bluuebunny/crossref_metadata_2025 huggingface dataset:
Malignant pleural mesothelioma
Authors: Boutin C , Schlesser M , Frenay C , Astoul P
Published: October 2002

The incidence of malignant pleural mesothelioma (MPM) has risen for some decades and is expected to peak between 2010 and 2020. Up to now, no single treatment has been proven to be effective and death usually occurs within about 12-17 months after diagnosis. Perhaps because of this poor prognosis, early screening has incited little interest. However, certain forms may have a better prognosis when diagnosed early and treated by multimodal therapy or intrapleural immunotherapy. Diagnosis depends foremost on histological analysis of samples obtained by thoracoscopy. This procedure allows the best staging of the pleural cavity with an attempt to detect visceral pleural involvement, which is one of the most important prognostic factors. Although radiotherapy seems necessary and is efficient in preventing the malignant seeding after diagnostic procedures in patients, there has been no randomized phase III study showing the superiority of any treatment compared with another. However, for the early-stage disease (stage I) a logical therapeutic approach seems to be neoadjuvant intrapleural treatment using cytokines. For more advanced disease (stages II and III) resectability should be discussed with the thoracic surgeons and a multimodal treatment combining surgery, radiotherapy and chemotherapy should be proposed for a randomized controlled study. Palliative treatment is indicated for stage IV. In any case, each patient should be enrolled in a clinical trial.
Primary ciliary dyskinesia: diagnosis and standards of care
Authors: Bush A , Cole P , Hariri M , Mackay I , Phillips G , O'Callaghan C , Wilson R , Warner JO
Published: October 2002

Primary ciliary dyskinesia (PCD) is characterized by disease of the upper and lower respiratory tract, in association with visceral mirror image arrangement in 50% of cases, due to abnormal structure and/or function of cilia. The purpose of this paper is to review the clinical features, diagnosis and management of PCD. Presentations include neonatal respiratory distress, recurrent lower respiratory tract infection, chronic rhinosinusitis and male infertility. PCD enters the differential diagnosis of bronchiectasis, atypical asthma, and unusually severe upper airway disease. Diagnosis is by a cascade of investigations, starting with the saccharin test in patients older than 10 yrs; ciliary beat frequency and pattern on light microscopy; and electron microscopy to assess ciliary morphology and orientation. It is important not to confuse primary and secondary ciliary abnormalities. Nasal nitric oxide is low in PCD, and this measurement shows promise as a screening test for PCD. Diagnosis is important, in order to prevent the development of bronchiectasis and to avoid any unnecessary otorhinolaryngological procedures. Regular follow-up is essential, and management should be multidisciplinary, with input from centres with a special interest in PCD, having access to paediatric and adult chest physicians, otolaryngologists and audiological physicians, physiotherapists, counselling services and fertility clinics. The prognosis is good, but morbidity can be considerable if PCD is incorrectly managed.
Haemoptysis associated with pulmonary varices: demonstration using computed tomographic angiography
Authors: Ferretti GR , Arbib F , Bertrand B , Coulomb M
Published: October 2002

A 67 yr old female with mitral stenosis presented with an acute haemoptysis caused by the rupture of pulmonary varices. Chest radiography and bronchoscopy showed nonspecific abnormalities. The diagnosis of this rare but potentially lethal complication was made using computed tomographic angiography with three-dimensional volume rendering.
Melanoptysis as a complication of fibreoptic bronchoscopy
Authors: Mena MJ , Rodriguez-Nieto MJ , Gomez M , Flandes J , Melchor R
Published: October 2002

The case is presented of a coal miner with bilateral masses of progressive massive fibrosis, who developed acute cavitation following fibreoptic bronchoscopy and biopsies. Indeed, immediately upon bronchoscopy with transbronchial biopsy, there was expectoration of abundant melanoptysis. Three days later, the chest radiograph showed a cavity and the patient again coughed up black material, in the context of pulmonary infection. One week later, there was complete emptying of the conglomerate mass. To the authors' knowledge, this is the first reported case of a conglomerate mass of progressive massive fibrosis which cavitated as a result of bronchoscopy.
Acute allergic reaction and demonstration of specific IgE antibodies against alpha-1-protease inhibitor
Authors: Meyer FJ , Wencker M , Teschler H , Steveling H , Sennekamp J , Costabel U , Konietzko N
Published: October 2002

A 44 yr-old female with severe pulmonary emphysema and reduced alpha-1-protease inhibitor (alpha1-PI) serum levels developed an acute anaphylactic reaction following the third intravenous infusion of human alpha1-PI which was administered to prevent the progression of pulmonary emphysema. Specific immunoglobulin E-antibodies against human alpha1-PI could be demonstrated in the patient's serum using an enzyme allergosorbent test. Because of the risk of further severe anaphylactic reaction, the replacement therapy with alpha1-PI was discontinued. Physicians should be aware of this rare complication.
Independent course of childhood auditory hallucinations: A sequential 3-year follow-up study
Authors: Escher Sandra , Romme Marius , Buiks Alex , DELESPAUL PHILIPPE , Van Os Jim
Published: October 2002

Background

Childhood hallucinations of voices occur in a variety of contexts and have variable long-term outcomes.

