bluuebunny/crossref_metadata_2025_split huggingface dataset:
Staff and bed distribution in public sector mental health services in the Eastern Cape Province, South Africa
Authors: Sukeri Kiran , Alonso-Betancourt Orlando , Emsley Robin 
Published: June 2017

<p><strong>Background. </strong>The Eastern Cape Province of South Africa is a resource-limited province with a fragmented mental health service. </p><p><strong>Objective. </strong>To determine the current context of public sector mental health services in terms of staff and bed distribution, and how this corresponds to the population distribution in the province.</p><p><strong>Method. </strong>In this descriptive cross-sectional study, an audit questionnaire was submitted to all public sector mental health facilities. Norms and indicators were calculated at provincial and district level. This article investigates staff and bed distribution only.</p><p><strong>Results. </strong>Results demonstrated that within the province, only three of its seven districts have acute beds above the national baseline norm requirement of 13/100 000. The private mental health sector provides approximately double the number of medium- to long-stay beds available in the public sector. Only two regions have staff/population ratios above the baseline norm of 20/100 000. However, there are significant differences in this ratio among specific staff categories. There is an inequitable distribution of resources between the eastern and western regions of the province. When compared with the western regions, the eastern regions have poorer access to mental health facilities, human resources and non-governmental organisations. </p><p><strong>Conclusion. </strong>Owing to the inequitable distribution of resources, the provincial authorities urgently need to develop an equitable model of service delivery. The province has to address the absence of a reliable mental health information system.</p>
Magnetic resonance imaging study of corpus callosum abnormalities in patients with different subtypes of schizophrenia
Authors: Unlu Ebru , Bagcioglu Erman , Acay Mehtap B , Kacar Emre , Turamanlar Ozan , Gonul Yucel , Cevik Mehmet , Akpinar Abdullah , Coskun Kerem Senol 
Published: June 2017

<p><strong>Background.</strong> Reductions in the size of the corpus callosum (CC) have been described for schizophrenia patients, but little is known about the possible regional differences in schizophrenia subtypes (paranoid, disorganised, undifferentiated, residual). </p><p><strong>Methods. </strong>We recruited 58 chronically schizophrenic patients with different subtypes, and 31 age-and-gender matched healthy controls. The callosum was extracted from a midsagittal slice from T1 weighted magnetic resonance images, and areas of the total CC, its five subregions, CC length and total brain volume were compared between schizophrenia subtypes and controls. Five subregions were approximately matched to fibre pathways from cortical regions. </p><p><span><strong>Results. </strong>Schizophrenia patients had reduced CC total area and length when compared with controls. Disorganised and undifferentiated schizophrenics had a smaller prefrontal area, while there was no significant difference for the paranoid and residual groups. The premotor/supplementary motor area was smaller in all schizophrenia subtypes. The motor area was smaller only in the disorganised group. A smaller sensory area was found in all subtypes except the residual group. Parietal, temporal and occipital areas were smaller in the paranoid and undifferentiated groups. Total brain volume was smaller in all schizophrenia subtypes compared with controls, but did not reach statistical significance. </span></p><p><strong>Conclusion. </strong>These findings suggest that the heterogeneity of symptoms may lead to the different CC morphological characteristics in schizophrenia subtypes.</p>
Rape victim assessment: Findings by psychiatrists and psychologists at Weskoppies Hospital
Authors: Coetzee Kobus , Lippi G 
Published: June 2017

