine, cannabis, opium, hallucinogens, barbiturates, amphetamines, and tranquilizers) are produced, distributed, and possessed outside strictly controlled medical and scientific channels. At the turn of the twenty‐first century, the global trade in illegal drugs remained a vast enterprise, estimated at more than $300 billion a year, with the United States as the largest single retail market. Colombia, Peru, and Bolivia remain the world's main exporters of cocaine, with the Golden Triangle and the Golden Crescent countries (Burma, Afghanistan, Iran, Pakistan, Laos, and Thailand) as the world's chief suppliers of opium. Currently, Afghanistan and Morocco are the world's foremost suppliers of cannabis, with Mexico and Paraguay following their lead.
Microgravity Stress: Bone and Connective Tissue
Authors: Bloomfield Susan A. , Martinez Daniel A. , Boudreaux Ramon D. , Mantri Anita V.
Published: March 2016

The major alterations in bone and the dense connective tissues in humans and animals exposed to microgravity illustrate the dependency of these tissues' function on normal gravitational loading. Whether these alterations depend solely on the reduced mechanical loading of zero g or are compounded by fluid shifts, altered tissue blood flow, radiation exposure, and altered nutritional status is not yet well defined. Changes in the dense connective tissues and intervertebral disks are generally smaller in magnitude but occur more rapidly than those in mineralized bone with transitions to 0 g and during recovery once back to the loading provided by 1 g conditions. However, joint injuries are projected to occur much more often than the more catastrophic bone fracture during exploration class missions, so protecting the integrity of both tissues is important. This review focuses on the research performed over the last 20 years in humans and animals exposed to actual spaceflight, as well as on knowledge gained from pertinent ground‐based models such as bed rest in humans and hindlimb unloading in rodents. Significant progress has been made in our understanding of the mechanisms for alterations in bone and connective tissues with exposure to microgravity, but intriguing questions remain to be solved, particularly with reference to biomedical risks associated with prolonged exploration missions. © 2016 American Physiological Society.Compr Physiol6:**‐**, 2016.
Metabolic Flexibility: Hibernation, Torpor, and Estivation
Authors: Staples James F.
Published: March 2016

Many environmental conditions can constrain the ability of animals to obtain sufficient food energy, or transform that food energy into useful chemical forms. To survive extended periods under such conditions animals must suppress metabolic rate to conserve energy, water, or oxygen. Amongst small endotherms, this metabolic suppression is accompanied by and, in some cases, facilitated by a decrease in core body temperature—hibernation or daily torpor—though significant metabolic suppression can be achieved even with only modest cooling. Within some ectotherms, winter metabolic suppression exceeds the passive effects of cooling. During dry seasons, estivating ectotherms can reduce metabolism without changes in body temperature, conserving energy reserves, and reducing gas exchange and its inevitable loss of water vapor. This overview explores the similarities and differences of metabolic suppression among these states within adult animals (excluding developmental diapause), and integrates levels of organization from the whole animal to the genome, where possible. Several similarities among these states are highlighted, including patterns and regulation of metabolic balance, fuel use, and mitochondrial metabolism. Differences among models are also apparent, particularly in whether the metabolic suppression is intrinsic to the tissue or depends on the whole‐animal response. While in these hypometabolic states, tissues from many animals are tolerant of hypoxia/anoxia, ischemia/reperfusion, and disuse. These natural models may, therefore, serve as valuable and instructive models for biomedical research. © 2016 American Physiological Society.Compr Physiol6:737‐7771, 2016.
PTH and Vitamin D
Authors: Khundmiri Syed Jalal , Murray Rebecca D. , Lederer Eleanor
Published: March 2016

PTH and Vitamin D are two major regulators of mineral metabolism. They play critical roles in the maintenance of calcium and phosphate homeostasis as well as the development and maintenance of bone health. PTH and Vitamin D form a tightly controlled feedback cycle, PTH being a major stimulator of vitamin D synthesis in the kidney while vitamin D exerts negative feedback on PTH secretion. The major function of PTH and major physiologic regulator is circulating ionized calcium. The effects of PTH on gut, kidney, and bone serve to maintain serum calcium within a tight range. PTH has a reciprocal effect on phosphate metabolism. In contrast, vitamin D has a stimulatory effect on both calcium and phosphate homeostasis, playing a key role in providing adequate mineral for normal bone formation. Both hormones act in concert with the more recently discovered FGF23 and klotho, hormones involved predominantly in phosphate metabolism, which also participate in this closely knit feedback circuit. Of great interest are recent studies demonstrating effects of both PTH and vitamin D on the cardiovascular system. Hyperparathyroidism and vitamin D deficiency have been implicated in a variety of cardiovascular disorders including hypertension, atherosclerosis, vascular calcification, and kidney failure. Both hormones have direct effects on the endothelium, heart, and other vascular structures. How these effects of PTH and vitamin D interface with the regulation of bone formation are the subject of intense investigation. © 2016 American Physiological Society.Compr Physiol6:561‐601, 2016.
Retail Buyer Control Systems: Implications of Buyer Behavior Strategies for Performance
Authors: Kim Changju , Takashima Katsuyoshi
Published: March 2016