Aim

To study the course of experience of voices sequentially over a 3-year period in those with and those without a need for mental health care (patient status).

Method

In a group of 80 children of mean age 12.9 years (s.d.=3.1), of which around 50% were not receiving mental health care, baseline measurement of voice characteristics, voice attributions, psychopathology, stressful life events, coping mechanisms and receipt of professional care were used to predict 3-year course and patient status.

Results

The rate of voice discontinuation over the 3-year period was 60%. Patient status was associated with more perceived influence on behaviour and feelings and more negative affective appraisals in relation to the voices. Predictors of persistence of voices were severity and frequency of the voices, associated anxiety/depression and lack of clear triggers in time and place.

Conclusions

Need for care in the context of experience of voices is associated with appraisal of the voices in terms of intrusiveness and ‘omnipotence’. Persistence of voices is related to voice appraisals, suggesting that experience of voices by children should be the target of specific interventions.
Family history of psychiatric disorders and age at first contact in schizophrenia: An epidemiological study
Authors: Byrne Majella , Agerbo Esben , Mortensen Preben Bo
Published: October 2002

Background

The risk for schizophrenia has been associated with a family history of this and other psychiatric disorders. The relationship between age at first contact and family history of psychiatric illness is not certain.

Aims

To estimate the risks for schizophrenia associated with a range of psychiatric diagnoses in family members and to investigate the relationship between these risks and age at first contact for schizophrenia.

Method

A nested case–control study design was employed. Psychiatric admission data and socio-economic data were available for 7704 cases admitted between 1981 and 1998 in Denmark, 192 590 gender- and age-matched controls, and for the parents and siblings of all subjects.

Results

Controlling for socio-economic factors, risk for schizophrenia was associated with a family history of all psychiatric disorders except substance misuse and independently with a family history of suicide. The risk for schizophrenia associated with a family history of psychiatric disorders decreased as age at first contact increased.

Conclusions

Risk for schizophrenia is associated with a range of psychiatric disorders in family members and these risks are not constant across the risk period.
Distinguishing characteristics of subjects with good and poor early outcome in the Edinburgh High-Risk Study
Authors: Johnstone Eve C. , Cosway Richard , Lawrie Stephen M.
Published: October 2002

Background

High-risk’ studies of schizophrenia have the potential to clarify the pathogenesis of schizophrenia. Here, results of extreme outcome groups in the Edinburgh High-Risk Study are presented.

Aims

To compare groups of good and poor outcome from the Edinburgh High-Risk Study and clarify the nature of the change from the state of vulnerability to that of developing psychosis.

Method

The recruitment procedure is described. Good and poor outcome are defined. These groups are compared in terms of genetic liability and of baseline and change in neuropsychology and neuroanatomy.

Results

Demographic characteristics and genetic liability do not differ between the groups. The good outcome group perform better at baseline in some neuropsychological tests, but there is little neuroanatomical difference. The poor outcome group show consistently impaired memory function and a tendency to reduction in temporal lobe size.

Conclusions

In genetically predisposed subjects, the change from vulnerability to developing psychosis may be marked by a reduced size and impaired function of the temporal lobe.
First-episode schizophrenia, bipolar disorder and other psychoses in a rural Irish catchment area: Incidence and gender in the Cavan–Monaghan study at 5 years
Authors: Scully Paul J. , Quinn John F. , Morgan Maria G. , Kinsella Anthony , O'Callaghan Eadbhard , Owens John M. , Waddington John L.
Published: October 2002

Background

The potential of first-episode studies in schizophrenia is maximised through systematic epidemiological, clinical and biological comparisons between homogeneous populations of the psychoses.

Aims

To conduct prolonged accrual of ‘all’ cases of non-affective and affective psychotic illness on an epidemiologically complete basis.

Method

Within the region covered by Cavan–Monaghan psychiatric service (population 102 810), all putative cases of first-episode psychosis were diagnosed using DSM–IV.

Results

From 1995 to 2000, 69 cases of psychosis were ascertained, the incidence being 2.3-fold lower in females than in males. On resolving the ‘core’ diagnoses of schizophrenia and bipolar disorder, incidence of schizophrenia among women was 7.5-fold lower than among men whereas incidence of bipolar disorder among women was 6.6-fold lower than among men.

Conclusions

This homogeneous population, which eliminates factors associated with urbanicity and minimises confounding factors such as socioeconomic, ethnic and geographical diversity, shows a markedly reduced incidence among females both of schizophrenia and of bipolar disorder.
Subjective and objective neuropsychological abnormalities in a psychosis prodrome clinic
Authors: Hambrecht Martin , Lammertink Michael , Klosterkötter Joachim , Matuschek Eveline , Pukrop Ralf
Published: October 2002

Background

Predicting transitions to psychosis is difficult. Neuropsychology might facilitate predictions.

Aims

To report preliminary data on self-perceived and objectively measurable neurocognition in prodromal patients of the first German early recognition centre.