<p><strong>Background.</strong> A significant increase in rape victim assessment referrals by the courts has been noted in recent years at Weskoppies Hospital. Rape victims are referred by courts to determine: (<em>i</em>) their competency as a witness; (<em>ii</em>) their ability to give consent to sexual acts; (<em>iii</em>) their mental age; and (<em>iv</em>) their level of mental retardation. These evaluations are done by psychologists and psychiatrists at state hospitals. The findings are reported to the courts in a report format.</p><p><strong>Objectives.</strong> To present the findings of the reports compiled by psychologists and psychiatrists on rape victims from 2009 to 2013 as they comment on the court’s referral questions, and compare these findings with similar studies done at other psychiatric institutions.</p><p><strong>Methods.</strong> A total of 108 reports was obtained from the electronic database at Weskoppies Hospital. The findings of the reports were summarised on a datasheet and were categorised according to the referral questions of the courts. </p><p><strong>Results.</strong> In the 68 reports where mention was made of mental age, almost three-quarters found it to be between 4 and 12 years. Intellectual disability was found as the diagnosis in the vast majority of reports. Of these, the most common severity of impairment was moderate (<em>n</em>=22, 21.8%) and moderate to severe (<em>n</em>=21, 20.8%) in nature. Most reports (<em>n</em>=61, 56.6%) found that the rape victims were not able to consent to sexual intercourse. Seventy-one (65.7%) reports stated that victims were not able to testify in court.</p><p><strong>Conclusion.</strong> Most reports stated that victims suffered from intellectual disability and their capacity to testify in court was impaired. More than half of the victims evaluated did not have the capacity to give consent to sexual acts.</p>
Needs-based gap analysis for service transformation in the Eastern Cape
Authors: Sukeri Kiran , Alonso-Betancourt Orlando , Emsley Robin 
Published: June 2017

<p><strong>Objectives. </strong>Part I of this research article presents a needs-based analysis for the management of schizophrenia, bipolar mood disorder and major depression for the Eastern Cape (EC) Province, South Africa. This part of the research paper focuses on quantifying human resources and bed needs for these three severe mental illnesses. Human resource expenditure is calculated for nursing staff at acute, ambulatory and medium-to-long-stay services. A further objective was to conduct a gap analysis for human resources and beds for the EC in order to assist mental health planners in the commissioning of services. </p><p><strong>Methods. </strong>Data from previous research conducted in the province, and international and national epidemiological studies were utilised to quantify the requirements for human resources (psychiatrists, medical officers/registrars, psychologists, nurses, occupational therapists and social workers) and beds for acute, medium-to-long-stay and ambulatory services at provincial and regional levels, to provide mental healthcare. The authors focused on three of the eight priority conditions set by the World Health Organization. A target coverage rate of 80% was used in all calculations. A gap analysis was conducted to demonstrate deficits and excesses, utilising available data on human resources and beds available in the province.</p><p><strong>Results. </strong>The results showed that the districts of Alfred Nzo and Ukhahlamba have no human resources or beds for the provision of mental health services. The province has a deficit of 23 psychiatrists and 243 nurses trained in psychiatry, and an oversupply of 486 other nurses. The results also clearly demonstrated an inequitable distribution of resources in the province. </p><p><strong>Conclusions. </strong>This is the first study that has provided detailed estimates of human resource and bed deficits in the EC. The study demonstrates that the areas of greatest need in terms of bed and human resource requirements are in the eastern regions of the province, which includes the former homelands of the Transkei and Ciskei. This study will assist provincial mental health planners/commissioners in developing an equitable mental health delivery programme.</p>
Adolescent attachment, family functioning and depressive symptoms
Authors: Rawatlal Nishola , Kliewer Wendy , Pillay Basil J 
Published: June 2017

<p><span><strong>Background.</strong> Adolescence represents a challenging transitional period where changes in biological, emotional, cognitive and social domains can increase the risk of developing internalised problems including subthreshold depression. Adolescent-parent attachment style, perceived support and family functioning may increase risk for depressive symptoms or may reduce such risk. Adolescent-parent attachment, adolescent-perceived support from parents and family functioning were examined as correlates of depressive symptom presentation within this age group.</span></p><p><strong>Methods.</strong> Participants included a maternal parent and an adolescent (65.5% female) from each family. Adolescents were in Grade 7 (<em>n</em>=175) or Grade 10 (<em>n</em>=31). Data were collected through home interviews. The Self-Report of Family Inventory (SFI), Experiences of Close Relationships Scale (ECR), Network of Relationships Inventory (NRI), Children’s Depression Inventory (CDI) and Child Behavior Checklist (CBCL) were used to assess depression, parental support and attachment. </p><p><strong>Results. </strong>Two models were examined: one with adolescent report of depressive symptoms as the outcome and a second with parent report of adolescent internalising symptoms as the outcome. The model predicting adolescent-reported depressive symptoms was significant with older age, higher levels of avoidant attachment, and higher levels of youth-reported dysfunctional family interaction associated with more depressive symptomatology. In the model predicting parent report of adolescent internalising symptoms only higher levels of dysfunctional family interaction, as reported by the parent, were associated with higher levels of internalising symptoms.</p><p><strong>Conclusion. </strong>Positive family communication, cohesion and support predictive of a secure parent-adolescent attachment relationship reduced the risk of a depressive symptom outcome. Secure adolescents were able to regulate their emotions, knowing that they could seek out secure base attachment relations within their family and from friends during times of stress, buffering against the development of depressive symptoms.</p>
Depressive symptoms among children whose parents have serious mental illness: Association with children’s threat-related beliefs about mental illness
Authors: Ola Bolanle , Suren Rakendu , Ani Cornelius 
Published: June 2017

