Studies of saturated absorption and measurements of optical frequency for lines in the nu1 + nu3 and nu1 + 2nu4 bands of ammonia at 1.5 microm

A cavity-enhanced absorption spectrometer was used to saturate several lines of ammonia in the 1510 nm - 1560 nm region. Analysis of power broadening of the saturated absorption feature for one of the ammonia lines yielded a dipole moment value comparable to that of the lines in the nu(1)+nu(3) band in acetylene. Highly reproducible frequency measurements of four ammonia line centres were carried out using a frequency comb generated by a mode-locked Cr(4+):YAG laser. These results demonstrate the possible application of ammonia saturated absorption lines for frequency metrology and calibration in a spectral region lacking strong absorbers. To our knowledge, this is the first frequency measurement of saturated absorption lines in ammonia at near infrared frequencies and the first reported observation of saturated absorption lines in the nu(1)+2nu(4) band.

Access to medications in the community by patients in a palliative setting. A systems analysis

This study performed a systems analysis of the process by which patients under the care of a specialist palliative home care obtained medications, and highlighted factors that delay this process. Systems analysis is the science dealing with analysis of complex, large-scale systems and the interactions within those systems. This study used a mixed-methods approach of questionnaires of general practitioners, pharmacists and patients, and a prospective observational study of delays experienced by patients referred to the home care team over a three-month period. This study found the main factors causing delay to be: medications not being in stock in pharmacies, medications not being available on state reimbursed schemes and inability of patients and carers to courier medications.

Contemporary management of drug-packers

Experience with management of drug-packers (mules) is variable among different centres. However, despite a recorded increase in drug trafficking in general, as yet, no unified, clear guidelines exist to guide the medical management of those who only occasionally encounter these individuals. We describe our recent experience with this growing problem and discuss the most salient points concerning the contemporary management of body packers. Our recent experience demonstrates that type IV packages may now be managed conservatively for the most part.

Person Focused Training: a model for delivering positive behavioural supports to people with challenging behaviours

BACKGROUND

Person Focused Training is introduced as a model of service delivery for people with severe challenging behaviours. It is defined as training and supporting staff to conduct functional assessments and to design and implement positive behavioural support for specific individuals with challenging behaviours.

METHOD

Longitudinal outcome data are presented from 138 behaviour support plans developed by staff over a seven year period were analysed to determine reductions in frequency of challenging behaviours. Degree of behaviour change was determined across topography of behaviour, gender, age, level of disability, location of residence and role of course participant.

RESULTS

Results indicate that the implementation by staff of behaviour support plans are associated with significant improvement in 77% of cases at an average follow-up of 22 months after implementation of support plans. Only location of residence was identified as related to reduction in challenging behaviours with large residential centres being associated with lower rates of behavioural improvement.

CONCLUSIONS

It is argued that Person Focused training may represent an alternative to existing models of supporting individuals with challenging behaviours. The implications of front-line staff designing and implementing behaviour support plans for the organisation of services and the role of the clinical psychologist are considered.

The self-assessed oral health status of individuals from White, Indian, Chinese and Black Caribbean communities in South-east England

OBJECTIVES

To determine the level of self-assessed oral symptoms and the impact of such symptoms among individuals from four ethnic groups resident in South-east England and the relationship between self-assessed oral health status, age, gender, employment status, educational level and ethnicity.

METHOD

Cross-sectional survey of a convenience sample of 366 individuals drawn from four ethnic groups.

MEASURES

Subjective Oral Health Status Indicators (SOHSI).

PARTICIPANTS

Individuals were recruited through community groups. All participants self-classified their ethnicity. Only completed questionnaires from participants categorising themselves as White, Black Caribbean, Chinese or Indian were included in the data analysis.

FINDINGS

Univariate statistical analysis revealed significant differences between ethnic groups in all but one of the SOHSI scales. Age and ethnicity (in particular membership of the Chinese community) emerged as significant predictors of SOHSI scale scores.