Method

Subjective neuropsychological disturbances were assessed in 51 patients with potentially prodromal symptoms of schizophrenia. Initial neurocognitive functioning was compared with matched normals and patients with schizophrenia.

Results

Self-perceived deficits mostly concerned perception, cognition and stress reactivity. Five transitions happened during the 15-month follow-up. Recently emerging or intensifying deficits were to some extent predictive of transition. Persons at risk performed worse than controls on objectively measured verbal capacity, attention and memory functions.

Conclusions

Neuropsychological deficits, either self-perceived or objectively measured, characterise persons at risk for schizophrenia and may contribute to predicting transitions.
Executive dysfunction in first-episode schizophrenia and relationship to duration of untreated psychosis: The West London Study
Authors: Joyce Eileen , Hutton Sam , Mutsatsa Stan , Gibbins Heidi , Webb Emma , Paul Sonja , Robbins Trevor , Barnes Thomas
Published: October 2002

Background

Many studies have demonstrated early generalised cognitive impairment in schizophrenia.

Aims

To examine executive function in first-episode schizophrenia, characterise the nature of the impairment and specify any relationships with symptoms and duration of untreated psychosis (DUP).

Method

Patients (n=136) and normal controls (n=81) were assessed with the Cambridge Automated Neuropsychological Test Battery, National Adult Reading Test IQ, and Scales for the Assessment of Positive and Negative Symptoms.

Results

Memory and executive impairments in patients were independent of IQ level. Spatial working memory was impaired because of inadequate strategy use. On a planning task, patients showed reduced planning times and suboptimal problem-solving. On an attentional set-shifting task, 75% of patients were able to perform an extra-dimensional shift thought to be a core attribute of prefrontal cortex function. Those who failed had significantly longer DUP.

Conclusions

Prefrontal cortex function deteriorates at the onset of psychosis and continues to worsen over time.
Improvement in cognitive functioning in patients with first-episode psychosis during treatment with quetiapine: An interim analysis
Authors: Good Kimberley P. , Kiss Ivan , Buiteman Christine , Woodley Hazel , Rui Qing , Whitehorn David , Kopala Lili
Published: October 2002

Background

The efficacies of second-generation antipsychotic medications in reducing symptoms are reasonably well-documented, but their effects on cognition are less clearly understood.

Aims

To undertake an interim analysis of an open label, 2-year study examining the effects of quetiapine on cognition in patients with a first episode of schizophrenia and related disorders.

Method

Cognitive testing was performed before quetiapine was initiated and repeated after 3, 6 and 12 months of treatment. To date, 13 patients have been fully assessed (mean dose 517.9 mg/day; s.d.=225.8).

Results

Statistically significant improvement was noted on measures of attention (Continuous Performance Test; CPT), verbal productivity (Verbal Fluency Test) and executive function (Object Alternation Test) after 6 and 12 months of treatment. For the CPT, improvement was also noted after 3 months of treatment.

Conclusions

During treatment for 1 year with quetiapine, cognitive performance was improved in young patients with psychosis. Continued controlled investigations of the effects of quetiapine on cognition are desirable.
Neurological soft signs in first-episode psychosis: A systematic review
Authors: Dazzan Paola , Murray Robin M.
Published: October 2002

Background

Neurological soft signs (NSS) are minor neurological signs indicating non-specific cerebral dysfunction. Their presence has been documented extensively in schizophrenia but not during the first psychotic episode.

Aims

To review studies that have specifically investigated NSS at the time of the first psychotic episode.

Method

A review of studies investigating neurological function in first-episode psychosis, using a clinical examination.

Results

Patients with first-episode psychosis show an excess of NSS, particularly in the areas of motor coordination and sequencing, sensory integration and in developmental reflexes. Furthermore, NSS may be associated with a specific laterality pattern.

Conclusions

More studies on first-onset schizophrenia are needed, evaluating both sensory and motor neurological domains (scoring separately for the two sides of the body), integrating this knowledge with neuroimaging findings and clarifying the role of NSS as markers of cognitive dysfunction.
Structural magnetic resonance imaging in patients with first-episode schizophrenia, psychotic and severe non-psychotic depression and healthy controls
Authors: Salokangas R. K. R. , Cannon T. , Van Erp T. , Ilonen T. , Taiminen T. , Karlsson H. , Lauerma H. , Leinonen K.-M. , Wallenius E. , Kalijonen A. , Syvälahti E. , Vilkman H. , Alanen A. , Hietala J.
Published: October 2002

Background

Structural brain abnormalities are prevalent in patients with schizophrenia and affective disorders.

Aims

To study how regional brain volumes and their ratios differ between patients with schizophrenia, psychotic depression, severe non-psychotic depression and healthy controls.

Method

Magnetic resonance imaging scans of the brain on first-episode patients and on healthy controls.

Results

Patients with schizophrenia had a smaller left frontal grey matter volume than the other three groups. Patients with psychotic depression had larger ventricular and posterior sulcal cerebrospinal fluid (CSF) volumes than controls. Patients with depression had larger white matter volumes than the other patients.

