P02-270 “Education, education, education-” adult liaison psychiatry (consultation-liaison): Can service development fulfil educational needs?

Introduction

Liaison Psychiatry is primarily concerned with the detection and treatment of psychiatric disorders within the general hospitals. 1A study2 also highlighted the presence of only 45.5 core trainee posts in this speciality nationally.

Aims & objective

To survey the liaison psychiatry service recently set up as a service provision at a psychiatry unit in North Derbyshire.

Methods

We retrospectively reviewed all case notes of patients who had been assessed from January 2007 to June 2009 by the consultation-liaison service.

Results

A total of 136 patients had been assessed since this service began in September 2007. Majority of the patients (72%) were between the ages of 31 to 65 years, while the gender was equally distributed. 51% were referred from the medical ward and most of them had been referred by core trainee. 95% of the referral was during working hours and 74% of the patients were assessed within 24 hours. Their diagnosis was variable, for e.g. 29% had depression, 19% had substance misuse problems, 8% had psychosis etc. 66% of patients were managed by medication advice, psycho-education and referral to CMHT/GP.

Conclusions

Liaison psychiatry was established for service provision, but it is apparent that it fulfilled both clinical and educational needs, despite the challenges. Adequate experience can be gained with a well supervised service. The overall educational value of designing and implementing a new service as a trainee cannot be overstated; it is something which is difficult to learn in classrooms.

Dominant spinal muscular atrophy with lower extremity predominance: linkage to 14q32

OBJECTIVE

Spinal muscular atrophies (SMAs) are hereditary disorders characterized by weakness from degeneration of spinal motor neurons. Although most SMA cases with proximal weakness are recessively inherited, rare families with dominant inheritance have been reported. We aimed to clinically, pathologically, and genetically characterize a large North American family with an autosomal dominant proximal SMA.

METHODS

Affected family members underwent clinical and electrophysiologic evaluation. Twenty family members were genotyped on high-density genome-wide SNP arrays and linkage analysis was performed.

RESULTS

Ten affected individuals (ages 7-58 years) showed prominent quadriceps atrophy, moderate to severe weakness of quadriceps and hip abductors, and milder degrees of weakness in other leg muscles. Upper extremity strength and sensation was normal. Leg weakness was evident from early childhood and was static or very slowly progressive. Electrophysiology and muscle biopsies were consistent with chronic denervation. SNP-based linkage analysis showed a maximum 2-point lod score of 5.10 (theta = 0.00) at rs17679127 on 14q32. A disease-associated haplotype spanning from 114 cM to the 14q telomere was identified. A single recombination narrowed the minimal genomic interval to Chr14: 100,220,765-106,368,585. No segregating copy number variations were found within the disease interval.

CONCLUSIONS

We describe a family with an early onset, autosomal dominant, proximal SMA with a distinctive phenotype: symptoms are limited to the legs and there is notable selectivity for the quadriceps. We demonstrate linkage to a 6.1-Mb interval on 14q32 and propose calling this disorder spinal muscular atrophy-lower extremity, dominant.

Electrochemical cell for neutron reflectometry studies of the structure of ionic liquids at electrified interface

We describe the design and use of a closed three-electrode electrochemical cell for neutron reflectometry studies of the structure of the electrical double-layer in ionic liquids. A transparent glass counter electrode was incorporated to allow easy monitoring of any gas bubbles trapped in the cell. A 100 mm diameter silicon wafer polished to 0.1 nm rms roughness coated with gold over a chromium adhesion layer was used as the working electrode. The utility of the cell was demonstrated during neutron reflectometry measurements of the ultrahigh purity ionic liquid 1-butyl-1-methylpyrrolidinium bis(trifluoromethylsulfonyl)imide ([C(4)mpyr][NTf(2)]) at two different applied potentials.

Using response cards to increase student participation in an elementary classroom

The use of response cards during large-group social studies instruction was evaluated in a fourth-grade classroom. The experiment consisted of two conditions, hand raising and write-on response cards, alternated in an ABAB design. During baseline, the teacher called upon 1 student who had raised his or her hand in response to the teacher's question. During the response-card condition, each student in the class was provided with a white laminated board on which to write one- or two-word answers in response to each question asked by the teacher. Rate of active student response during instruction was much higher with response cards than with hand raising. Most students scored higher on daily quizzes following sessions in which response cards were used than they did on quizzes that followed hand-raising sessions. Response cards were preferred over hand raising by 19 of the 20 students in the class.

