bluuebunny/crossref_metadata_2025 huggingface dataset:
Integration of Central and Peripheral Respiratory Chemoreflexes
Authors: Wilson Richard J.A. , Teppema Luc J.
Published: March 2016

A debate has raged since the discovery of central and peripheral respiratory chemoreceptors as to whether the reflexes they mediate combine in an additive (i.e., no interaction), hypoadditive or hyperadditive manner. Here we critically review pertinent literature related to O2and CO2sensing from the perspective of system integration and summarize many of the studies on which these seemingly opposing views are based. Despite the intensity and quality of this debate, we have yet to reach consensus, either within or between species. In reviewing this literature, we are struck by the merits of the approaches and preparations that have been brought to bear on this question. This suggests that either the nature of combination is not important to system responses, contrary to what has long been supposed, or that the nature of the combination is more malleable than previously assumed, changing depending on physiological state and/or respiratory requirement. © 2016 American Physiological Society.Compr Physiol6:1005‐1041, 2016.
Lung Circulation
Authors: Suresh Karthik , Shimoda Larissa A.
Published: March 2016

The circulation of the lung is unique both in volume and function. For example, it is the only organ with two circulations: the pulmonary circulation, the main function of which is gas exchange, and the bronchial circulation, a systemic vascular supply that provides oxygenated blood to the walls of the conducting airways, pulmonary arteries and veins. The pulmonary circulation accommodates the entire cardiac output, maintaining high blood flow at low intravascular arterial pressure. As compared with the systemic circulation, pulmonary arteries have thinner walls with much less vascular smooth muscle and a relative lack of basal tone. Factors controlling pulmonary blood flow include vascular structure, gravity, mechanical effects of breathing, and the influence of neural and humoral factors. Pulmonary vascular tone is also altered by hypoxia, which causes pulmonary vasoconstriction. If the hypoxic stimulus persists for a prolonged period, contraction is accompanied by remodeling of the vasculature, resulting in pulmonary hypertension. In addition, genetic and environmental factors can also confer susceptibility to development of pulmonary hypertension. Under normal conditions, the endothelium forms a tight barrier, actively regulating interstitial fluid homeostasis. Infection and inflammation compromise normal barrier homeostasis, resulting in increased permeability and edema formation. This article focuses on reviewing the basics of the lung circulation (pulmonary and bronchial), normal development and transition at birth and vasoregulation. Mechanisms contributing to pathological conditions in the pulmonary circulation, in particular when barrier function is disrupted and during development of pulmonary hypertension, will also be discussed. © 2016 American Physiological Society.Compr Physiol6:897‐943, 2016.
Neuroendocrine Regulation of Growth Hormone Secretion
Authors: Steyn Frederik J. , Tolle Virginie , Chen Chen , Epelbaum Jacques
Published: March 2016

This article reviews the main findings that emerged in the intervening years since the previous volume on hormonal control of growth in the section on the endocrine system of the Handbook of Physiology concerning the intra‐ and extrahypothalamic neuronal networks connecting growth hormone releasing hormone (GHRH) and somatostatin hypophysiotropic neurons and the integration between regulators of food intake/metabolism and GH release. Among these findings, the discovery of ghrelin still raises many unanswered questions. One important event was the application of deconvolution analysis to the pulsatile patterns of GH secretion in different mammalian species, including Man, according to gender, hormonal environment and ageing. Concerning this last phenomenon, a great body of evidence now supports the role of an attenuation of the GHRH/GH/Insulin‐like growth factor‐1 (IGF‐1) axis in the control of mammalian aging. © 2016 American Physiological Society.Compr Physiol6:687‐735, 2016.
Regulation of the Hypothalamic‐Pituitary‐Adrenocortical Stress Response
Authors: Herman James P. , McKlveen Jessica M. , Ghosal Sriparna , Kopp Brittany , Wulsin Aynara , Makinson Ryan , Scheimann Jessie , Myers Brent
Published: March 2016

The hypothalamo‐pituitary‐adrenocortical (HPA) axis is required for stress adaptation. Activation of the HPA axis causes secretion of glucocorticoids, which act on multiple organ systems to redirect energy resources to meet real or anticipated demand. The HPA stress response is driven primarily by neural mechanisms, invoking corticotrophin releasing hormone (CRH) release from hypothalamic paraventricular nucleus (PVN) neurons. Pathways activating CRH release are stressor dependent: reactive responses to homeostatic disruption frequently involve direct noradrenergic or peptidergic drive of PVN neurons by sensory relays, whereas anticipatory responses use oligosynaptic pathways originating in upstream limbic structures. Anticipatory responses are driven largely by disinhibition, mediated by trans‐synaptic silencing of tonic PVN inhibition via GABAergic neurons in the amygdala. Stress responses are inhibited by negative feedback mechanisms, whereby glucocorticoids act to diminish drive (brainstem) and promote transsynaptic inhibition by limbic structures (e.g., hippocampus). Glucocorticoids also act at the PVN to rapidly inhibit CRH neuronal activity via membrane glucocorticoid receptors. Chronic stress‐induced activation of the HPA axis takes many forms (chronic basal hypersecretion, sensitized stress responses, and even adrenal exhaustion), with manifestation dependent upon factors such as stressor chronicity, intensity, frequency, and modality. Neural mechanisms driving chronic stress responses can be distinct from those controlling acute reactions, including recruitment of novel limbic, hypothalamic, and brainstem circuits. Importantly, an individual's response to acute or chronic stress is determined by numerous factors, including genetics, early life experience, environmental conditions, sex, and age. The context in which stressors occur will determine whether an individual's acute or chronic stress responses are adaptive or maladaptive (pathological). © 2016 American Physiological Society.Compr Physiol6:603‐621, 2016.
Euthyroid Sick Syndrome
Authors: Lee Sun , Farwell Alan P.
Published: March 2016