Conclusions

Left frontal lobe, especially its grey matter volume, seems to be specifically reduced in first-episode schizophrenia. Enlarged cerebral ventricles and sulcal CSF volumes are prevalent in psychotic depression. Preserved or expanded white matter is typical of non-psychotic depression.
Brain morphology in antipsychotic-naïve schizophrenia: A study of multiple brain structures
Authors: Cahn W. , Pol H. E. Hulshoff , Bongers M. , Schnack H. G. , Mandl R. C. W. , Haren N. E. M. Van , Durston S. , Koning H. , Van Der Linden J. A. , Kahn R. S.
Published: October 2002

Background

Although brain volume changes are found in schizophrenia, only a limited number of structural magnetic resonance imaging studies have exclusively examined antipsychotic-naïve patients.

Aims

To comprehensively investigate multiple brain structures in a single sample of patients who were antipsychotic-naïve.

Method

Twenty antipsychotic-naïve patients with first-episode schizophrenia and 20 healthy comparison subjects were included. Intracranial, total brain, frontal lobe, grey and white matter, cerebellar, hippocampal, parahippocampal, thalamic, caudate nucleus and lateral and third ventricular volumes were measured. Repeated-measures analyses of (co)variance were conducted with intracranial volume as covariate.

Results

Third ventricle volume enlargement was found in patients compared with the healthy subjects. No differences were found in other brain regions.

Conclusions

These findings suggest that some brain abnormalities are present in the early stages of schizophrenia. Moreover, it suggests that brain abnormalities reported in patients with chronic schizophrenia develop in a later stage of the disease and/or are medication induced.
Duration of untreated psychosis and pathways to care in first-episode psychosis
Authors: Skeate Amanda , Jackson Chris , Wood Max Birch , Jones Chris
Published: October 2002

Background

Studies have consistently found that many individuals with first-episode psychosis experience significant delays before receiving treatment. Current research investigating treatment delays has focused on the relationship between demographic factors and duration of untreated psychosis (DUP). However, treatment-seeking behaviours in this group have not been investigated.

Aims

To examine psychological processes that influence the decision-making process to contact primary care, in individuals with emerging psychosis.

Method

The influence of coping style, health locus of control and past health help-seeking behaviour on DUP was investigated in clients with a first episode of psychosis. This involved scrutiny of general practitioner (GP) records in an average of 6 years before the first treatment.

Results

Shorter DUP was associated with more frequent GP attendance in the 6 years before the onset of psychosis and lower health threat avoidant coping scores.

Conclusions

Patients with short DUP have a history of higher contact with their GP and, as a group, tend not to avoid health threats. The study underlines the importance of engaging young people and their families with primary care as one of a series of strategies to reduce DUP.
Randomised controlled trial of early detection and cognitive therapy for preventing transition to psychosis in high-risk individuals
Authors: Morrison A. P. , Bentall R. P. , French P. , Walford L. , Kilcommons A. , Knight A. , Kreutz M. , Lewis S. W.
Published: October 2002

Background

There is interest in the possibility of indicated prevention of psychosis. There is a strong case for using psychological approaches to prevent transition to psychosis in high-risk patients.

Aims

To identify individuals at high risk of transition to psychosis, and psychological characteristics relevant to the development of psychosis in this group.

Method

The design of a randomised controlled trial of cognitive therapy for the prevention of psychosis in people at high risk (meeting operational criteria of brief or attenuated psychotic symptoms, or first-degree family history with functional decline) is outlined. The first patients recruited are compared with non-patient samples on cognitive and personality factors; an interim analysis of transition rate is reported.

Results

Cases (n=31) were recruited mainly from primary care. Of the 23 high-risk patients monitored for 6–12 months, 5 (22%) made the transition to psychosis. The high-risk group scored significantly higher than non-patients on measures of schizotypy, metacognitive beliefs and dysfunctional self-schemas (sociotropy).

Conclusions

The findings validate the methods of identifying individuals at high risk of experiencing a psychotic episode. Compared with non-patient controls, the cases showed dysfunctional metacognitive beliefs and self-schemas.
Neurocognitive dimensions characterising patients with first-episode psychosis
Authors: Friis S. , Sundet K. , Rund B. R. , Vaglum P. , Mcglashan T. H.
Published: October 2002

Background

Assessment of neurocognitive dysfunction in schizophrenia is hampered by the multitude of tests used in the literature.

Aims

We aimed to identify the main dimensions of an assessment battery for patients with first-episode psychosis and to estimate the relationship between dimension scores and gender, age, education, diagnosis and symptoms.

Method

Eight frequently used neuropsychological tests were used. We tested 219 patients 3 months after start of therapy or at remission, whichever occurred first.

Results

We identified five dimensions: working memory (WM); verbal learning (VL); executive function (EF); impulsivity (Im); and motor speed (MS). Significant findings were that the MS score was higher for men, and the WM and VL scores were correlated with years of education.