CONCLUSIONS

Within the limitations imposed by convenience sampling, it has been found that differences exist among four ethnic groups in the UK in their reporting of self-assessed oral health status. Ethnicity and age, in particular, predict the reporting of self-assessed oral symptoms and the impact of such symptoms.

Joint and soft tissue injections in the community: questionnaire survey of general practitioners' experiences and attitudes

OBJECTIVES

To investigate the numbers and types of joint and soft tissue injections performed by general practitioners (GPs) and to explore attitudes to training in joint and soft tissue injection and perceived barriers to performing injections.

METHODS

A self administered questionnaire was mailed to a random sample of 410 (30%) of 1367 GPs in Northern Ireland. Two mailings were used to increase the response rate. Questions explored the GPs' demographic characteristics, types and numbers of injections performed, previous training experience, attitudes towards training, and perceived barriers.

RESULTS

The overall response rate was 75%. Practitioners who were men, worked in a "rural" or "mixed" locality, and had had a previous post in rheumatology, orthopaedics, or sports medicine were more likely to perform joint and soft tissue injections. Forty six per cent of GPs did not currently perform any injections; 5% of GPs performed most of the injections in the community. Injections into the shoulder, knee, and lateral epicondylitis were found to be the most commonly performed injections. The GPs preferred to train on "real patients" rather than "mannequin models". Those GPs who had trained on "real patients" were more likely to perform injections. The main perceived barrier to performing joint and soft tissue injections in the community was the "inability to maintain injection skills".

CONCLUSION

Postgraduate training, methods of training, and the ability to maintain injection skills seemed to be determinants affecting GP confidence and the amount of joint and soft tissue injections that they performed. Most injections were performed by a few GPs in the community. These findings may have implications for the developing role of GP specialists in primary care trusts.

The Assaulted Staff Action Program (ASAP) and declines in the prevalence of assaults: community-based replication

The Assaulted Staff Action Program (ASAP) has been associated with sharp reductions in the frequency of patient assaults on staff in four state hospital settings. Recent national trends in healthcare have resulted in an emphasis on community-based services. This case study sought to assess the effects of ASAP and findings of reduced assaults in a community-based program. In a single-case design, in which the facility served as its own control, an ASAP program was fielded in a community mental health center. A similar sharp reduction in violence was observed. The implications of the findings are presented.

The mouth-body split: conceptual models of oral health and their relationship to general health among ethnic minorities in South Thames Health Region

OBJECTIVE

To identify and describe conceptual models of oral health shared by people from different minority ethnic groups, in particular the relationship between 'oral health' and 'general health'. To identify how these conceptions vary across social factors.

BASIC RESEARCH DESIGN

In-depth interviews. Analysis of the interview data to identify the conceptual models used by participants in discussing oral health and its relationship to general health.

PARTICIPANTS

Ninety-five individuals from different ethnic groups.

RESULTS

Two models of 'health' were identified. The first reflected a traditional model which related health to the absence of disease. The second encompassed a broad definition of health including not only physical but social and psychological well-being and the ability to carry out everyday functions. The model within which an individual operated was influenced by ethnicity and gender. Additionally, two models of the relationship between oral health and general health were identified: one in which the two concepts were seen as separate but related; the other in which oral health and general health were viewed as inseparable aspects of a single dimension.

CONCLUSIONS

People from minority ethnic groups vary in their understanding of oral health and its relationship to general health. This variation can be explained in part by ethnic and cultural factors. This finding has important implications both for the design of measures which seek to assess oral health related quality of life, and for the development of health promotional materials.

A national survey of dental hygienists: working patterns and job satisfaction

OBJECTIVE

To describe the working practices and level of job satisfaction of dental hygienists in the United Kingdom.

DESIGN

Postal questionnaire survey of 3,955 dental hygienists registered with the General Dental Council. Replies were received from 2,533 (64%).

