The helping network approach: Community promotion of mental health

The Galt Helping Network Project was a two-year program to augment mental health and community services in a rural California community through the use of natural or informal resources. The experiment made use of a preventive intervention model which identified important needs of local youth and families, board and care residents, the entire community for recreation and for mental health services, and the Mexican American Community for recognition and participation. It brought a number of volunteers into the provision of direct services and created a number of institutional forms by which continued services and enlarged voluntary participation in community affairs are continuing beyond the official end of the project. This article concludes that the Galt Helping Network Model can provide a major contribution to mental health maintenance and community involvement through the recognition of natural helpers and the involvement of the community in an active form of problem solving. Through these methods a community with limited fiscal resources can take a major step toward providing a caring and helping environment for its members.

Light drinking versus abstinence in pregnancy - behavioural and cognitive outcomes in 7-year-old children: a longitudinal cohort study

OBJECTIVE

To assess whether light drinking in pregnancy is linked to unfavourable developmental outcomes in children.

DESIGN

Prospective population-based cohort.

SETTING

UK.

POPULATION

Ten thousand five hundred and thirty-four 7-year-olds.

METHODS

Quasi-experimental using propensity score matching (PSM) to compare children born to light (up to 2 units per week) and non-drinkers.

MAIN OUTCOME MEASURES

Behavioural difficulties rated by parents and teachers; cognitive test scores for reading, maths and spatial skills.

RESULTS

Ordinary least squares (OLS) regression and PSM analyses are presented. For behavioural difficulties, unadjusted estimates for percentage standard deviation (SD) score differences ranged from 2 to 14%. On adjustment for potential confounders, differences were attenuated, with a loss of statistical significance, except for teacher-rated boys' difficulties. For boys, parent-rated behavioural difficulties: unadjusted, -11.5; OLS, -4.3; PSM, -6.8; teacher-rated behavioural difficulties: unadjusted, -13.9; OLS, -9.6; PSM, -10.8. For girls, parent-rated behavioural difficulties: unadjusted, -9.6; OLS, -2.9; PSM, -4.5; teacher-rated behavioural difficulties: unadjusted, -2.4; OLS, 4.9; PSM, 3.9. For cognitive test scores, unadjusted estimates for differences ranged between 12 and 21% of an SD score for reading, maths and spatial skills. After adjustment for potential confounders, estimates were reduced, but remained statistically significantly different for reading and for spatial skills in boys. For boys, reading: unadjusted, 20.9; OLS, 8.3; PSM, 7.3; maths: unadjusted, 14.7; OLS, 5.0; PSM, 6.5; spatial skills: unadjusted, 16.2; OLS, 7.6; PSM, 8.1. For girls, reading: unadjusted, 11.6; OLS, -0.3; PSM, -0.5; maths: unadjusted, 12.9; OLS, 4.3; PSM, 3.9; spatial skills: unadjusted, 16.2; OLS, 7.7; PSM, 6.4.

CONCLUSION

The findings suggest that light drinking during pregnancy is not linked to developmental problems in mid-childhood. These findings support current UK Department of Health guidelines on drinking during pregnancy.

Coherent Josephson qubit suitable for scalable quantum integrated circuits

We demonstrate a planar, tunable superconducting qubit with energy relaxation times up to 44 μs. This is achieved by using a geometry designed to both minimize radiative loss and reduce coupling to materials-related defects. At these levels of coherence, we find a fine structure in the qubit energy lifetime as a function of frequency, indicating the presence of a sparse population of incoherent, weakly coupled two-level defects. We elucidate this defect physics by experimentally varying the geometry and by a model analysis. Our "Xmon" qubit combines facile fabrication, straightforward connectivity, fast control, and long coherence, opening a viable route to constructing a chip-based quantum computer.