Conclusions

Neurocognitive function in first-episode psychosis is described by at least five independent dimensions.
Randomised controlled trial of cognitive-behavioural therapy in early schizophrenia: Acute-phase outcomes
Authors: Lewis Shôn , Tarrier Nicholas , Haddock Gillian , Bentall Richard , Kinderman Peter , Kingdon David , Siddle Ronald , Drake Richard , Everitt Julie , Leadley Karen , Benn Andy , Grazebrook Katy , Haley Cliff , Akhtar Shahid , Davies Linda , Palmer Steve , Faragher Brian , Dunn Graham
Published: October 2002

Background

Cognitive–behavioural therapy (CBT) improves persistent psychotic symptoms.

Aims

To test the effectiveness of added CBT in accelerating remission from acute psychotic symptoms in early schizophrenia.

Method

A 5-week CBT programme plus routine care was compared with supportive counselling plus routine care and routine care alone in a multi-centre trial randomising 315 people with DSM–IV schizophrenia and related disorders in their first (83%) or second acute admission. Outcome assessments were blinded.

Results

Linear regression over 70 days showed predicted trends towards faster improvement in the CBT group. Uncorrected univariate comparisons showed significant benefits at 4 but not 6 weeks for CBTv. routine care alone on Positive and Negative Syndrome Scale total and positive sub-scale scores and delusion score and benefits v. supportive counselling for auditory hallucinations score.

Conclusions

CBT shows transient advantages over routine care alone or supportive counselling in speeding remission from acute symptoms in early schizophrenia.
OPUS study: Suicidal behaviour, suicidal ideation and hopelessness among patients with first-episode psychosis
Authors: Nordentoft M. , Jeppesen P. , Abel M. , Kassow P. , Petersen L. , Thorup A. , Krarup G. , Hemmingsen R. , Jørgensen P.
Published: October 2002

Background

Patients with first-episode psychosis comprise a high-risk group in terms of suicide.

Aims

To identify predictive factors for suicidal behaviour and to examine the effect of integrated treatment on suicidal behaviour and hopelessness.

Method

A total of 341 patients with a first-episode schizophrenia-spectrum disorder were randomised to integrated treatment or treatment as usual.

Results

During the 1-year follow-up period, 11% attempted suicide. This was associated with female gender, hopelessness, hallucinations and suicide attempt reported at baseline, with the two latter variables being the only significant ones in the final multivariate model. The integrated treatment reduced hopelessness.

Conclusions

Hallucinations and suicide attempt before inclusion in the study were the most significant predictors of suicide attempt in the follow-up period.
The mental health practitioner – bypassing the recruitment bottleneck
Authors: Kingdon David
Published: October 2002

Lack of resources has been a major restriction on the development of mental health services. However, even with the resources currently available there are insufficient numbers of trained medical, nursing, occupational therapy, psychology and social work staff to maintain services to adequate levels in many areas. This seriously interferes with provision of services, especially in acute wards but also in other areas. It certainly restricts developments and the use of skills attained through training (e.g. from THORN psychosocial intervention courses (Gournay & Birley, 1998)). The introduction of crisis resolution and early intervention teams, as described in the NHS Implementation Guide (Department of Health, 2001a), looks likely to simply deprive in-patient wards and community teams of staff, making the new teams ineffective through lack of core services. This will occur directly by recruitment of staff from them, or competitively through taking new entrants from nursing and social work programmes. Solutions proposed have included increasing numbers of support workers and administration staff; recruitment from abroad; or increased delegation of tasks, but there remains a need for more appropriately-trained professional staff.
A survey of opinions on the management of individuals who express suicidal ideation while intoxicated with alcohol
Authors: McCaffery Rosemary , Lee Alyson , Jauhar Pramod , Scott Jan
Published: October 2002

Aims and Method

It was noted that approaches to the assessment and management of individuals intoxicated with alcohol who express suicidal ideation varied widely. This study explored what guidance is currently available and sought the opinions of 218 junior and senior psychiatrists.

Results

The Royal College of Psychiatrists has no specific guidelines on this issue, but the Medical Defence Union and Scottish Central Legal Office gave opinion regarding a psychiatrist's duty of care and clinical responsibilities. This information did not reflect the opinions of the psychiatrists canvassed. There was no consensus among the 65% of clinicians who responded to the survey.

Clinical Implications

There is a need for greater clarity and guidance on the management of individuals who are intoxicated and express acute suicidal ideation. Sharing of good practice guidelines and greater integration of local and national policies is needed. It is certainly a topic worthy of inclusion in all induction days for junior psychiatrists.
Intensive day programme treatment for severe anorexia nervosa – the Leicester experience
Authors: Birchall H. , Palmer R. L. , Waine J. , Gadsby K. , Gatward N.
Published: October 2002

Aims and Method

To look at whether the opening of a day programme for the intensive care of people with severe anorexia nervosa in Leicester had the expected impact on admission rates, length of stay, cost of treatment and also simple measures of whether patients got better. Is this day programme an effective resource?

Results

Since the opening of the day programme, in-patient bed days and overall costs of treatment for local patients have been reduced, and the early results in terms of weight gain and readmission rates are promising.