This study investigates management control systems in retailing and examines how they connect to retail buyers’ behavior strategies and retail performance. We test hypotheses with a structure equation modeling (SEM) based on survey data from 149 merchandising division heads at Japanese supermarkets. The results reveal that outcome-based control promotes buyers’ price negotiation orientation while behavior-based control encourages buyers’ innovative behavior orientation. Moreover, both of these distinct behavior strategies yield greater retail performance. This study contributes toward the development of a generalized model of how retailers can manipulate buyers’ behavior strategies from the management perspective by applying organizational control theory in the field of retail buying.
Development of human white matter fiber pathways: From newborn to adult ages
Authors: Cohen Andrew H. , Wang Rongpin , Wilkinson Molly , MacDonald Patrick , Lim Ashley R. , Takahashi Emi
Published: March 2016

Major long‐range white matter pathways (cingulum, fornix, uncinate fasciculus [UF], inferior fronto‐occipital fasciculus [IFOF], inferior longitudinal fasciculus [ILF], thalamocortical [TC], and corpus callosal [CC] pathways) were identified in eighty‐three healthy humans ranging from newborn to adult ages. We tracked developmental changes using high‐angular resolution diffusion MR tractography. Fractional anisotropy (FA), apparent diffusion coefficient, number, length, and volume were measured in pathways in each subject. Newborns had fewer, and more sparse, pathways than those of the older subjects. FA, number, length, and volume of pathways gradually increased with age and reached a plateau between 3 and 5 years of age. Data were further analyzed by normalizing with mean adult values as well as with each subject's whole brain values. Comparing subjects of 3 years old and under to those over 3 years old, the studied pathways showed differential growth patterns. The CC, bilateral cingulum, bilateral TC, and the left IFOF pathways showed significant growth both in volume and length, while the bilateral fornix, bilateral ILF and bilateral UF showed significant growth only in volume. The TC and CC took similar growth patterns with the whole brain. FA values of the cingulum and IFOF, and the length of ILF showed leftward asymmetry. The fornix, ILF and UF occupied decreased space compared to the whole brain during development with higher FA values, likely corresponding to extensive maturation of the pathways compared to the mean whole brain maturation. We believe that the outcome of this study will provide an important database for future reference.
Ethical challenges in preclinical Alzheimer's disease observational studies and trials: Results of the Barcelona summit
Authors: Molinuevo José L. , Cami Jordi , Carné Xavier , Carrillo Maria C. , Georges Jean , Isaac Maria B. , Khachaturian Zaven , Kim Scott Y.H. , Morris John C. , Pasquier Florence , Ritchie Craig , Sperling Reisa , Karlawish Jason
Published: March 2016

Alzheimer's disease (AD) is among the most significant health care burdens. Disappointing results from clinical trials in late‐stage AD persons combined with hopeful results from trials in persons with early‐stage suggest that research in the preclinical stage of AD is necessary to define an optimal therapeutic success window. We review the justification for conducting trials in the preclinical stage and highlight novel ethical challenges that arise and are related to determining appropriate risk‐benefit ratios and disclosing individuals' biomarker status. We propose that to conduct clinical trials with these participants, we need to improve public understanding of AD using unified vocabulary, resolve the acceptable risk‐benefit ratio in asymptomatic participants, and disclose or not biomarker status with attention to study type (observational studies vs clinical trials). Overcoming these challenges will justify clinical trials in preclinical AD at the societal level and aid to the development of societal and legal support for trial participants.
Resolution of a warfarin and dabigatran‐resistant left atrial appendage thrombus with apixaban
Authors: Miwa Yosuke , Minamishima Toshinori , Sato Toshiaki , Sakata Konomi , Yoshino Hideaki , Soejima Kyoko
Published: March 2016