In this review, we discuss the characteristics, pathophysiology, and therapeutic implications of the euthyroid sick syndrome. Multiple mechanisms have been identified to contribute to the development of euthyroid sick syndrome, including alterations in the iodothyronine deiodinases, thyroid‐stimulating hormone secretion, thyroid hormone binding to plasma protein, transport of thyroid hormone in peripheral tissues, and thyroid hormone receptor activity. The euthyroid sick syndrome appears to be a complex mix of physiologic adaptation and pathologic response to acute illness. The underlying cause for these alterations has not yet been elucidated. Treatment of the euthyroid sick syndrome with thyroid hormone to restore normal serum thyroid hormone levels in an effort to improve disease prognosis and outcomes continues to be a focus of many clinical studies, although currently available data do not provide evidence of a clear benefit of treatment. © 2016 American Physiological Society.Compr Physiol6:1071‐1080, 2016.
Adhesion Molecules: Master Controllers of the Circulatory System
Authors: Schmidt Eric P. , Kuebler Wolfgang M. , Lee Warren L. , Downey Gregory P.
Published: March 2016

This manuscript will review our current understanding of cellular adhesion molecules (CAMs) relevant to the circulatory system, their physiological role in control of vascular homeostasis, innate and adaptive immune responses, and their importance in pathophysiological (disease) processes such as acute lung injury, atherosclerosis, and pulmonary hypertension. This is a complex and rapidly changing area of research that is incompletely understood. By design, we will begin with a brief overview of the structure and classification of the major groups of adhesion molecules and their physiological functions including cellular adhesion and signaling. The role of specific CAMs in the process of platelet aggregation and hemostasis and leukocyte adhesion and transendothelial migration will be reviewed as examples of the complex and cooperative interplay between CAMs during physiological and pathophysiological processes. The role of the endothelial glycocalyx and the glycobiology of this complex system related to inflammatory states such as sepsis will be reviewed. We will then focus on the role of adhesion molecules in the pathogenesis of specific disease processes involving the lungs and cardiovascular system. The potential of targeting adhesion molecules in the treatment of immune and inflammatory diseases will be highlighted in the relevant sections throughout the manuscript. © 2016 American Physiological Society.Compr Physiol6:945‐973, 2016.
Development of the Neuroendocrine Hypothalamus
Authors: Burbridge Sarah , Stewart Iain , Placzek Marysia
Published: March 2016

The neuroendocrine hypothalamus is composed of the tuberal and anterodorsal hypothalamus, together with the median eminence/neurohypophysis. It centrally governs wide‐ranging physiological processes, including homeostasis of energy balance, circadian rhythms and stress responses, as well as growth and reproductive behaviours. Homeostasis is maintained by integrating sensory inputs and effecting responses via autonomic, endocrine and behavioural outputs, over diverse time‐scales and throughout the lifecourse of an individual. Here, we summarize studies that begin to reveal how different territories and cell types within the neuroendocrine hypothalamus are assembled in an integrated manner to enable function, thus supporting the organism's ability to survive and thrive. We discuss how signaling pathways and transcription factors dictate the appearance and regionalization of the hypothalamic primordium, the maintenance of progenitor cells, and their specification and differentiation into neurons. We comment on recent studies that harness such programmes for the directed differentiation of human ES/iPS cells. We summarize how developmental plasticity is maintained even into adulthood and how integration between the hypothalamus and peripheral body is established in the median eminence and neurohypophysis. Analysis of model organisms, including mouse, chick and zebrafish, provides a picture of how complex, yet elegantly coordinated, developmental programmes build glial and neuronal cells around the third ventricle of the brain. Such conserved processes enable the hypothalamus to mediate its function as a central integrating and response‐control mediator for the homeostatic processes that are critical to life. Early indications suggest that deregulation of these events may underlie multifaceted pathological conditions and dysfunctional physiology in humans, such as obesity. © 2016 American Physiological Society.Compr Physiol6:623‐643, 2016.
Lung Structure and the Intrinsic Challenges of Gas Exchange
Authors: Hsia Connie C.W. , Hyde Dallas M. , Weibel Ewald R.
Published: March 2016