Clinical Implications

With many areas planning to set up eating disorder services for local patients, it is important to consider which are the best resources to invest in. The experience of a well-established specialist service in Leicester has shown that a day programme can be an enriching and cost-effective way to treat patients with anorexia nervosa, but that it does not replace the need for the availability of in-patient beds.
An audit of seizure duration in electroconvulsive therapy
Authors: MacEwan Tom
Published: October 2002

Aims and Method

Brief or missed seizures might indicate that electronvulsive therapy (ECT) is not being delivered effectively. This cycle of audit at an ECT clinic aimed to measure rates of brief or missed seizures in two study periods, before and after the acquisition of a more powerful ECT machine.

Results

There was a significant reduction in the rate of brief or missed seizures in audit two. There was a significant increase in the restimulation rate in audit two, but without the desired effect of inducing adequate seizures.

Clinical Implications

Ineffective delivery of ECT might result in poor response to the treatment and should be minimised. Certain aspects of ECT delivery improved in the clinic studied but some patients received an ineffective second dose of electrical charge.
Clozapine initiation in the community
Authors: O'Brien Aileen , Firn Mike
Published: October 2002

Aims and Method

The study aims to describe the experience of an assertive community treatment team when commencing clozapine at home rather than in hospital, following a locally-devised policy. Any failed attempts and problems experienced are described.

Results

There have been no serious adverse events with 13 patients who have been started on clozapine at home.

Clinical Implications

For an assertive community treatment team, home-initiation of clozapine is a practical option, particularly when patients refuse to come in to hospital.
Acute wards: problems and solutions. Acute hospital care
Authors: Muijen Matt
Published: October 2002

It would be surprising if a public service was tolerated when it was feared by its customers, who are put at risk; unable to show evidence of its effectiveness; very expensive; and paying its staff uncompetitively. It would be astonishing if, nevertheless, such a service could not cope with demand.
Acute wards: problems and solutions. A participant observation study of life on an acute psychiatric ward
Authors: Quirk Alan , Lelliott Paul
Published: October 2002

The College Research Unit is undertaking an ethnographic study to describe life on acute psychiatric wards from the point of view of patients. The project is funded by a generous donation from Jim Birley, former President of the Royal College of Psychiatrists. It aims to bring a new perspective to our understanding of the current state of acute wards. The underlying premise is that solutions to current problems must be informed by a good understanding of what actually happens on the wards and what it feels like to be a patient there.
Acute wards: problems and solutions: Alternatives to acute wards: users' perspectives
Authors: Relton Peter , Thomas Phil
Published: October 2002

The move from institutional to community care in the second half of the twentieth century arose in a climate in which civil rights became increasingly prominent, and out of which the modern survivor movement grew (Campbell, 1996). Government policy for mental health services, as set out in Standard Five of the National Service Framework (NSF; Department of Health, 1999), requires that care should be provided in hospital, or an alternative in the least restrictive environment, and as close to home as possible. At the same time, Government policy also attaches increasing importance to the involvement of service users and carers in the planning, delivery and evaluation of services. This paper examines alternatives to hospital care from a user perspective. The problem is that the evidence base for the NSF largely consists of quantitative studies designed to answer questions of concern to mental health professionals. This tells us little about the perspectives of the service user, which is the strength and value of user-led research (Faulkner & Thomas, 2002). Much of what follows is taken from this area, but in addition we describe briefly our own experience of home treatment, which the NSF sets out as one of the main alternatives to in-patient care.
Monitoring patients on lithium – a good practice guideline
Authors: Nicholson Joy , Fitzmaurice Brian
Published: October 2002

Aims and Method

To develop a guideline that would encourage a systematic approach for both psychiatrists and general practitioners in the provision of safe, effective and consistent management of patients who are prescribed lithium. A multi-disciplinary working group developed the guideline following literature review and consultation with lithium clinics and specialist centres nationally.

Results

The Lothian lithium guidelines include three sections: (a) a lithium treatment plan; (b) advice for clinicians on managing lithium levels; and (c) pointers for counselling patients on lithium. The treatment plan is a key document in the guidelines which, once completed, ensures continuity of care with the transfer of patient-specific information.

Clinical Implications

This development has provided the opportunity for primary and secondary care services to work together in producing a guideline that will improve patient care and minimises risk.
Anaesthesia for electroconvulsive therapy: a role for etomidate
Authors: Benbow Susan M. , Shah Priti , Crentsil Joe
Published: October 2002

Aims and Method

Three cases are described to illustrate the elective use of etomidate in electroconvulsive therapy (ECT) anaesthesia.

Results

Use of etomidate is described in an individual who was treated with an electrical stimulus at the maximum level for the ECT machine in use; in a person who had severe side-effects with an alternative induction agent; and in a person with severe cardiac disease.