The majority of embolisms associated with atrial fibrillation (AF) are from the left atrial appendage (LAA). To treat the existing thrombus, warfarin and novel anticoagulants have been used. However, there has been no clinical information regarding the difference of the effects of congealing the fibrinogenolysis system among these oral anticoagulants. Here, we report a case of persistent AF, in whom apixaban, factor Xa inhibitor resolved an LAA clot refractory to warfarin and direct thrombin inhibition. Factor Xa inhibitor, apixaban, could resolve the left appendage thrombosis refractory to warfarin and dabigatran.
Clinical and genetic features of Australian families with long QT syndrome: A registry‐based study
Authors: Burns Charlotte , Ingles Jodie , Davis Andrew M. , Connell Vanessa , Gray Belinda , Hunt Lauren , McGaughran Julie , Semsarian Christopher
Published: March 2016

Background

Familial long QT syndrome (LQTS) is a primary arrhythmogenic disorder caused by mutations in ion channel genes. The phenotype ranges from asymptomatic individuals to sudden cardiac arrest and death. LQTS is a rare but significant health problem for which global data should exist. This study sought to provide the first clinical and genetic description of Australian families with LQTS.

Methods

We performed a cross‐sectional study to evaluate clinical and genetic features of families with LQTS. We recruited individuals from the Australian Genetic Heart Disease Registry and Genetic Heart Disease Clinic, in Sydney, Australia, and included those with a diagnosis of LQTS according to the most recent consensus statement.

Results

Among 108 families with LQTS, 173 individuals were affected. Twenty‐five (32%) probands had a sudden cardiac death (SCD) event (including appropriate implantable cardioverter defibrillator [ICD] therapy, or resuscitated cardiac arrest). There were 64 (82%) probands who underwent genetic testing, and 34 (53%) had a pathogenic or likely pathogenic mutation in. Having a family history of LQTS was significantly associated with identification of a pathogenic result (79% versus 14%, p<0.0001). There were 16 (9%) participants who experienced delay to diagnosis of at least 12 months.

Conclusions

This is the first clinical and genetic study in a large cohort of Australian families with LQTS. Findings from this study suggest that the clinical and genetic features in this population are not dissimilar to those described in North American, European, and Asian cohorts. Global‐scale information about families with LQTS is an important initiative to ensure diagnostic and management approaches are applicable to different populations and ethnicities.
Competencias genéricas adquiridas, según estudiantes de una carrera de la salud
Authors: Rojo Venegas Rossana , Navarro Hernández Nancy
Published: March 2016

Objetivo: Desvelar la percepción del estudiantado de la carrera de Obstetricia y Puericultura de la Universidad de La Frontera, en relación con el logro de las competencias genéricas y las actividades curriculares que las favorecen.
Método: Se realizó un estudio cualitativo a través de un estudio de caso intrínseco. La muestra fue intencionada por criterio de 16 internas/os que a partir de sus experiencias personales participaron en dos grupos focales y dos entrevistas en profundidad, previa firma de consentimiento informado. El análisis de datos se realizó a través del método de comparación constante de Glaser y Strauss (1967) y los pasos descritos por Miles y Huberman; reducción de datos, disposición y transformación, obtención y verificación de conclusiones, utilizando el programa Atlas ti como recurso computacional.
Resultados: Se identificaron 407 unidades de significados, las que fueron agrupadas en 33 categorías, emergiendo 10 metacategorías y tres dominios cualitativos: «proceso enseñanza-aprendizaje»,«competencias genéricas» y «actividades curriculares centradas en el estudiante».
Conclusión: Los estudiantes perciben el desarrollo principalmente de competencias genéricas interpersonales y sistémicas, siendo las actividades curriculares favorables aquellas en las que son protagonistas y gestores de su proceso educativo, por lo que debieran ser fortalecidas durante la formación, así contribuir a una adecuada inserción al mundo laboral.
Hypothyroidism in patients treated with radiotherapy for head and neck carcinoma: standardised long-term follow-up study
Authors: Alba J R , Basterra J , Ferrer J C , Santonja F , Zapater E
Published: March 2016

Objective:

Hypothyroidism is a common complication when radiotherapy is part of the treatment for head and neck tumours. This study aimed to show the incidence of hypothyroidism and possible risk factors in these patients.

Methods:

Factors related to the population, tumour, treatment and occurrence of hypothyroidism were analysed in 241 patients diagnosed with head and neck carcinoma.