Effects of response cards on student participation and academic achievement: A systematic replication with inner-city students during whole-class science instruction

We evaluated the use of response cards during science instruction in a fifth-grade inner-city classroom. The experiment consisted of two methods of student participation-hand raising and write-on response cards-alternated in an ABAB design. During hand raising, the teacher called upon 1 student who had raised his or her hand in response to the teacher's question. During the response-card condition, each student was provided with a laminated board on which to write one- or two-word answers in response to each question asked by the teacher. Frequency of active student response was 14 times higher with response cards than with hand raising. All 22 students scored higher on next-day quizzes and on 2-week review tests that followed instruction with response cards than they did on quizzes and tests that covered facts and concepts taught with the hand-raising procedure.

Effects of active student response during error correction on the acquisition, maintenance, and generalization of science vocabulary by elementary students: A systematic replication

We compared active student response (ASR) error correction and no-response (NR) error correction while teaching science terms to 5 elementary students. When a student erred on ASR terms, the teacher modeled the definition and the student repeated it. When a student erred on NR terms, the teacher modeled the definition while the student looked at the vocabulary card. ASR error correction was superior on each of the study's seven dependent variables.

A carotid artery aneurysm with a twist: case report and review

BACKGROUND

Since their original description in 1687, aneurysms of the extracranial internal carotid artery (ICA) remain rare and account for less than 2% of all carotid operations (Zwolak et al. in: J Vasc Surg 1:415-422, 1984; El-Sabrout, Cooley in: J Vasc Surg 31:702-712, 2000). Cerebrovascular morbidity and mortality rates remain high without intervention (Zwolak et al. in: Vasc Surg 1:415-422, 1984).

CASE REPORT

We report an unusual case of a saccular extracranial ICA aneurysm associated with kinking of the ICA and highlight the potential complications and risks associated with such an extreme anatomical deformation.

CONCLUSION

Extracranial ICA aneurysm can be associated with unusual anatomical variations which can lead to unstable clinical symptomatology due to the variable presence of atherosclerotic material. Despite advances in diagnosis and treatment, surgical repair is not without risks and patients need to be informed of the potential complications.

Induced increase in virulence of low virulence highly [corrected] pathogenic avian influenza by serial intracerebral passage in chickens

Two highly pathogenic avian influenza (HPAI) virus clones that met the criteria for high-pathogenicity avian influenza viruses, by possessing a multibasic hemagglutinin (HA) cleavage site, were isolated from an H5N1 outbreak in Norfolk, England, in 1991-92. These two isolates, A/turkey/England/50-92/91 (50-92) and A/turkey/England/87-92/91 (87-92), displayed differences in virulence as determined by intravenous pathogenicity index-3 and -0, respectively. DNA sequencing of these two isolates identified 10 amino acid differences throughout the genome: three in HA and polymerase B2 (PB2) and two in polymerase B1 (PB1) and single mutations in nucleoprotein (NP) and polymerase A (PA). Serial intracerebral passages were performed in 1- or 2-day-old specific pathogen free (SPF) chicks with 87-92. Viruses reisolated from each bird passage displayed increases in intracerebral pathogenicity index values (from 0 to 1.9) and therefore virulence. Reverse transcriptase polymerase chain reaction and DNA sequencing on viruses isolated at each passage displayed nine out of the 10 mutations associated with the higher pathogenic genotype of 50-92, except for the mutation found in NP, which retained the amino acid residue associated with 87-92. Serial passage through 9-day-old SPF embryonated chicken eggs and serial intravenous passage in 6-wk-old birds could not reproduce these results. These results further highlight that nucleotide changes in the genome other than at the HA cleavage site can attenuate the virulence of HPAI viruses.

Measurement of the D(s)+ lifetime

A high statistics measurement of the D(s)+ lifetime from the Fermilab fixed-target FOCUS photoproduction experiment is presented. We describe the analysis of the two decay modes, D(s)+ --> phi(1020)pi+ and D(s)+ -->K*(892)0K+, used for the measurement. The measured lifetime is 507.4 +/- 5.5(stat) +/- 5.1(syst) fs using 8961 +/- 105 D(s)+ --> phi(1020)pi+ and 4680 +/- 90 D(s)+ --> K*(892)0K+ decays. This is a significant improvement over the present world average.

International Master Classes in health informatics

Master Classes arose within the performing arts and are now being offered in system sciences. The IPhiE group of faculty from six universities in Europe and the United States has offered Master Classes in health informatics to provide an integrative forum for honors students. Featured are international views of health systems, varied opportunities for student interaction and promotion of informatics professionalism. Five years of experience indicate the success of this concept and suggest changes that will be considered for the future.