Clinical Implications

The anaesthetic drug should be tailored to the individual needs of the person being treated with ECT. Clinics should involve local anaesthetic departments in reviewing their anaesthetic practice.
Time for cognitive reframing – becoming a specialist in adult psychiatry
Authors: Lovett Kate F.
Published: October 2002

Psychiatry has always relegated itself to being the Cinderella speciality of medicine. Nowadays it appears that general adult psychiatry is competing for the Cinderella subspeciality of the speciality. The profession may or may not be in crisis but it probably is depressed. Would we accept, unchallenged, such low self-regard and hopelessness from patients? Not if we are trying to be in the least bit therapeutic.
Stop-and-Go Urban Traffic Noise Simulation and Prediction
Authors: Pamanikabud Pichai , Tharasawatpipat Chaisri
Published: October 2002

This paper presents techniques for simulating of urban traffic noise along with a mathematical model of stop-and-go traffic noise for the road network in the city center. The road network in the central part of Bangkok surrounded by the cordon line of Rajchadapisek Ring Road was used as the study area. The analysed data consisted of traffic characteristics and its noise levels which were collected from the study area together with the geometrical dimensions of road sections at each data collection locations. Finally, the stop-and-go traffic noise models generated by this study in the form of acceleration and deceleration lane models, and their statistical goodness of fit tests are presented.
Global adaptive output feedback controllers with application to non‐linear friction compensation
Authors: Santosuosso Giovanni L. , Tomei Patrizio
Published: October 2002

In this paper, we consider a class of non‐linear systems in which a set of constant parameters is unknown and some state variables are not available for measurement. For such systems we provide a constructive procedure for the solution of the global adaptive tracking problem with dynamic partial state feedback. We illustrate an application of the control strategy to the adaptive non‐linear friction compensation of a DC motor servomechanism. We improve previous results in tow directions: we allow for a subset of the unmeasurable states to enter in a system non‐linearly; we consider systems which are linearly parametrized with respect to a set of unknown constant parameters. Copyright © 2002 John Wiley & Sons, Ltd.
Modelling and simulation of a double‐star induction machine vector control using copper‐losses minimization and parameters estimation
Authors: Mimouni M.F. , Dhifaoui R.
Published: October 2002

This paper shows that it is possible to extend the principle of field‐oriented control (FOC) approach to a double‐star induction motor (DSIM). In the first stage, a robust variable structure current controller based on space phasor voltages PWM scheme is established. In this current controller design, only the stator currents and rotor speed sensors are used. In the second stage, the FOC method developed for DSIM is motivated by the minimization of the copper losses. The developed approach uses a loss model controller (LMC) and an adaptive rotor flux observer to compute the adequate rotor flux value minimizing the copper losses. The control variables are the stator currents or the machine input power. Compared to the constant rotor flux approach, it is proved that higher performances are achieved. However, the sensitivity of the FOC to parameter error of the machine still remains a problem. To guarantee the performance of the vector control, the stator and rotor resistances are adapted on‐line, based on the Lyapunov theory. An appropriate choice of the reference model allows building a Lyapunov function by means of which the updating law can be found. The simulation results show the satisfactory behaviour of the proposed identification algorithm. Copyright © 2002 John Wiley & Sons, Ltd.
Sex differences in the pattern of age‐dependent increase in the BMI from 20–59 years
Authors: Welon Zygmunt , Szklarska Alicja , Bielicki Tadeusz , Malina Robert M.
Published: October 2002

This study tested the hypothesis of a linear increase of the BMI with age among adults. Materials comprised 32,762 occupationally active females and males 23–59 years age resident in Wroclaw, southwestern Poland. All subjects were medically examined in the course of health screening. The BMI increases linearly with age in women, but increases with age in men in two stages—a more intensive rise between 20–40 years and much slower increase between 40–60 years. This hypothesis was verified with a linear regression model in women but for men piecewise regression with a break at 40 years of age fits the age trends. Am. J. Hum. Biol. 14:693–698, 2002. © 2002 Wiley‐Liss, Inc.
Secular trend in peak oxygen consumption among United States youth in the 20th century
Authors: Eisenmann Joey C. , Malina Robert M.
Published: October 2002

The purpose of this study was to examine secular change in peak oxygen consumption (Vo2) in U.S. boys and girls using available data from the 20th century. Studies were primarily identified from review articles and a Medline search. To be included in the analysis, studies must have included direct measurement of peak Vo2 on healthy (free from overt disease) United States children and youth from the general population separated by sex. Data (mean values) were divided by decade and separated into three age groups: 6–12, 13–15, and 16–18 years for boys, and 6–11, 12–14, and 15–18 years for girls. Peak Vo2 values were expressed as related to bipedal locomotion; therefore, cycle ergometry values were corrected by a factor of 1.075. Mean values were fit by least squares, goodness‐of‐fit regression lines. Results indicate that absolute (L·min−1) and relative (ml·kg−1·min−1) peak Vo2 have remained relatively stable among boys and young girls. In adolescent girls, particularly those 15 years of age and older, peak Vo2 has decreased by approximately 20% over the past few decades. The available data indicate that aerobic fitness has not decreased in United States youth except in adolescent girls over the past few decades. Am. J. Hum. Biol. 14:699–706, 2002. © 2002 Wiley‐Liss, Inc.
Inbreeding and demographic transition in the Orozco Valley (Basque Country, Spain)
Authors: Peña J.A. , Alfonso‐Sánchez M.A. , Calderón R.
Published: October 2002