Results:

Approximately 53 per cent of patients were diagnosed with radiation-induced hypothyroidism. Its occurrence was related to: tumour location, laryngeal surgery type, neck dissection type, post-operative complications, cervical radiotherapy and radiotherapy unit type (linear particle accelerator or telecobalt therapy technology).

Conclusion:

Control of thyroid function should be standardised for several years after treatment, particularly in patients with risk factors, such as those treated with telecobalt therapy, those with post-operative complications and for whom the thyroid parenchyma is included in the irradiated area (laryngeal or pharyngeal location and bilateral cervical radiation).
Meat and milk intake in the rice-based Korean diet: impact on cancer and metabolic syndrome
Authors: Jun Shinyoung , Ha Kyungho , Chung Sangwon , Joung Hyojee
Published: March 2016

Over a few decades, Korean diet has changed from traditional diet, mainly composed of rice and vegetables, to Westernised diet rich, in meat and milk, along with the economic development and globalisation. Increasing prevalence of diet-related chronic diseases such as cancer and metabolic syndrome (MetS) is becoming a heavy burden to society and requires further attention. In this review, the association of meat and milk consumption with cancer and MetS among Koreans was discussed. Previous meta-analyses showed that meat intake was positively associated with increased risk of cancers, especially colon, as well as obesity and type 2 diabetes mellitus, and that the intake of milk and dairy products was negatively associated with colorectal cancer, obesity, and type 2 diabetes mellitus, based on studies conducted mostly in Western countries. In Korea and other Asian countries, the association of meat and milk intake with cancers were inconclusive and varied by types of cancers. Conversely, milk intake was negatively associated with MetS risk as reported in Western countries. The difference in results between Korea and Western countries might come from the differences in dietary patterns and study designs. Most Koreans still maintain traditional dietary pattern, although rapid change towards Westernised diet is underway among the younger age group. Randomised clinical trials or prospective cohort studies with consideration of combined effects of various dietary factors in Korea and other Asian countries are needed to elucidate the impact of meat and milk or related dietary patterns in their diet.
Depressive vulnerability, stressful life events and episode onset of major depression: a longitudinal model
Authors: Kendler K. S. , Gardner C. O.
Published: March 2016

Background

The nature of the relationship between depressive vulnerability (DV) and acute adversity in the etiology of major depression (MD) remains poorly understood.

Method

Stressful life events (SLEs) and MD onsets in the last year were assessed at four waves in cohort 1 (females) and at two waves in cohort 2 (males and females) from the Virginia Adult Twin Study. Structural equation modeling was conducted in Mplus.

Results

In cohort 1, DV was strongly indexed by depressive episodes over the four waves (paths from +0.72 to 0.79) and predicted by SLEs in the month of their occurrence (+0.31 to 0.36). Wave-specific DV was associated both with stable DV (+0.29 to 0.33) and by forward transmission of DV from the preceding wave (+0.33 to 0.36). SLEs were predicted by stable DV (+0.29) and from SLEs in the preceding month (+0.06). As the cohort aged, MD onsets were better indexed by DV and more poorly predicted by SLEs. Parameter estimates were similar in males and females from cohort 2. In individuals with prior depressive episodes, the association between MD onset and SLEs was weakened while the prediction of SLEs from DV was substantially strengthened. We found no evidence for ‘reverse causation’ from MD episodes to SLEs.

Conclusion

The interrelationship between DV and acute adversity in the etiology of MD is complex and temporally dynamic. DV impacts on MD risk both directly and indirectly through selection into high stress environments. Over time, depressive episodes become more autonomous. Both DV and SLEs transmit forward over time and therefore form clear targets for intervention.
Canopy gaps do not help establish pioneer species in a South Florida dry forest
Authors: Diamond Joshua M. , Ross Michael S.
Published: March 2016

Canopy gaps create a temporary spatial heterogeneity, often allowing pioneer species to establish and grow in mature forests. In this study, we asked whether the above model holds for tropical dry forests in the Florida Keys. Six hundred and forty-eight canopy gaps in an extensive Key Largo forest were identified with a LiDAR digital canopy model. The structure and composition of juvenile trees were examined in 45 selected gaps in three stands of known age, and weighted averaging calibration and regression were applied to the data to determine the successional age optimum for each tree species, and the inferred age for each gap based on its sapling composition. Less than 1% of the forest area was recorded as canopy gaps in the LiDAR model. The inferred stand ages were about 70 y greater in canopy gaps in young forest than in the surrounding, unimpacted forest. This suggested that gap formation advanced succession rather than reversing or resetting it. The apparent lack of recruitment by early-successional species may be due to the small size of canopy gaps in this forest, and the minimal contrast between gap and understorey environments; light and water conditions in the small gaps may favour late-successional rather than pioneer species. Establishment of pioneer species may not take place without intense, large-scale disturbances such as fires and hurricanes that remove the entire canopy and consume or erode soils.
SEMANTIC REPRESENTATION OF NEWLY LEARNED L2 WORDS AND THEIR INTEGRATION IN THE L2 LEXICON
Authors: Bordag Denisa , Kirschenbaum Amit , Rogahn Maria , Opitz Andreas , Tschirner Erwin
Published: March 2016