Excitation of superconducting qubits from hot nonequilibrium quasiparticles

Superconducting qubits probe environmental defects such as nonequilibrium quasiparticles, an important source of decoherence. We show that "hot" nonequilibrium quasiparticles, with energies above the superconducting gap, affect qubits differently from quasiparticles at the gap, implying qubits can probe the dynamic quasiparticle energy distribution. For hot quasiparticles, we predict a non-negligible increase in the qubit excited state probability Pe. By injecting hot quasiparticles into a qubit, we experimentally measure an increase of Pe in semiquantitative agreement with the model and rule out the typically assumed thermal distribution.

Immunological indicators of coeliac disease activity are not altered by long-term oats challenge

Coeliac disease is a gluten-sensitive enteropathy that develops in genetically susceptible individuals. The disease exhibits many features of an autoimmune disorder. These include the production of highly specific anti-endomysial autoantibodies directed against the enzyme tissue transglutaminase. It is well accepted that wheat-, barley- and rye-based foods should be excluded in the gluten-free diet. Although several studies report that oats ingestion is safe in this diet, the potential toxicity of oats remains controversial. In the current study, 46 coeliac patients ingested oats for 1 year and were investigated for a potential immunogenic or toxic effect. Stringent clinical monitoring of these patients was performed and none experienced adverse effects, despite ingestion of a mean of 286 g of oats each week. Routine histological analysis of intestinal biopsies showed improvement or no change in 95% of the samples examined. Furthermore, tissue transglutaminase expression in biopsy samples, determined quantitatively using the IN Cell Analyzer, was unchanged. Employing immunohistochemistry, oats ingestion was not associated with changes in intraepithelial lymphocyte numbers or with enterocyte proliferation as assessed by Ki-67 staining. Finally, despite the potential for tissue transglutaminase to interact with oats, neither endomysial nor tissue transglutaminase antibodies were generated in any of the patients throughout the study. To conclude, this study reaffirms the lack of oats immunogenicity and toxicity to coeliac patients. It also suggests that the antigenic stimulus caused by wheat exposure differs fundamentally from that caused by oats.

Catch and release of microwave photon states

We demonstrate a superconducting resonator with variable coupling to a measurement transmission line. The resonator coupling can be adjusted through zero to a photon emission rate 1000 times the intrinsic resonator decay rate. We demonstrate the catch and release of photons in the resonator, as well as control of nonclassical Fock states. We also demonstrate the dynamical control of the release waveform of photons from the resonator, a key functionality that will enable high-fidelity quantum state transfer between distant resonators or qubits.

Lithium in patients with amyotrophic lateral sclerosis (LiCALS): a phase 3 multicentre, randomised, double-blind, placebo-controlled trial

Background

Lithium has neuroprotective effects in cell and animal models of amyotrophic lateral sclerosis (ALS), and a small pilot study in patients with ALS showed a significant effect of lithium on survival. We aimed to assess whether lithium improves survival in patients with ALS.

Methods

The lithium carbonate in amyotrophic lateral sclerosis (LiCALS) trial is a randomised, double-blind, placebo-controlled trial of oral lithium taken daily for 18 months in patients with ALS. Patients aged at least 18 years who had ALS according to the revised El Escorial criteria, had disease duration between 6 and 36 months, and were taking riluzole were recruited from ten centres in the UK. Patients were randomly assigned (1:1) to receive either lithium or matched placebo tablets. Randomisation was via an online system done at the level of the individual by block randomisation with randomly varying block sizes, stratified by study centre and site of disease onset (limb or bulbar). All patients and assessing study personnel were masked to treatment assignment. The primary endpoint was the rate of survival at 18 months and was analysed by intention to treat. This study is registered with Eudract, number 2008-006891-31.

Findings

Between May 26, 2009, and Nov 10, 2011, 243 patients were screened, 214 of whom were randomly assigned to receive lithium (107 patients) or placebo (107 patients). Two patients discontinued treatment and one died before the target therapeutic lithium concentration could be achieved. 63 (59%) of 107 patients in the placebo group and 54 (50%) of 107 patients in the lithium group were alive at 18 months. The survival functions did not differ significantly between groups (Mantel-Cox log-rank χ² on 1 df=1·64; p=0·20). After adjusting for study centre and site of onset using logistic regression, the relative odds of survival at 18 months (lithium vs placebo) was 0·71 (95% CI 0·40–1·24). 56 patients in the placebo group and 61 in the lithium group had at least one serious adverse event.