Inbreeding in the Orozco Valley (Basque Country, Spain) between the 18th and 20th centuries was investigated on the basis of ecclesiastical dispensations and surname lists. The variations over time are very similar to those observed elsewhere in Europe, with a major increase in the coefficient of inbreeding in the late 19th and early 20th centuries. This is due mainly to an increase in marriages between first cousins. A highly marked decrease in inbreeding is observed during the 20th century. The secular trends described by the coefficient calculated on the basis of dispensations and by that calculated on isonymy are very similar. The nonrandom component of isonymy reveals a selective search for a related spouse during the period of maximum inbreeding. These results are associated with the process of demographic transition which affected European populations as a whole in the 19th century, resulting in a greater availability of kin among potential mates and thus enabling inbreeding to increase to levels far higher than those observed for earlier centuries. Am. J. Hum. Biol. 14:713–720, 2002. © 2002 Wiley‐Liss, Inc.
Modeling birthweight and gestational age distributions: Additive vs. multiplicative processes
Authors: Gage Timothy B.
Published: October 2002

Researchers have traditionally employed Gaussian distributions to model quantitative biological traits. Recently, mixtures of Gaussian distributions have begun to be used as well. However, there are many alternatives to the Gaussian distribution. From a theoretical perspective, the lognormal distribution is as applicable as the Gaussian (both are justified on the basis of the Central Limit Theorem). Here, the utility of mixtures of Gaussians and lognormals for describing birthweight and gestational age distributions are compared. This is carried out within the context of the hybrid‐lognormal distribution, in which the Gaussian and lognormal are special cases. The data consists of African American births (1985–1988) and European American births (1988) in the state of New York. The results suggest that of the conventional distributions, a mixture of two Gaussians generally provides the best fit to birthweight and gestational age. However, in the case of birthweight a two‐component hybrid‐lognormal fits better than any of the simpler models. This may be due to a feature of the hybrid‐lognormal distribution that can be interpreted as maternal constraints on fetal development. Am. J. Hum. Biol. 14:728–734, 2002. © 2002 Wiley‐Liss, Inc.
Rapid change in height and body proportions of Maya American children
Authors: Bogin B. , Smith P. , Orden A.B. , Varela Silva M.I. , Loucky J.
Published: October 2002

Maya families from Guatemala migrated to the United States in record numbers from the late 1970s to the early 1990s. Births to Maya immigrant women have created a sizable number of Maya American children. The height and sitting height of 5 to 12 years children (n = 431) were measured in 1999 and 2000. Leg length was estimated and the sitting height ratio was calculated. These data were compared with a sample of Maya children living in Guatemala measured in 1998 (n = 1,347). Maya American children are currently 11.54 cm taller and 6.83 cm longer‐legged, on average, than Maya children living in Guatemala. Consequently, the Maya Americans have a significantly lower average sitting height ratio (i.e., relatively longer legs in proportion to length of the head and trunk) than do the Maya in Guatemala. These results add support to the hypothesis that both the height and body proportions of human populations are sensitive indicators of the quality of the environment for growth. Am. J. Hum. Biol. 14:753–761, 2002. © 2002 Wiley‐Liss, Inc.
Linus Pauling's “molecular diseases”: Between history and memory
Authors: Strasser Bruno J.
Published: October 2002

In 1949, Linus Pauling and his collaborators published a study in the journal Science entitled “Sickle Cell Anemia, a Molecular Disease.” In this now classic study, they showed that hemoglobin from patients suffering from sickle cell anemia has a different electrical charge than hemoglobin from healthy individuals. This result demonstrated for the first time that an abnormal protein could be causally linked to a disease, and that genes determined the structure of proteins. This report made headline news and had a powerful impact on both the biomedical community and the general public. Fifty years later, this study is discussed in almost every medical and biological textbook and has became a favorite example in editorials to illustrate the progress of biomedical research. This article explores the history of Pauling's sickle cell anemia and its subsequent integration in different collective memories, up to the present day. It also discusses the function of the collective memories of Pauling's discovery for contemporary biomedical research. © 2002 Wiley‐Liss, Inc.
Medical genetics and scientific expertise in Switzerland in the 1940s
Authors: Geiser Marc
Published: October 2002

In Switzerland, the first course in human genetics for physicians was organized during World War II. The topic had less to do with human genetics than with eugenics, however. After this course, bitter opposition was forthcoming from physicians. The second course was held in quite a different context. The war was almost over and the Swiss authorities had to prove that they were on the side of the Allies. As eugenics was deemed to be a Nazi science, opposition to it became stronger. Given this context, the proponents of human genetics changed their discourse. This article explores how this debate on human genetics influenced not only the discourse on this science, but also human genetics practices in postwar Switzerland. © 2002 Wiley‐Liss, Inc.