The present semantic priming study explores the integration of newly learnt L2 German words into the L2 semantic network of German advanced learners. It provides additional evidence in support of earlier findings reporting semantic inhibition effects for emergent representations. An inhibitory mechanism is proposed that temporarily decreases the resting levels of the representations with which the new representation is linked and thus enables its selection despite its low resting level.
Factors that influence patients' attitudes to antipsychotic medication
Authors: Haq Farhan , Behan Caragh , McGlade Nicola , Mulkerrin Una , O'Callaghan Eadbhard , Kinsella Anthony , Corvin Aiden , Donohoe Gary , Gill Michael
Published: March 2016

Objective: The aim of this study was to investigate the attitudes to medication in relation to insight, purpose in life, symptoms and sociodemographic factors among a cohort of stable patients with a diagnosis of schizophrenia and schizoaffective disorder.

Method: We included 70 patients with a diagnosis of schizophrenia and schizoaffective disorder attending a Dublin suburban mental health service. All participants were 18 years or older and were excluded if they had a learning disability, acquired brain injury resulting in unconsciousness, and psychosis secondary to a general medical condition or illicit substance misuse. All participants were given self report questionnaires which included Drug Attitude Inventory (DAI-30), Birchwood Insight Scale, and Purpose in Life test. Symptoms were assessed using the Scale for Assessment of Positive and Negative symptoms. All data was analysed using the Statistical Package for the Social Sciences.

Results: We found that 86% (n = 60) of the participants had positive attitudes to medication, and 82% (n = 58) had good insight into their illness. Only 27% (n = 19) were found to have a definite purpose in life. There was a significant negative relationship between attitudes to medication and delusions (r = -0.25, n = 70, p < 0.05) and a significant positive relationship between insight and attitudes to medication (r = 0.0.28, n = 70, p < 0.05).

Conclusion: Many factors are involved in the multifaceted issue of attitudes to medication. Researchers must realise that these factors do not remain constant and may change with time and over the course of illness and treatment.
Psychiatric illness and driving: Irish psychiatrists' documentation practices
Authors: Langan Camilla
Published: March 2016

Objective: Psychiatric illness and the use of psychotropic medication are recognised as factors that may impair driving ability. Clinicians in the UK have a legal duty to advise patients on the effects of illness and prescribed medication on driving ability. Although clinicians in Ireland have no equivalent legal obligations, good medical practice suggests that doctors should be aware of whether patients are active drivers, and issue appropriate advice, supported by adequate documentation in clinical notes.

Method: The initial phase of the study analysed 44 outpatient records and 48 discharge records to ascertain the level of documentation regarding driving status, and advice given to patients regarding the effect of illness or medication on driving ability. The second phase involved distribution of an anonymous questionnaire to 18 psychiatrists employed in the acute psychiatric unit setting.

Results: Although there was minimal documentation regarding the potential effect of illness on driving ability, more than 50% of case notes revealed documented advice to patients regarding side-effects of medication and driving ability. Over 50% of case notes contained advice about medication compliance, but none contained cautionary advice about operating machinery. All psychiatrists admitted not being aware of the driving status of every patient they reviewed. Over 50% admitted to advising patients of the effect of illness or medication on driving ability, but fewer reported documenting this advice on every occasion. All psychiatrists reported that they would benefit from training in this area.