Structural and functional complexities of the mammalian lung evolved to meet a unique set of challenges, namely, the provision of efficient delivery of inspired air to all lung units within a confined thoracic space, to build a large gas exchange surface associated with minimal barrier thickness and a microvascular network to accommodate the entire right ventricular cardiac output while withstanding cyclic mechanical stresses that increase several folds from rest to exercise. Intricate regulatory mechanisms at every level ensure that the dynamic capacities of ventilation, perfusion, diffusion, and chemical binding to hemoglobin are commensurate with usual metabolic demands and periodic extreme needs for activity and survival. This article reviews the structural design of mammalian and human lung, its functional challenges, limitations, and potential for adaptation. We discuss (i) the evolutionary origin of alveolar lungs and its advantages and compromises, (ii) structural determinants of alveolar gas exchange, including architecture of conducting bronchovascular trees that converge in gas exchange units, (iii) the challenges of matching ventilation, perfusion, and diffusion and tissue‐erythrocyte and thoracopulmonary interactions. The notion of erythrocytes as an integral component of the gas exchanger is emphasized. We further discuss the signals, sources, and limits of structural plasticity of the lung in alveolar hypoxia and following a loss of lung units, and the promise and caveats of interventions aimed at augmenting endogenous adaptive responses. Our objective is to understand how individual components are matched at multiple levels to optimize organ function in the face of physiological demands or pathological constraints. © 2016 American Physiological Society.Compr Physiol6:827‐895, 2016.
Thin Filament Structure and the Steric Blocking Model
Authors: Lehman William
Published: March 2016

By interacting with the troponin‐tropomyosin complex on myofibrillar thin filaments, Ca2+and myosin govern the regulatory switching processes influencing contractile activity of mammalian cardiac and skeletal muscles. A possible explanation of the roles played by Ca2+and myosin emerged in the early 1970s when a compelling “steric model” began to gain traction as a likely mechanism accounting for muscle regulation. In its most simple form, the model holds that, under the control of Ca2+binding to troponin and myosin binding to actin, tropomyosin strands running along thin filaments either block myosin‐binding sites on actin when muscles are relaxed or move away from them when muscles are activated. Evidence for the steric model was initially based on interpretation of subtle changes observed in X‐ray fiber diffraction patterns of intact skeletal muscle preparations. Over the past 25 years, electron microscopy coupled with three‐dimensional reconstruction directly resolved thin filament organization under many experimental conditions and at increasingly higher resolution. At low‐Ca2+, tropomyosin was shown to occupy a “blocked‐state” position on the filament, and switched‐on in a two‐step process, involving first a movement of tropomyosin away from the majority of the myosin‐binding site as Ca2+binds to troponin and then a further movement to fully expose the site when small numbers of myosin heads bind to actin. In this contribution, basic information on Ca2+‐regulation of muscle contraction is provided. A description is then given relating the voyage of discovery taken to arrive at the present understanding of the steric regulatory model. © 2016 American Physiological Society.Compr Physiol6:1043‐1069, 2016.
Addition of Nucleophiles to Fluorinated Michael Acceptors
Authors: Ramb Daniel C. , Lerchen Andreas , Kischkewitz Marvin , Beutel Bernd , Fustero Santos , Haufe Günter
Published: March 2016

A series of nucleophiles, including primary and secondary amines, primary alcohols, and thiols, as well as diethyl malonate and nitromethane, were added to different fluorinated Michael acceptors including 2‐fluoroalk‐1‐en‐3‐ones and 2‐fluoro‐1‐phenylprop‐2‐en‐1‐one. The resulting β‐substituted α‐fluoro ketones were isolated in 34–92 % yield, depending on the substrate and the nucleophile. The best yields were obtained with secondary amines and with p‐methylthiophenol.
Macrosteres: The Deltic Guanidin­ium Ion
Authors: Mishiro Kenji , Hu Fanghao , Paley Daniel W. , Min Wei , Lambert Tristan H.
Published: March 2016

The “deltic guanidinium” ion is described here as a “macrostere” of the guanidinium ion. The use of the 2,4‐dimethoxybenzyl protecting group allows for the synthesis of the fully unsubstituted parent compound and a variety of derivatives bearing multiple N–H functions for the first time. Deltic urea, deltic thiourea, and deltic benzamidine are also synthesized. A comparison of the physical properties of guanidinium and deltic guanidinium ions is provided. The use of a deltic guanidinium dendrimer for cell transport is demonstrated.
Impact of Consumption Emotions on WOM in Movie Consumption: Empirical Evidence from Emerging Markets
Authors: Mishra Prashant , Bakshi Madhupa , Singh Ramendra
Published: March 2016

In this study, we empirically investigate the impact of consumers’ pleasure and arousal on customer satisfaction, likelihood of WOM and positive WOM, in the context of Bollywood movies in India. We collected data from a random sample of 274 consumers of Bollywood movies in India using a survey questionnaire. We analyze the data to test our hypotheses using structural equation modeling (SEM).The results confirmed that for Bollywood movies, consumer emotions such as pleasure and arousal are important predictors of customer satisfaction. We also found that the impact of arousal and pleasure differentially impact customer satisfaction, which in turn partially mediates the impact of these customer emotions on (1) likelihood of word of mouth and (2) positive word of mouth. We also found moderating impact of gender, income, and age. The study provides valuable insights for the entertainment and media industry to tweak their marketing strategies for designing, positioning, and promoting movies in emerging markets such as India. Movie producers and distributors may leverage the differential impact of pleasure and arousal on satisfaction of Bollywood moviegoers. Male and female customers are also impacted differently, which can be leverage for more customized promotions for the movie. Given that WOM is one of the most influential information sources for movie selection and success, the present study adds to the knowledge on movie consumption behaviors. Moreover, we validate the P–A theory in the context of moviegoers in emerging market of India for the first time.
Assessment and preparation of obese adolescents for bariatric surgery
Authors: Ahmad Noman , Bawazir Osama A.
Published: March 2016