RESULTS

At the time of the survey only a small proportion of respondents (11%) were not working as dental hygienists, the most common reason for a current career break being child rearing. The majority of dental hygienists (78%) were employed in general dental practices, and most worked in more than one practice (64%). Approximately half worked part-time (fewer than 30 hours per week), and part-time working was more common amongst those respondents with childcare responsibilities. In the region of 60% of respondents had taken one or more career breaks during their working life, and the average total duration of career breaks was 11 months, the most common reason for all career breaks was child rearing. Additional qualifications had been gained by 35% of the sample, a high proportion (75%) had attended training courses in the previous year. The respondents expressed a high degree of job satisfaction, those who were older and who had childcare responsibilities expressed higher levels of job satisfaction.

CONCLUSIONS

Dental hygienists express a high level of job satisfaction. A proportion take breaks in their career, most commonly for pregnancy and child rearing. The majority return to part-time employment after their career break. Planning of future requirements for the training of professionals complementary to dentistry should be informed by a consideration of the working patterns of dental hygienists.

The working practices and job satisfaction of dental therapists: findings of a national survey

OBJECTIVE

To describe the working practices and level of job satisfaction of dental therapists in the United Kingdom.

DESIGN

Postal questionnaire survey of 380 dental therapists registered with the General Dental Council.

RESULTS

Only 13% of dental therapists are also qualified as dental hygienists. Around 75% of those registered with the GDC are currently employed as dental therapists. Of those not currently working as dental therapists most were either working as hygienists or caring for their children at home. Over 90% of those working as therapists are employed within the Community Dental Service. About half work part-time. Part-time working is more common among respondents with childcare responsibilities. Most dental therapists are employed in clinical roles, and perform a limited range of treatments. A small proportion appear to have been asked to undertake duties which are not currently legal for them to perform. Three-quarters of those who were currently working as dental therapists had taken career breaks at some point, the most common reasons for such a break being a change in career and/or child rearing. The respondents expressed a high level of job satisfaction, particularly among older dental therapists.

CONCLUSIONS

Dental therapy offers a potentially rewarding career in terms of job satisfaction. Any planned increase in the numbers of training places for dental therapists should their role be expanded, for example to include working in general dental practice, would need to take cognisance of the high rate of part-time working and the proportion who could be expected to take career breaks at some point in their working lives, as is the case with female dental practitioners.

Susceptibility and outcome in oral cancer: preliminary data showing an association with polymorphism in cytochrome P450 CYP2D6

Members of the cytochrome P450 and glutathione S-transferase supergene families are candidates for susceptibility and outcome in oral squamous cell cancer. We determined GSTM1, GSTM3, GSTT1, CYP1A1 and CYP2D6 genotypes in 100 Caucasian cases and 467 control individuals. The frequency of homozygosity for mutant CYP2D6 alleles was higher in the cases (P = 0.001, OR = 3.2, 95% CI = 1.6-6.5) than control individuals. In the cases, the frequency of homozygosity for mutant alleles was greater and that of homozygosity for wild-type CYP2D6 alleles was lower in those diagnosed at > or = 65 years (P = 0.009) than in those diagnosed at < or = 64 years. The older cases included relatively more women and patients who did not consume tobacco or alcohol. The association of CYP2D6 with outcome was assessed using the Cox's proportional hazards model. The time to first cervical node metastasis was shorter in heterozygotes and homozygotes for mutant CYP2D6 alleles compared with homozygotes for wild-type alleles after correction for age at diagnosis, gender, alcohol and tobacco consumption and tumour differentiation (P = 0.04, hazard ratio 3.6, 95% CI 1.1-12.5). The mechanism for the association of CYP2D6 alleles with susceptibility and outcome is unclear though the data are compatible with the view that homozygosity for mutant alleles confers impaired detoxication of an unknown carcinogen. No associations between GSTM1, GSTM3, GSTT1 or CYP1A1 genotypes and susceptibility or, time to node metastases were identified. We previously showed that CYP2D6 genotypes were not associated with susceptibility to squamous cell cancer in the pharynx or larynx. Therefore, the data presented suggest that susceptibility to squamous cell cancer in the various parts of the upper aerodigestive tract is associated with different genes and allelic variants.