Conclusion: This study suggests that there is underdocumentation of advice given to patients regarding the effect of their symptoms or medication on driving ability. Clinicians need to improve their awareness of patients' driving status, in addition to receiving training on what their responsibilities are in this regard.
Competency based training in Irish psychiatry
Authors: Nwachukwu Izu
Published: March 2016

The goal of undertaking postgraduate training in psychiatry is to become a competent specialist, and the educational model under which one is trained and assessed is crucial in achieving this goal. Over the years, traditional training models have emphasised what trainees know, over a given period of time, with outcomes assessed mainly by simple recall of knowledge. While these traditional approaches have met with varying levels of success, they are less than optimal when the goal is to train individuals to perform specific, job-related skills. This recognition has led to a global move towards competency based training models where the focus of training and assessment is the mastery of specific knowledge and skills as well as the conduct of the doctor in day-to-day clinical situations. In this article, a general overview of competency-based training in psychiatry is followed by a review of recent developments in Ireland in a global context.
Dialectical behaviour therapy in an Irish community mental health setting
Authors: Blennerhassett Richard , Bamford Lindsay , Whelan Anthony , Jamieson Sarah , Wilson O'Raghaillaigh Jennifer
Published: March 2016

Objectives:

Dialectical behaviour therapy (DBT) is a recommended treatment of patients with borderline personality disorder, yet there are few descriptions of the approach in public community mental health settings where the majority of such patients present. This study describes the development and evaluation of a DBT programme in an Irish setting.

Methods:

The DBT programme was run over a six month period. Participants were assessed at baseline and post intervention with the following instruments: The Structured Clinical Interview for DSM III R personality disorders (SCID II), the clinical Outcomes in Routine Evaluation (CORE) and the symptom checklist 90 Revised (SCL-90-Revised). Inpatient bed usage was determined from case note review.

Results:

Outcome data was available for eight subjects. Significant improvement (p < 0.005) was seen on all CORE subscales. SCL-90-R showed significant improvement (p < 0.05) on the global severity index and on the positive symptom distress index. A decrease in self harming behaviour was found. Subjects' inpatient bed days dropped from a mean of 58 in the year pre intervention to a mean of four days in the year post intervention. A novel finding was that 43% of subjects who originally fulfilled criteria for avoidant personality disorder no longer did so post intervention.

Conclusions:

The study found that DBT can be applied in a community mental health setting with benefits similar to more specialist settings. Significant difficulties were encountered in implementing the programme. The clinical implications are that specialist psychotherapy services need to be an integral part of psychiatric services to achieve better outcomes for patients with borderline personality disorder.
Barriers to care in the mental health service: who gets in – who gets out?
Authors: Doherty Anne
Published: March 2016

“People with mental health problems are particularly vulnerable to social exclusion” – Vision for Change.

People with mental health problems are very vulnerable. However those with mental health problems who have additional social problems are even more vulnerable.

Currently psychiatric services in Ireland are provided on a ‘catchment area’ basis, with a consultant psychiatrist leading a multi-disciplinary team providing a service to the population of a defined geographical area. These services comprise both outpatient and inpatient care, and there is significant regional variation in terms of both bed availability and multidisciplinary team staffing. Sub-specialities, with the exception of child psychiatry and psychiatry of old age, are often unavailable, particularly outside Dublin. In such cases, some additional duties (eg. liaison, rehabilitation, perinatal) are assumed by the local general adult services.

However, the overall distribution of services is uneven. Instead of services being concentrated upon those areas of greatest need, the opposite is often the case, with the most deprived areas having the least services in terms of acute beds and community mental health teams per thousand people. These areas also have less psychological services and specialist services despite increased levels of mental illness.

Within this vulnerable population there are a number of sub-groups who are even further marginalised, and for whom there are significant barriers both at point of contact with services and with accessing appropriate follow up services. These include the homeless, the ever-increasing cohort of migrants to this country, those in prison and children and adolescents. Stigma and discrimination are the greatest barriers to social inclusion, quality of life and recovery for people with mental illness.
Recent advances in the biological treatment of mood disorders
Authors: McDonald Gary , Hallahan Brian
Published: March 2016

Welcome to the first module in our Continuing Professional Development Section (CPD). CPD is now a key element in the clinical activity of all health professionals and a cornerstone of good clinical governance throughout mental health services. This section of the Irish Journal of Psychological Medicine will provide CPD modules dedicated to key topics in mental health care. In order to assist learning and self-assessment, multiple choice questions will be provided at the end of each module.

This module and its multiple choice questions are available online on the website of the Irish Journal of Psychological Medicine (www.ijpm.org). The CPD policy of the College of Psychiatry of Ireland indicates that psychiatrists who participate in suitable online learning which fits the criteria for CPD may claim CPD points under the Personal CPD category (up to a maximum of 5 points per year).