Obesity is generally considered an adult disease, although there has been a constant increase in the prevalence of overweight and obese children in the last few decades. Childhood obesity is not limited to developed countries, with increasing numbers being reported from developing countries as well as from Saudi Arabia. Young populations with obesity suffer from similar comorbidities as obese adults, including type 2 diabetes mellitus, dyslipidemia, obstructive sleep apnea, polycystic ovarian syndrome, pseudotumor cerebri, and fatty liver disease. Recent advances in weight loss surgery have given hope to obese adolescents who are refractory to lifestyle changes and low-calorie diet plans. This review emphasizes a holistic approach for obese adolescents and describes in detail a multidisciplinary team and their role in adolescent bariatric surgery. There are unique medical, psychological, and nutritional requirements during the pre-operative, immediate post-operative, and long-term phases to achieve a desirable outcome. Identification of an appropriate candidate for bariatric surgery is critical and must balance the risks and benefits of weight loss surgery. Different surgical procedures are available and should be tailored to the needs of the patient and the expertise of the surgeon.
Genetic risk factors for the posterior cortical atrophy variant of Alzheimer's disease
Authors: Schott Jonathan M. , Crutch Sebastian J. , Carrasquillo Minerva M. , Uphill James , Shakespeare Tim J. , Ryan Natalie S. , Yong Keir X. , Lehmann Manja , Ertekin‐Taner Nilufer , Graff‐Radford Neill R. , Boeve Bradley F. , Murray Melissa E. , Khan Qurat ul Ain , Petersen Ronald C. , Dickson Dennis W. , Knopman David S. , Rabinovici Gil D. , Miller Bruce L. , González Aida Suárez , Gil‐Néciga Eulogio , Snowden Julie S. , Harris Jenny , Pickering‐Brown Stuart M. , Louwersheimer Eva , van der Flier Wiesje M. , Scheltens Philip , Pijnenburg Yolande A. , Galasko Douglas , Sarazin Marie , Dubois Bruno , Magnin Eloi , Galimberti Daniela , Scarpini Elio , Cappa Stefano F. , Hodges John R. , Halliday Glenda M. , Bartley Lauren , Carrillo Maria C. , Bras Jose T. , Hardy John , Rossor Martin N. , Collinge John , Fox Nick C. , Mead Simon
Published: March 2016

Introduction

The genetics underlying posterior cortical atrophy (PCA), typically a rare variant of Alzheimer's disease (AD), remain uncertain.

Methods

We genotyped 302 PCA patients from 11 centers, calculated risk at 24 loci for AD/DLB and performed an exploratory genome‐wide association study.

Results

We confirm that variation in/near APOE/TOMM40 (P = 6 × 10−14) alters PCA risk, but with smaller effect than for typical AD (PCA: odds ratio [OR] = 2.03, typical AD: OR = 2.83, P = .0007). We found evidence for risk in/near CR1 (P = 7 × 10−4), ABCA7 (P = .02) and BIN1 (P = .04). ORs at variants near INPP5D and NME8 did not overlap between PCA and typical AD. Exploratory genome‐wide association studies confirmed APOE and identified three novel loci: rs76854344 near CNTNAP5 (P = 8 × 10−10 OR = 1.9 [1.5–2.3]); rs72907046 near FAM46A (P = 1 × 10−9 OR = 3.2 [2.1–4.9]); and rs2525776 near SEMA3C (P = 1 × 10−8, OR = 3.3 [2.1–5.1]).

Discussion

We provide evidence for genetic risk factors specifically related to PCA. We identify three candidate loci that, if replicated, may provide insights into selective vulnerability and phenotypic diversity in AD.
The phenotypical core of Alzheimer's disease‐related and nonrelated variants of the corticobasal syndrome: A systematic clinical, neuropsychological, imaging, and biomarker study
Authors: Di Stefano Francesca , Kas Aurélie , Habert Marie‐Odile , Decazes Pierre , Lamari Foudil , Lista Simone , Hampel Harald , Teichmann Marc
Published: March 2016

Introduction

The corticobasal syndrome (CBS) constitutes a neurodegenerative disease spectrum with substantial phenotypical or biological heterogeneity, requiring large or multimodal studies to identify its clinico‐biological signature while disentangling Alzheimer's disease (AD)‐related from non‐AD‐related CBS.

Methods

We analyzed a large (N = 45) monocenter expert‐clinic CBS cohort, recruited in motor and/or cognitive units to avoid recruitment biases, assessed with standardized motor and/or cognitive‐language tests, brain perfusion imaging, and cerebrospinal fluid biomarkers.