<p><strong>Background. </strong>Sixty-eight per cent of women and 57% of men with mental illness are parents. There is increasing evidence of adverse psychosocial impact of parental mental illness on their children. However, among children whose parents have mental illness, the potential contribution of the children’s beliefs about mental illness to their own emotional distress is still poorly understood.</p><p><strong>Aim. </strong>To explore among children whose parents have serious mental illness, the relationship between the children’s beliefs about mental illness and their own depressive symptoms.</p><p><strong>Methodology. </strong>We conducted an interview-administered questionnaire survey of 67 Nigerian children whose parents were psychiatric inpatients. The children’s beliefs about mental illness were explored with five questions – two of which embedded threat-related beliefs. Their depressive symptoms were assessed with the Short Mood and Feelings Questionnaire (SMFQ) (Cronbach alpha 0.91). Based on stigma theory, we hypothesised that among this cohort, the children who hold threat-related beliefs about people with mental illness would report statistically significantly more depressive symptoms than those without similar beliefs. </p><p><strong>Results. </strong>The mean age (standard deviation (SD)) of the children was 13.3 (2.8) years, and 38% were males. Twenty-four per cent of the children believed mental illness is infectious. In line with our hypothesis, those holding this belief had statistically significantly more depressive symptoms compared with those without similar beliefs (<em>p</em>=0.001). Fifty-seven per cent of the children believed that people with mental illness are dangerous. However, contrary to our hypothesis, this belief was not associated with increased depressive symptoms (<em>p</em>=0.2). Multiple regression showed that statistically significant predictors of increased emotional symptoms were ‘belief that mental illness is infectious’ and younger age. The model explained 39.8% of the variance in SMFQ.</p><p><strong>Conclusion. </strong>In this and similar settings, psycho-education for children whose parents have serious mental illness should explore whether the children believe that mental illness is infectious. Providing reassurance to children holding such beliefs could reduce their risk of psychological distress.</p>
Late Holocene temperature variability in Tasmania inferred from borehole temperature data
Authors: Suman Asadusjjaman , Dyer Fiona , White Duanne 
Published: June 2017

Abstract. Thirty-six borehole temperature–depth profiles were analysed to reconstruct the ground surface temperature history (GSTH) of eastern Tasmania for the past 5 centuries. We used the singular value decomposition method to invert borehole temperatures to produce temperature histories. The quality of borehole data was classified as high or low based on model misfit. The quality of the borehole data was not dependent on topography or land use. Analysis reveals that three to five high-quality borehole temperature–depth profiles were adequate to reconstruct robust paleotemperature records from any area. Average GSTH reconstructed from Tasmanian boreholes shows temperature increases about 1.2 ± 0.2 °C during the past 5 centuries. Reconstructed temperatures were consistent with meteorological records and other proxy records from Tasmania during their period of overlap. Temperature changes were greatest around the north-east coast and decreased towards the centre of Tasmania. The extension of the East Australian Current (EAC) further south and its strengthening around the north-east coast of Tasmania over the past century was considered a prime driver of warmer temperatures observed in north-east Tasmania.
Deferred Frozen Embryo Transfer: What Benefits can be Expected from this Strategy in Patients with and without Endometriosis?
Authors: Bourdon Mathilde , Santulli Pietro , Gayet Vanessa , Maignien Chloé , Marcellin Louis , Chapron Charles 
Published: June 2017