Clomipramine challenge responses covary with Tridimensional Personality Questionnaire scores in healthy subjects

Cloninger's Unified Biosocial Theory of Personality postulates a relationship between the relative functional activity of central serotonergic, dopaminergic, and noradrenergic neurotransmitter systems, and the strength of three elemental dimensions of personality. These dimensions are Harm Avoidance, Novelty Seeking, and Reward Dependence, respectively. Accordingly, we predicted that neuroendocrine responses to serotonergic challenge would correlate with Harm Avoidance scores, but not with Novelty Seeking or Reward Dependence scores. We examined the relationship between the prolactin and cortisol responses to a 12.5-mg intravenous clomipramine challenge and these personality dimensions as measured by Cloninger's Tridimensional Personality Questionnaire in 32 healthy subjects. The cortisol response correlated only with Harm Avoidance scores, as predicted; however, prolactin response did not correlate with Harm Avoidance scores. Instead, it demonstrated an inverse relationship with Novelty Seeking scores. There was a positive relationship of baseline prolactin with Harm Avoidance in a post hoc analysis. Cortisol response to serotonergic challenge may be a better indicator for responsivity of serotonergic systems as they relate to the personality dimension of Harm Avoidance than is prolactin. Prolactin responses may be overly affected by dopaminergic influences; however, baseline prolactin may still be a valid indicator of serotonergic tone.

An audit of one surgeon's experience of oral squamous cell carcinoma using computerised malignancy database

The results of an audit of a single surgeon's experience of oral squamous cell carcinoma over a 5-year period is reported and the benefits of adopting a prospective computerized malignancy database outlined. Oral cancer occurred mainly in the 7th decade of life, women were on average 5 years younger than men at presentation. Men were affected 1.7 times as often as women and presented with more advanced disease than women. The mean delay from referral to histological diagnosis was 6.4 days and the mean delay from diagnosis to treatment was 25.8 days. The majority of patients consumed alcohol and smoked tobacco, but a significant minority were lifelong nondrinkers and non-smokers. While the incidence of most site-specific oral cancers were similar to the national averages the incidences of alveolar and floor of mouth cancers were higher than expected. The TNM stage at presentation was an unreliable prognostic indicator of future disease progression and outcome. Auditing treatment and outcome is a major component of the recent proposals to centralise the provision of cancer services in dedicated cancer centres and units (1). Audit can only be effective if it is based on current, reliable and accurate data and this can only be achieved by the use of a computerised malignancy database.

Cumulative operative procedures in patients aged 14 years and older with unilateral or bilateral cleft lip and palate

Sixty-seven consecutive patients over the age of 14 with either unilateral (n = 38) cleft lip and palate or bilateral (n = 29) cleft lip and palate seen over a 15-month period at the University of Michigan Craniofacial Program were reviewed to determine the total number of surgical procedures performed over the course of treatment. The demographics of the two groups differed: There were 25 males and 13 females who were a mean age of 17 years and 9 months with unilateral cleft lip and palate and 23 males and 6 females who were a mean age of 18 years and 5 months with bilateral cleft lip and palate. Lip and palate repairs were carried out on all patients. Lip adhesions were performed in 29 and 62 percent; pharyngoplasties (either pharyngeal flap or modified Ortichochea) in 39 and 38 percent; alveolar bone grafts in 82 and 79 percent; Abbé flaps in 0 and 10 percent; and orthognathic surgery was done in 10.5 and 13.8 percent and recommended and/or done in 26 and 24 percent of patients with unilateral cleft lip and palate and bilateral cleft lip and palate, respectively. Lip revisions averaged 1.13 and 2.17 per patient and secondary nasal surgeries averaged 1.13 and 1.18 per patient in the unilateral cleft lip and palate and bilateral cleft lip and palate, respectively. All totaled, the average number of operations was 6.12 per patient (range 3 to 12) in the unilateral cleft lip and palate and 8.04 per patient (range 5 to 15) in the bilateral cleft lip and palate.(ABSTRACT TRUNCATED AT 250 WORDS)