Results

CBS mainly manifests as a motor and/or language disorder incorporating a “mixed progressive aphasia” phenotype, consistent with left‐lateralized damage to frontal‐parietal‐temporal cortices. Biomarker expression indicates in 18% underlying AD causing predominant parietal‐temporal damage and Gerstmann syndrome (sensitivity 75%; specificity 75%), whereas non‐AD‐CBS presented with predominant prefrontal and lexical‐semantic impairment.

Discussion

CBS is primarily a “motor‐plus‐aphasia” disease unfolding into AD‐related and non‐AD‐related variants with distinctive cognitive‐anatomic patterns. CBS, and notably its “Gerstmann variant”, should be included in the new AD “lexicon” and categorized in the evolving diagnostic spectrum of “atypical AD”d.
Utility of a Novel Reflective Marker Visualized by Flash Photography for Assessment of Personnel Contamination During Removal of Personal Protective Equipment
Authors: Tomas Myreen E. , Cadnum Jennifer L. , Mana Thriveen S.C. , Jencson Annette L. , Koganti Sreelatha , Alhmidi Heba , Kundrapu Sirisha , Sunkesula Venkata C.K. , Donskey Curtis J.
Published: March 2016

In an experimental study, the frequency of contamination of healthcare personnel during removal of contaminated personal protective equipment (PPE) was similar for bacteriophage MS2 and a novel reflective marker visualized using flash photography. The reflective marker could be a useful tool to visualize and document personnel contamination during PPE removal.

Infect Control Hosp Epidemiol 2016;37:711–713
Monitoring of prolactin levels in children and adolescents prescribed antipsychotic medication: a complete audit cycle
Authors: Uduehi E. , Gallagher L. , Alugo T.
Published: March 2016

Aims and methods

Antipsychotics have proven benefits in children and adolescents with autism spectrum disorders. However, notwithstanding some therapeutic benefits significant side effects are associated with the use of antipsychotics, such as hyperprolactinaemia. We completed an audit cycle between April 2013 and December 2013 to evaluate the practice in the Beechpark Autism Service with respect to monitoring and managing hyperprolactinaemia in children and adolescents prescribed antipsychotics. The re-audit assessed whether the recommended guidelines and changes had been implemented. The National Institute for Health and Care Excellence guidelines were used as a gold standard for this audit.

Results

Basal determinations of serum prolactin improved significantly at the end of the audit cycle (28.6% v. 57%) with slight improvement in six monthly repeat prolactin monitoring (28.6% v. 39.1%) showing some change in clinical practice. However, there was minimal improvement in managing hyperprolactinaemia (0% v. 12.5%).

Clinical implication

There is growing awareness about hyperprolactinaemia associated with the use of antipsychotic medication in children and adolescents and the long-term effects. Clear documented guidelines will help increase and improve the monitoring and management of hyperprolactinaemia in these groups of patients. However, more needs to be done in improving the practice of monitoring and managing hyperprolactinaemia in children and adolescent prescribed antipsychotic medication giving the documented long-term effects.
The timing of the evening meal: how is this associated with weight status in UK children?
Authors: Coulthard Janine D. , Pot Gerda K.
Published: March 2016

There is some evidence from studies in adults and limited evidence from studies in children that eating later in the day may increase the risk of overweight and obesity. In this cross-sectional study, we investigated associations between evening meal timing in children and their weight status and energy intake. Dietary data obtained from the UK’s National Diet and Nutrition Survey Rolling Programme (2008–2012) for 768 children aged 4–10 years and 852 children aged 11–18 years were analysed. We tested for an association between evening meal timing (consuming the evening meal before or after 20.00 hours) and risk of overweight and/or obesity, adjusting for relevant confounding variables. We also explored whether evening meal timing was associated with overall nutrient intake. We found no association between evening meal timing and risk of obesity or risk of overweight and obesity combined in either the 4–10 years age group (obesity: OR 1·43; 95 % CI 0·49, 4·13; obesity and overweight combined: OR 1·33; 95 % CI 0·53, 3·33) or the 11–18 years age group (obesity: OR 0·50; 95 % CI 0·24, 1·02; obesity and overweight combined: OR 0·83; 95 % CI 0·50, 1·38), split by sex or as combined. No significant associations were found between evening meal timing and energy intake, and no clear patterns in variation of nutrient intakes with evening meal times were identified. In conclusion, we found no evidence that, for children aged 4–18 years in the UK, eating the evening meal after 20.00 hours was associated with excess weight or increased energy intake.
Characteristics of the acidity and sulphate fractions in acid sulphate soils and their relationship with rice yield
Authors: HUANG Q. , TANG S. , HUANG X. , YANG S. , YI Q.
Published: March 2016