Effects of iron deficiency on the secretion of interleukin-10 by mitogen-activated and non-activated murine spleen cells

Interleukin (IL)-10 plays crucial regulatory roles in immune responses by inhibiting the secretion of several cytokines (IL-2, IL-12, interferon-gamma (IFN-gamma)) and lymphocyte proliferation. Iron deficiency, a public health problem for children, alters these immune responses. To determine whether these changes are related to altered IL-10 secretion, we measured IL-10 in 24 and 48 h supernatant of spleen cell cultures from iron deficient (ID), control (C), pairfed (PF), and ID mice fed the control diet (iron repletion) for 3 (R3) and 14 (R14) days (d, n = 12/group). Mean levels of hemoglobin, hematocrit, and liver iron stores varied as follows: C approximately equal PF approximately equal R14 > R3 > ID (P < 0.01). Mean baseline IL-10 levels of ID mice tended to be higher than those of other groups (P > 0.05, ANOVA). Mean IL-10 levels secreted by concanavalin A (Con A) and antibody raised against cluster of differentiation molecule 3 (anti-CD3)-treated cells (+/-background) were lower in ID than in C (48 h) and iron replete mice (P < 0.05). Underfeeding also reduced IL-10 secretion by anti-CD3-treated cells (48 h, P < 0.05). Lymphocyte proliferative responses to anti-CD3 +/- anti-CD28 antibodies were lower in ID than in C and PF mice, and they were corrected by iron repletion (P < 0.05). IL-10 levels negatively correlated with indicators of iron status (r <or= -0.285) and lymphocyte proliferation (r <or= -0.379 [r <or= -0.743 for ID mice]), but positively correlated with IFN-gamma levels (r <or= 0.47; P < 0.05). Data suggest that iron deficiency has a generalized deleterious effect on cells that secrete both cytokines. Reduced IL-10 secretion by activated cells does not overcome the inhibition of lymphocyte proliferation due to other factors of T cell activation that are regulated by iron.

A high statistics measurement of the Lambda(+)(c) lifetime

A high statistics measurement of the Lambda(+)(c) lifetime from the Fermilab fixed-target FOCUS photoproduction experiment is presented. We describe the analysis technique with particular attention to the determination of the systematic uncertainty. The measured value of 204.6 +/- 3.4 (stat) +/- 2.5 (syst) fs from 8034 +/- 122 Lambda(+)(c)-->pK(-)pi(+) decays represents a significant improvement over the present world average.

Search for CP violation in the decays D+--> K(S)pi+ and D+-->K(S)K+

A high-statistics sample of photoproduced charm from the FOCUS experiment has been used to search for direct CP violation in the decay rates for D+-->K(S)pi+ and D+-->K(S)K+. We have measured the following asymmetry parameters relative to D+-->K-pi+pi+: A(CP)(K(S)pi+) = (-1.6+/-1.5+/-0.9)%, A(CP)(K(S)K+) = (+6.9+/-6.0+/-1.5)%, and A(CP)(K(S)K+) = (+7.1+/-6.1+/-1.2)% relative to D+-->K(S)pi+. We have also measured the relative branching ratios and found Gamma(D+-->K(0)pi+)/Gamma(D+-->K-pi+pi+) = (30.60+/-0.46+/-0.32)%, Gamma(D+-->K(0)K+)/Gamma(D+-->K-pi+pi+) = (6.04+/-0.35+/-0.30)%, and Gamma(D+-->K(0)K+)/Gamma(D+-->K(0)pi+) = (19.96+/-1.19+/-0.96)%.

Measurement of the branching ratios of D(+) and D(+)(s) hadronic decays to four-body final states containing a K(S)

We have studied hadronic four-body decays of D(+) and D(+)(s) mesons with a K(S) in the final state using data recorded during the 1996-1997 fixed-target run of the Fermilab high energy photoproduction experiment FOCUS. We report a new branching ratio measurement of gamma(D(+)-->K(S)K-pi(+)pi(+))/gamma(D(+)-->K(S)pi(+)pi(+)pi(-)) = 0.0768+/-0.0041+/-0.0032. We make the first observation of three new decay modes with branching ratios gamma(D(+)-->K(S)K+pi(+)pi(-))/gamma(D(+)-->K(S)pi(+)pi(+)pi(-)) = 0.0562+/-0.0039+/-0.0040, gamma(D(+)-->K(S)K+K-pi(+))/gamma(D(+)-->K(S)pi(+)pi(+)pi(-)) = 0.0077+/-0.0015+/-0.0009, and gamma(D(+)(s)-->K(S)K+pi(+)pi(-))/gamma(D(+)(s)-->K(S)K-pi(+)pi(+)) = 0.586+/-0.052+/-0.043, where in each case the first error is statistical and the second error is systematic.