Central serotonergic changes following antidepressant treatment: a neuroendocrine assessment

We employed a neuroendocrine challenge paradigm to study the effects of antidepressant treatment on serotonergic systems in depressed patients. We compared the maximum prolactin response to intravenous clomipramine (CMI) in depressed patients who responded to antidepressant treatment to that of nonresponders. Pretreatment baseline prolactin concentrations and pretreatment prolactin responses to clomipramine challenge were not different in responders compared to non-responders. However, following antidepressant treatment, the 6 responders demonstrated a significant change in their clomipramine challenge test results, as indicated by an increase in prolactin responses. In contrast, the 7 nonresponders did not demonstrate a change in their prolactin response to clomipramine challenge following treatment. These data support the hypothesis that serotonergic system dysfunction, as manifested by blunted prolactin response to clomipramine challenge, tends to normalize after successful treatment for depression, and that abnormal serotonergic function may be a state-dependent characteristic.

Circulating natural killer cell phenotypes in men and women with major depression. Relation to cytotoxic activity and severity of depression

The effects of major depression on peripheral blood natural killer cell phenotypes and natural killer cell activity were studied by comparing depressed and normal control subjects. Depressed subjects exhibited (1) significant reductions in Leu-11 (CD16) natural killer effector cells and natural killer cell activity and (2) a dissociation of the normal positive correlation between the percentage of Leu-11 cells and natural killer cell activity. These findings suggest that alterations in the availability and the killing capacity of circulating Leu-11 natural killer cells appear to be responsible for depression-related reductions in natural killer cell activity. Moreover, men with major depression showed marked reductions in Leu-11 cells, natural killer cell activity, and Leu-7 (HNK-1) lymphocytes compared with normal control men. By contrast, depressed women did not differ significantly from normal control women on any of these three immune function measures. Severity of depression as assessed by Hamilton Rating Scale for Depression scores was not associated with natural killer cell activity or Leu-7 lymphocyte levels in either men or women with major depression. Hamilton Rating Scale for Depression severity ratings were, however, strongly inversely correlated with Leu-11 lymphocyte counts among men, but not women, with major depression. These data begin to elucidate the immunological mechanisms by which natural killer cell activity is altered in depression and suggest that some measures of immunity may be differentially affected in male and female subjects with the syndrome of major depression.

Analysis of E1A-mediated growth regulation functions: binding of the 300-kilodalton cellular product correlates with E1A enhancer repression function and DNA synthesis-inducing activity

Adenovirus E1A transforming function requires two distinct regions of the protein. Transforming activity is closely linked with the presence of a region designated conserved domain 2 and the ability of this region to bind the product of the cellular retinoblastoma tumor suppressor gene. We have investigated the biological properties of the second transforming region of E1A, which is located near the N terminus. Transformation-defective mutants containing deletions in the N terminus (deletion of residues between amino acids 2 and 36) were deficient in the ability to induce DNA synthesis and repress insulin enhancer-stimulated activity. The function of the N-terminal region correlated closely with binding of the 300-kilodalton E1A-associated protein and not with binding of the retinoblastoma protein. These results indicate that transformation by E1A is mediated by two functionally independent regions of the protein which interact with different specific cellular proteins and suggest that the 300-kilodalton E1A-associated protein plays a major role in E1A-mediated cell growth control mechanisms.