Most acid sulphate soils (ASSs) in the Pearl River Delta of South China have been traditionally reclaimed for rice cultivation, but the rice yield in most of these paddy fields is lower than the average rice yield in China due to extremely high soil acidity. In the present study, a range of sulphate and acidity parameters were investigated in ASS profiles in three types of paddy fields in Taishan City (Guangdong Province, China) divided based on the local rice productivity (4500, 3000 and 1500 kg/ha) using an abandoned ASS (uncultivated) as the control treatment to ascertain key yield constraining parameters. Soluble acidity (SA), exchangeable acidity (ExA), soluble sulphate (SS) and net acid-soluble sulphate (NAS) increased with increasing soil depths from 0 to 100 cm and then decreased abruptly with further increases in the depth. However, the depth distribution of exchangeable sulphate (ES) was uniform. The soil acidity and sulphate contents differed significantly in three sampled paddy fields. The values of SA and SS in the soils at depths of 0–100 cm in the studied ASS were lower compared with those in the uncultivated ASS and the ExA in soils at depths of 0–40 cm in ASS were lower compared with those observed in the uncultivated ASS. A correlation analysis revealed that SA was strongly correlated with SS and ExA with NAS. Soluble acidity, ExA, SS and NAS in the ASS were significantly associated with rice yield. Exchangeable acidity in the plough layer (0–20 cm) of soils was the most sensitive indicator of soil quality affecting rice yield among those in soils from 0 to 140 cm depth. It is interesting to note that SA, SS and NAS were more sensitive indicators of soil quality affecting rice yield at 60–100 cm than at 0–40 cm depth. Principal component analysis showed that pH value, ExA and ES in soils at depths of 0–40 cm and SA, SS and NAS in soils at depths of 60–100 cm constituted the critical soil acidity and sulphate characteristics that were strongly correlated with rice yields. This finding implies that controlling the ExA in the plough layer and the SA and NAS in the Jarosite layer should be the major focus of studies aimed at the amelioration of ASSs.
Temporomandibular joint involvement as a positive clinical prognostic factor in necrotising external otitis
Authors: Yeheskeli E , Eta R Abu , Gavriel H , Kleid S , Eviatar E
Published: March 2016

Objective:

Necrotising otitis externa is associated with high morbidity and mortality rates. This study investigated whether temporomandibular joint involvement had any prognostic effect on the course of necrotising otitis externa in patients who had undergone hyperbaric oxygen therapy after failed medical and sometimes surgical therapy.

Methods:

A retrospective case series was conducted of patients in whom antibiotic treatment and surgery had failed, who had been hospitalised for further treatment and hyperbaric oxygen therapy.

Results:

Twenty-three patients with necrotising otitis externa were identified. The temporomandibular joint was involved in four patients (17 per cent); these patients showed a constant gradual improvement in C-reactive protein and were eventually discharged free of disease, except one patient who was lost to follow up. Four patients (16 per cent) without temporomandibular joint involvement died within 90 days of discharge, while all patients with temporomandibular joint involvement were alive. Three patients (13 per cent) without temporomandibular joint involvement needed recurrent hospitalisation including further hyperbaric oxygen therapy; no patients with temporomandibular joint involvement required such treatment.

Conclusion:

Patients with temporomandibular joint involvement had lower rates of recurrent disease and no mortality. Therefore, we suggest considering temporomandibular joint involvement as a positive prognostic factor in necrotising otitis externa management.
Uvular approximation as an articulatory vowel feature
Authors: Evans Jonathan P. , Sun Jackson T.-S. , Chiu Chenhao , Liou Michelle
Published: March 2016

This study explores the phenomenon of uvularization in the vowel systems of two Heishui County varieties of Qiang, a Sino-Tibetan language of Sichuan Province, China. Ultrasound imaging (one speaker) shows that uvularized vowels have two tongue gestures: a rearward gesture, followed by movement toward the place of articulation of the corresponding plain vowel. Time-aligned acoustic and articulatory data show how movement toward the uvula correlates with changes in the acoustic signal. Acoustic correlates of uvularization (taken from two speakers) are seen most consistently in raising of vowel F1, lowering of F2 and in raising of the difference F3-F2. Imaging data and the formant structure of [l] show that uvular approximation can begin during the initial consonant that precedes a uvularized vowel. Uvularization is reflected phonologically in the phonotactic properties of vowels, while vowel harmony aids in the identification of plain–uvularized vowel pairs. The data reported in this paper argue in favor of a revision of the catalog of secondary articulations recognized by the International Phonetic Alphabet, in order to include uvularization, which can be marked with the symbol [ʶ] in the case of approximation and [χ] for secondary uvular frication.
USING CLAIMS DATA FOR EVIDENCE GENERATION IN MANAGED ENTRY AGREEMENTS
Authors: Brandes Alina , Schwarzkopf Larissa , Rogowski Wolf H.
Published: March 2016

Objectives: This study assesses the use of routinely collected claims data for managed entry agreements (MEA) in the illustrative context of German statutory health insurance (SHI) funds.

Methods: Based on a nonsystematic literature review, the data needs of different MEA were identified. A value-based typology to classify MEA on the basis of these data needs was developed. The typology is oriented toward health outcomes and utilization and costs, key components of a new technology's value. For each MEA type, the suitability of claims data in establishing evidence of the novel technology's value in routine care was systematically assessed. Assessment criteria were data availability, completeness, timeliness, confidentiality, reliability, and validity.

Results: Claims data are better suited to MEA addressing uncertainty regarding the utilization and costs of a novel technology in routine care. In schemes where safety aspects or clinical effectiveness are assessed, the role of claims data is limited because clinical information is not included in sufficient detail.