We are confident that this CPD Section of the Irish Journal of Psychological Medicine will prove to be a valuable resource for consultant psychiatrists, psychiatric trainees and all journal readers. We welcome feedback from readers and, especially, any suggestions for topics to be covered in future CPD modules. Suggestions should be emailed to:psychological@medmedia.ie
Clozapine induced myocarditis: a case report and literature review
Authors: Okereke Sunday O , Mohd Abdoh Wan MY , Murphy Bernadette M
Published: March 2016

Clozapine, the drug of choice for treatment resistant schizophrenia, has a range of serious cardiac side-effects. This paper describes a fatal case of myocarditis in a 48 year old man four weeks after starting clozapine. In particular, this case illustrates how incipient the disorder can be and the need for a high level of suspicion. Difficulties in diagnosing clozapine induced myocarditis and ways to minimise its risk are also discussed.
Psychiatric morbidity in male remanded and sentenced committals to Irish prisons
Authors: Curtin Katharine , Monks Stephen , Wright Brenda , Duffy Dearbhia , Linehan Sally , Kennedy Harry G
Published: March 2016

Objectives: To describe the prevalence of psychiatric morbidity and the treatment needs of new committals to Irish prisons.

Methods: A population survey of 615 prisoners representing 7.9% of male committals to Irish prisons in the year of survey, 313 remands (9.6% of total remand committals) and 302 sentenced committals (6.4% of total sentenced committals). The main outcome measures were ICD-10 diagnoses of mental disorder based on interviews using SADS-L and prison medical records.

Results: Current prevalence rates of any psychotic illness were 3.8% (remand) and 0.3% (sentenced), six month prevalence rate 5.1% (remand) and 2.6% (sentenced) and lifetime rate 9.3% (remand) and 6.6% (sentenced). Schizophrenia and drug/organic psychoses were the most common psychoses. Major depressive disorder had a current prevalence of 4.5% (remand) and 4.6% (sentenced), a six month prevalence of 4.8% (remand) and 6.0% (sentenced), and a lifetime prevalence of 8.6% (remand) and 15.9% (sentenced). Sixty-point-six per cent of the sample had a current substance misuse problem.

Conclusions: There is significant psychiatric morbidity in committal prisoners.
Has the Mental Health Act 2001 altered the clinical profile of involuntary admissions?
Authors: Murray Ivan , Hallahan Brian , McDonald Colm
Published: March 2016

Objectives: To assess whether transition from the Mental Treatment Act (MTA), 1945 to the Mental Health Act (MHA), 2001 has had any impact on the clinical profile of patients in the West Galway Mental Health Services who are admitted on an involuntary basis.

Methods: Data were collected from clinical records in relation to all those individuals residing in the West Galway Mental Health Services who were admitted involuntarily in the 12 months prior to and subsequent to the introduction of the MHA 2001.

Results: A total of 175 individuals were included in this study (n = 91 - MTA 1945; and n = 84 - MHA 2001). No significant differences were found between the two groups in relation to demographic data, rates of involuntary detention or duration of involuntary detention. The applicant was less likely to be a family member under the MHA 2001 (54%) than the MTA 1945 (85%).

Conclusions: Transition from the MTA 1945 to the MHA 2001 has had minimal impact on the admission rates, clinical profile or duration of detention of patients admitted involuntarily in the West Galway Mental Health Services.
Current psychotherapy training for psychiatry trainees in Northern Ireland
Authors: McNeill Owen , Ingram Richard
Published: March 2016

Objectives: To investigate psychotherapy training for psychiatry trainees in N.Ireland.

Method: A detailed survey of both trainee's current experience and completion of Royal College requirements.

Results: While trainees rated experience highly in terms of enjoyment and relevance to psychiatry, we found a large proportion (94%) were failing to meet requirements for psychotherapy training, despite awareness being high (91%). Both cognitive-behavioural and psychodynamic therapy were the predominant models of therapy trainees had experience in and although most supervision was rated highly, a number of trainees had irregular or no case supervision.

Conclusions: At a time when it is becoming increasingly recognised that psychological therapies play a central role in the treatment of many psychiatric disorders, current training fails to provide a substantial experience. With such a high proportion of trainees not meeting the mandatory requirements and similar findings being replicated in other parts of the UK, serious consideration must be given to both the nature of the guidelines and the opportunities for psychotherapy training if future psychiatrists are going to be equipped to deliver a truly biopsychosocial model of care.
Association between antipsychotic medication and venous thromboembolism
Authors: Gunasekaran Santhana
Published: March 2016

Objective: This study aims to identify and review available evidence in the literature to determine the strength of association between antipsychotic medications and thromboembolism as an adverse effect.

Method: Electronic databases were searched for evidence.