Progress with cryopreservation techniques have enabled development of the deferred frozen-thawed embryo transfer (DET) strategy as an alternative to relying on fresh embryo transfers. With DET, the entire embryo cohort is cryopreserved, and embryo transfer is then performed in a subsequent cycle that takes place separately from the controlled ovarian stimulation (COS). Initially developed to limit the risk of ovarian hyperstimulation syndrome that occurs with high responders, this strategy has been applied extensively with other populations in an effort to improve implantation rates. The assumption is that COS, which is essential for in vitro fertilization/intra cytoplasmic sperm injection (IVF/ICSI) procedures to obtain a multi-follicular development, could have a detrimental impact on the endometrium as a result of greatly elevated levels of steroids. It is currently not clear whether the DET strategy can be generally applied to all women requiring an IVF/ICSI procedure. The objectives of this literature review regarding DET, were hence: (i) to present the scientific background that contributed to extensive adoption of this technique, (ii) to detail the pregnancy outcomes and potential obstetric and neonatal consequences, (iii) to report on its ability to prevent risks induced by COS, and (iv) to propose indications for the DET strategy in clinical practice.
Laparoscopic Surgery for Colorectal Endometriosis and its Impact upon Fertility: An Updated Australian Series of 307 Cases
Authors: Wills Hannah , Tsaltas Jim , Cooper Michael J.W. , Reid Geoffrey D. , Morgan Matthew , Woods Rod , Barel Oshri 
Published: June 2017

Introduction Colorectal involvement occurs in up to 12% of cases of endometriosis. Various surgical options for its management have been described, including segmental resection and disc excision, with debate surrounding indications for surgery and the impact of such procedures. The current study aimed to describe the experiences of three Australian gynaecologists regarding laparoscopic bowel surgery for colorectal endometriosis. Methods The records of three gynaecological surgeons were analysed for patients who underwent surgical removal of colorectal endometriosis by way of appendicectomy, bowel disc excision and/or segmental resection, between 1999 and 2012. Results A total of 307 patients were identified. Sixteen (5.2%) underwent appendicectomy, 146 (47.6%) underwent disc excision, 126 (41.0%) underwent segmental resection and 19 (6.2%) underwent simultaneous procedures. The majority of procedures were performed laparoscopically (265 of 307; 86.3%). Nineteen procedures (6.2%) were planned laparotomies due to the known extent of disease. Twenty-three procedures were converted from laparoscopy to laparotomy (conversion rate of 7.5%). Complications occurred in 35 of the 307 cases (11.4%). Sixty-seven women amongst the 122 wishing to conceive post-operatively achieved at least one pregnancy (pregnancy rate of 54.9%). Of the 84 pregnancies achieved amongst the 67 women who conceived, 49 (58.3%) were achieved through assisted reproductive technologies, and 31 pregnancies (36.9%) were conceived spontaneously. This information was unavailable for 4 pregnancies (4.8%). Conclusions The current series demonstrates that laparoscopic surgery for severe disease is feasible in specialised centres. Furthermore, such surgery may have a positive impact upon post-operative fertility.
Defining Skin Ulcers in Systemic Sclerosis: Systematic Literature Review and Proposed World Scleroderma Foundation (WSF) Definition
Authors: Suliman Yossra Atef , Bruni Cosimo , Johnson Sindhu R. , Praino Emanuela , Alemam Mohamed , Borazan Nabeel , Cometi Laura , Myers Bethany , Khanna Dinesh , Allanore Yannick , Baron Murray , Krieg Thomas , Herrick Ariane , Afonso Ana , Distler Oliver , Kafaja Suzanne , Denton Christopher P. , Matucci-Cerinic Marco , Furst Daniel E. 
Published: June 2017