Conclusions: The suitability of claims data depends on the source of uncertainty and, in consequence, the outcome measures chosen in the agreements. In all schemes, the validity of claims data should be judged with caution as data are collected for billing purposes. This framework may support manufacturers and payers in selecting the most suitable contract type and agreeing on contract conditions. More research is necessary to validate these results and to address remaining medical, economic, legal, and ethical questions of using claims data for MEA.
Genetic diversity ofDidelphis virginianarelated to different levels of disturbance in the Highlands and the Central Depression regions of Chiapas, Mexico
Authors: Cruz-Salazar Bárbara , Ruiz-Montoya Lorena , Vázquez-Domínguez Ella , Navarrete-Gutiérrez Darío , Espinoza-Medinilla Eduardo E. , Vázquez Luis-Bernardo
Published: March 2016

The Virginia opossum (Didelphis virginiana) is considered highly adaptable to anthropogenic disturbances; however, the genetic effects of disturbance on this marsupial have not been studied in wild populations in Mexico. Here we evaluated the genetic diversity ofD. virginianaat sites with different levels of disturbance within the Highlands and Central Depression regions of Chiapas in southern Mexico. Twelve microsatellite loci were used and the results demonstrated moderate mean heterozygosity (He= 0.60;Ho= 0.50). No significant differences in heterozygosity were found among sites with different levels of disturbance in both regions (rangeHo= 0.42–0.57). We observed low but significant levels of genetic differentiation according to disturbance level. The inbreeding coefficient did not differ significantly from zero, suggesting that low genetic differentiation in these environments may be associated with sufficient random mating and gene flow, a result associated with the high dispersal and tolerance characteristics of this marsupial. Our results forD. virginianain this particular area of Mexico provide a foundation for exploring the impact of human disturbance on the genetic diversity of a common and generalist species.
Psychopathology, insight and compliance in schizophrenia
Authors: Bajaj Vikrant , Sengupta Somnath , Gupta Dhanesh Kumar
Published: March 2016

Abstraact

Objective: A four-week longitudinal study was conducted to assess the relationship between insight, psychopathology and treatment compliance in schizophrenia.

Method: The study was conducted using Insight and Treatment Attitude Questionnaire (ITAQ), Positive and Negative Syndrome Scale (PANSS) and Medication Adherence Rating Scale (MARS). The sample comprised 50 patients with schizophrenia diagnosed according to research criteria of the International Classification of Diseases (ICD-10), with a mean duration of illness of 5.32 years.

Results: Substantial psychopathology was observed at intake and it improved significantly at the end of four weeks. Similar changes were observed in the score of insight and of compliance over four weeks. The insight and the compliance were positively correlated to each other at the beginning and at the end of four weeks. Both of these were negatively correlated with psychopathology scores on both occasions.

Conclusion: Insight and psychopathology remain important determinants of treatment compliance in schizophrenia over short term and long term follow up.
Drug users' failure to modify alcohol consumption in response to hepatitis C
Authors: Noonan Angela , Kavanagh Paul , Sweeney Brion
Published: March 2016

Objective: To measure (a) the prevalence of problem drinking in a population of methadone-treated drug users, (b) independent associations with problem drinking, (c) the effect of hepatitis C status on drinking behaviour, (d) the knowledge of drug users of their hepatitis C status and their perception of their drinking behaviour and (e) the attitude of drug users to the effect of alcohol on hepatitis C virus (HCV) related disease.

Method: A cross sectional survey of 130 drug users in treatment at the National Drug Treatment Centre, Dublin was carried out. A questionnaire incorporated the Alcohol Use Disorders Identification Test (AUDIT), and data were collected on sociodemographics, drug use history, perceived HCV status and drinking behaviour, and attitudes to the impact of drinking on HCV related disease. Hepatitis serology and drug urine data were collected from clinical records.

Results: The prevalence of problem drinking was 41% (95% CI 33-51%). Unstable accommodation, older age, male gender and longer duration of heroin use were independent associations with being a problem drinker. There was no significant difference in the prevalence of problem drinking across HCV status. Knowledge of HCV status was accurate, however 35% of those identified as AUDIT cases failed to recognise their problem drinking.

Conclusion: HCV infection among Irish drug users is compounded by a high prevalence of problem drinking with drug users failing to modify their drinking in response. Incorrect perception of problem drinking status could be a barrier to addressing this potentially remediable risk factor.
Insight in mental illness: an educational review
Authors: McFarland John , McDonald Colm , Hallahan Brian
Published: March 2016

Insight is an elusive concept in psychiatry with a long history of divergent definitions and methods of measurements. Although insight was previously presumed to be a binary construct that an individual could possess or lack, there is an emerging consensus that insight is a multi-dimensional construct consisting of a spectrum of phenomena. Over recent years there has been increasing interest in the topic of insight, especially in relation to psychotic disorders where insight is frequently diminished. In this educational review we will discuss the history associated with the construct of insight, current theories in relation to insight, the association of insight with clinical symptoms and prognosis with particular reference to psychosis, the various methods of measuring insight, the aetiology of insight and present deficiencies in our understanding of insight.
Mental capacity: legislation and medical treatment decisions in Ireland
Authors: Agyapong Vincent IO , Wrigley Margo
Published: March 2016

This paper examines mental capacity legislation in Ireland and its implications for medical treatment decisions for people whose capacities are believed to be impaired. It draws on inferences from case laws and legislations in other jurisdictions and concludes that there is an urgent need for the enactment of appropriate mental capacity legislation in Ireland.
Deliberate self-harm in young people: attendance at a paediatric emergency department
Authors: Morgan Sophia , Byrne Sinead , Boylan Carole , McLearie Stephen , Fitzpatrick Carol
Published: March 2016

Objectives: Deliberate self-harm (DSH) is the strongest predictor of suicidal behaviour. This retrospective study reviewed all DSH presentations to our Paediatric Emergency Department between 2002-2006.