Results: A total of 15 case reports, 14 case series, two observational studies and three case-control studies were found in the literature. Two case control studies found significantly increased risk of venous thromboembolism (OR 13.3 and 7.1 respectively). The risk was high for low potency antipsychotics. Studies were critically appraised to determine the strength of evidence.

Conclusion: The studies reviewed indicate a significant association between antipsychotics and venous thromboembolism. Patients using the antipsychotics and those who prescribe them should be aware of this association.
Adherence in psychiatry
Authors: Duffy Richard , D Kelly Brendan
Published: March 2016

The word ‘adherence’ refers to the provision of consistent support (eg. for a political party or religion) or the act of holding particular elements together (eg. in constructing a building). In the medical context, adherence refers to the extent to which patients take their medications as prescribed. While the terminology related to medical adherence has changed significantly over the past two millennia, the core issue has not. Most recently, the term ‘adherence’ has replaced the term ‘compliance’, although it still jostles with ‘concordance’ in a growing literature which focuses now, as always, on one key question: why do so many people seek treatment for illness but then decide not to take their prescribed medication? This is an important question, both in terms of public health and societal cost: in the US, up to 50% of patients do not take their prescribed medications, resulting in additional healthcare costs of $290 billion per year. The greatest cost of non-adherence, however, relates to prolonged illness, increased rates of relapse and reduced wellness.
Patient attitudes towards compulsory community treatment orders and advance directives
Authors: O'Donoghue Brian , Lyne John , Hill Michele , O'Rourke Linda , Daly Sally , Feeney Larkin
Published: March 2016

Objectives: The Mental Health Act 2001 was implemented in Ireland in 2006, however, within this new legislation there is no provision for compulsory community treatment or advance directives, which are now established practice in other countries. We aimed to determine the proportion of patients who believe that compulsory treatment may be justified, the preference for where the treatment should be delivered and factors which may influence this preference. We also sought to determine the proportion of people who would be interested in the option of having an advance directive in their future care plan.

Methods: Patients who had been admitted involuntarily in a 183 bedded psychiatric hospital in Dublin (St John of God Hospital) over a 15 month period were interviewed one year following discharge. A structured interview was used and included the Birchwood Insight Scale and Drug Attitude Inventory (DAI).

Results: Sixty-seven patients were interviewed, which resulted in a follow-up rate of 68%. A total of 56% of participants believe that there are situations in which involuntary treatment with medication may be justified. Of the participants 59% think that the person should be admitted to hospital if they are going to be administered medication without consent. A total of 41 % of participants stated they would have preferred to have been treated at home rather than hospital and this was associated with having a diagnosis of an affective disorder or it being their first involuntary admission. Of the participants 84% expressed interest in having the option of an advance directive in their treatment care plan.

Conclusions: With the increasing community based provision of mental health services in Ireland a debate on compulsory community treatment orders and advance directives needs to take place amongst all stakeholders.
Do we need community treatment orders in Ireland?
Authors: Walsh Dermot
Published: March 2016

Objectives: Re-admissions to inpatient psychiatric care are now so frequent as to be designated the ‘revolving door’ phenomenon and constitute 72% of admissions to Irish inpatient psychiatric units and hospitals. It is commonly believed that treatment non-adherence with aftercare following inpatient discharge contributes to readmission. Attempts to improve adherence and reduce or shorten readmission through compulsory community treatment orders have been made in several countries including Scotland in 2005 and, from November 2008, England and Wales. Provision for conditional discharge in Ireland has already been furnished by the Criminal Law (Insanity) Act 2006 but has been compromised by the inability to impose enforcement of conditions. The paper aims to determine whether compulsory community treatment orders are effective in improving adherence and reducing re-admission and whether, in consequence, their introduction in Ireland should be considered.

Method: The legislative measures adopted to improve treatment adherence and thereby reduce re-admissions are presented. The evidence of their effectiveness is examined.

Results: Evaluation of the effectiveness of community treatment orders is limited and hindered by confounding factors. What evidence there is does not provide convincing evidence of their utility.

Conclusions: It is concluded that there is insufficient evidence to advocate their early introduction in Ireland in civil mental health legislation. Instead a wait and see policy is suggested with critical assessment of the outcome of such developments in Scotland and England and Wales. In addition further research on the characteristics of revolving door patients in Ireland and the circumstances determining their readmission is advocated. There is an anomaly in the Criminal Law (Insanity) Act 2006 which allows of conditional discharge but does not provide for its enforcement.