Purpose There is a lack of a valid definition for skin ulcers in systemic sclerosis (SSc) to be used in clinical trials. Our aim was to develop a consensus definition for SSc skin ulcers based on the results of a systematic literature review (SLR) for skin ulcer definitions and expert opinion; and to evaluate its face validity, reliability and feasibility. Methods SLR for skin ulcer definitions was conducted using PubMed, Web of Science, and Cochrane library for articles published from inception to January 1st, 2016. SSc experts were to discuss the definition categories and vote for the relevant terms. Reliability of the definition was tested in a second expert meeting, seven SSc experts evaluated 7 SSc patients with skin lesions twice. Face validity and feasibility were evaluated by sending out case report forms (CRFs) to four SSc experts, who were each asked to use the definition in five patients. Results A total of 3464 abstracts and titles were screened, and 446 articles were fully evaluated. Of these, 66 met eligibility criteria and skin ulcer definitions were extracted. SSc experts discussed, refined, and voted on the consensus definition using nominal process. Kappa for inter-rater agreement was 0.51 and for intra-rater agreement was 0.90. The mean time to decide if the lesion is an ulcer was 7.4 seconds. All investigators endorsed the face validity of the new definition in the CRFs. Conclusions Using an SLR and a nominal technique, we developed a preliminary consensus-based definition of SSc skin ulcers. Face validity, feasibility and reliability were demonstrated for the developed definition.
Ultrasound Vector Flow Imaging – could be a new tool in evaluation of arteriovenous fistulas for hemodialysis?
Authors: Fiorina Ilaria , Raciti Maria Vittoria , Goddi Alfredo , Cantisani Vito , Bortolotto Chandra , Chu Shane , Calliada Fabrizio 
Published: June 2017

Introduction We report the use of a new ultrasound technique to evaluate the axial and lateral components of a complex flow in the arteriovenous fistula (AVF). Vector Flow Imaging (VFI) allows to identify different components of the flow in every direction, even orthogonal to the flow streamline, represented by many single vectors. VFI could help to identify flow alterations in AVF, probably responsible for its malfunction. Methods From February to June 2016, 14 consecutive patients with upper-limb AVF were examined with a Resona 7 (Mindray, Shenzhen, China) ultrasound scanner equipped with VFI. An analysis of mean velocity, angular direction and mean number of vectors impacting the vessel wall was carried out. We also identified main flow patterns present in the arterial side, into the venous aneurysm and in correspondence of significant stenosis. Results A disturbed flow with the presence of vectors directed against the vessel walls was found in 9/14 patients (64.28%): in correspondence of the iuxta-anastomotic venous side (4/9; 44.4%), into the venous aneurysmal tracts (3/9; 33.3%) and in concomitance of stenosis (2/9; 22.2%). The mean velocity of the vectors was around 20-25 cm/s, except in presence of stenosis, where the velocities were much higher (45-50 cm/s). The vectors directed against the vessel walls presented high angle attack (from 45° to 90°, with a median angular deviation 65°). Conclusions VFI was confirmed to be an innovative and intuitive imaging technology to study the flow complexity in the arteriovenous fistulas.
Virgilian Echoes: Arms and the Man and the Aeneid
Authors: Leary Daniel 
Published: June 2017

ABSTRACT
This article began as “From Caesar to Joan: Shaw's Epic Hero with a Dozen Faces.” Then the author decided to add another character: Bluntschli of Arms and the Man since Bluntschli was a version of Aeneas in the play the title of which was taken from the opening of Virgil's Aeneid. That Shaw had epic in mind is confirmed by this title and by his very apparent use of Virgilian echoes, especially in the first act. This early play provides a clear view of Shaw assembling the characteristics of an epic, while doing his educating variations, very craftily. This article treats Act I as the first stage, the Literal stage, of a four-stage approach that it takes from Dante's reading of scripture. At this time, it deals only with the first three stages. The article moves from the Literal How to the Why of the Tropecal (sic) level, then to the Moral level. (It leaves the fourth level, the Anagogical, for a later article.)
The Shavian Protagonists and Shaw's Changing Use of Classical Myths
Authors: Li Kay 
Published: June 2017

ABSTRACT
This article illustrates Shaw's changing use of classical myths to portray his protagonists. As these protagonists developed with his theory of the Life Force and Creative Evolution, they were structurally configured and supported through manipulations of classical myths. First, Shaw makes use of mythical elements in his early writings. Then he thinks through classical myths. Ultimately, he makes his own myth of the Life Force and Creative Evolution and, in so doing, dismantles the scaffolding provided by the classical myths. As Shaw drifts away from the socialist and political writer wanting to amend the defects of social systems and becomes a visionary and a mystic, he is increasingly reliant on classical myths as elevated platforms to work out his concept of the superman.