Method: Using database and medical records we profiled these presentations. Data was coded and statistically analysed.

Results: There were 253 DSH attendances. Twenty-four percent were living in care, 15% were under 12 years and 14% presented more than once. Overdoses (61%) were more common than cutting (16%) and 56% had a psychiatric condition.

Conclusions: DSH presents an ongoing challenge to child and adolescent mental health services and those working in suicide prevention. Identifying the characteristics of these young people is essential to providing appropriate treatment for this high-risk group.
The distribution of wellbeing in Ireland
Authors: Delaney Liam , Doyle Orla , McKenzie Kenneth , Wall Patrick
Published: March 2016

Objectives: There is a substantial knowledge gap about the distribution of mental health in community populations. The European Social Survey is particularly useful as it contains information on over 40,000 individuals, including 2,286 Irish adults. The objective of this study is to conduct a large scale statistical analysis to examine the distribution and determinants of mental wellbeing in a large representative sample of the Irish population.

Method: Analysis of the European Social Survey using robust multiple linear and non-linear regression techniques. The data-set contains WHO-Five scores and subjective wellbeing for a sample of 2,286 Irish people interviewed in their homes in 2005.

Results: Ireland has the second highest average WHO-Five score among the 22 countries in the European Social Survey. Multiple linear regression analysis across the distribution of WHO-Five reveals a wellbeing gradient largely related to education and social capital variables. A probit model examining the determinants of vulnerability to psychiatric morbidity reveals that a similar set of factors predict scores below the threshold point on the WHO-Five scale.

Conclusions: The results are consistent with marked differences in mental wellbeing across education levels and variables relating to social capital factors. Such indicators provide a useful index for policy-makers and researchers. However, much further work is needed to identify causal mechanisms generating observed differences in mental health across different socioeconomic groups.
Client satisfaction among outpatients attending an Irish community mental health service
Authors: Hill Shane , Turner Niall , Barry Siobhan , O'Callaghan Eadbhard
Published: March 2016

Objectives: To assess patient satisfaction with mental health services. Client satisfaction with mental health services is attracting increasing attention and is now considered a key outcome variable in evaluating mental health services. The Quality Framework (Mental Health Commission (MHC)), and Vision for Change (VFC) support such evaluation. However, there are no published quantitative data from Irish users of a community mental health service.

Method: We invited outpatients attending a Dublin community mental health service to complete a standardised self-report instrument (Client Satisfaction Questionnaire, CSQ-8) and provide qualitative feedback.

Results: Of the seventy-nine respondents, 80% report they were ‘satisfied’ or ‘very satisfied’ with the service. However, they were critical of; access to, operation of, and communication with the mental health services.

Conclusions: Although satisfied, when given the opportunity to comment, service users can be critical of aspects of the service they receive. Only using quantitative evaluation of outpatient client satisfaction levels may fail to capture important consumer suggestions for service development. Recent recommendations and upcoming changes would address a number of the criticisms of mental health services identified in this study.
An audit of new long-stay patients in Irish psychiatric inpatient services
Authors: Daly Antoinette , Walsh Dermot
Published: March 2016

Objectives: The most recent census of psychiatric inpatients (Daly and Walsh, 2006) examined the decline of the long-stay population (both new and old long-stay) from 1963 to 2006. The aim of the present study was to identify new long-stay patients (patients in hospital between one and five years) in the 2006 psychiatric in-patient census and follow them up one year later to determine the number remaining as inpatients, ie. not having been discharged

Methods: New long-stay patients were extracted from the 2006 psychiatric inpatient census data base and were followed up one year later.

Results: Sixty-eight per cent (315/460) of new longstay patients on 31/03/06 were still resident in units and hospitals one year later on 31/03/07, the majority in psychiatric hospitals Forty-two per cent (133/315) of patients had a primary diagnosis of schizophrenia, 13% (40/315) of depressive disorder, 11% (33/315) of organic mental disorder and 8% of intellectual disability (24/315). The number of new long-stay patients discharged or who died showed a sharp decline on previous years.

Conclusions: Unless current services are improved and extended as advocated in A Vision for Change, it will be a number of years before this population leaves psychiatric hospitals and such hospitals can close because of the lack of suitable alternatives. In accordance with policy recommendations, the continuing requirement for the development of specialised rehabilitation services to cater for the broad needs of those who remain in psychiatric hospitals is of the utmost importance.
Current approaches to the management of schizophrenia
Authors: Behan Caragh
Published: March 2016

Welcome to the second 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