Interpretation

We found no evidence of benefit of lithium on survival in patients with ALS, but nor were there safety concerns, which had been identified in previous studies with less conventional designs. This finding emphasises the importance of pursuing adequately powered trials with clear endpoints when testing new treatments.

Funding

The Motor Neurone Disease Association of Great Britain and Northern Ireland.

Apolipoprotein E and change in episodic memory in blacks and whites

BACKGROUND

Apolipoprotein E (APOE) ε4 is related to faster decline in episodic memory in Whites, but the relation is unknown in Blacks. The purpose of this study was to determine whether ε4 has a selective effect on decline in episodic memory in Blacks.

METHODS

Data are from two cohort studies with similar design. The sample consisted of 1,211 participants [28.4% Blacks, mean age = 78.6 years (SD = 7.4), education = 14.7 years (SD = 3.1)] without dementia at baseline, who underwent annual clinical evaluations for up to 6 years. Summary measures of 5 cognitive abilities were derived from 18 neuropsychological tests.

RESULTS

In mixed models that controlled for age, sex, education, and race, possession of ε4 (present in 32.9% of Blacks and 21.0% of Whites, p < 0.001) was related to faster decline in episodic memory and 4 other cognitive abilities (all p values <0.01). In separate models that examined the interaction of race and ε4 on decline, there was no significant difference between Blacks and Whites in the effect of ε4 on decline in episodic memory, perceptual speed, or visuospatial ability. By contrast, the effect of ε4 differed for semantic memory and working memory. Results were similar after adjusting for vascular conditions.

CONCLUSIONS

The results suggest that APOE ε4 is related to a faster rate of decline in episodic memory in Blacks similar to Whites. In addition, there were racial differences in the effect of ε4 in other cognitive abilities such that the ε4 allele was related to faster decline in semantic memory and working memory for Whites but not for Blacks.

Finger tourniquets: two safe and cost effective techniques and a discussion of the literature

Finger tourniquets are used in a variety of operative procedures in both the trauma and elective setting. A wide range of methods are used in clinical practise as there is no standardised method. Many of the methods in use have significant drawbacks such as the inability to exsanguinate the digit or the more concerning problem of inadvertently leaving the tourniquet on the digit on completion of the procedure. We discuss two techniques that are quick, cheap and easy that do not have these drawbacks. There is a brief discussion of the literature assessing the various attributes of published methods. We feel that the adoption of these methods could result in easier and safer finger exsanguination and haemostasis.

In search of Pinkel's children: unravelling the biological heterogeneity of childhood acute lymphoblastic leukaemia by genotype and treatment molecular response

BACKGROUND

Acute lymphoblastic leukaemia (ALL), the commonest childhood malignancy has seen remarkable progress since the 1960s with cure rates now approaching 85%. To achieve this patients undergo intensive treatment that usually takes 2.5-3.5 years involving on average 15 different chemotherapeutic drugs. In 1971, Donald Pinkel reported Total Therapy-Protocol V that used 5 drugs and cranial radiation therapy over a similar time period. Today, one half of these patients (Pinkel's children) remain alive and free of leukaemia.

AIM

The aim of this study was to evaluate the impact post-induction minimal residual disease (MRD) levels had on survival and its relationship with the more established clinical and biological prognostic predictors of outcome in the hope of identifying a subgroup of patients that are at very low risk of failure.

METHODS

A retrospective review of 250 Irish children with ALL was carried out. MRD status after 28 days of induction chemotherapy and other known predictors of outcome were correlated with 5 year event-free survival (EFS).

RESULTS

MRD status was the strongest predictor of outcome with 5 year EFS rates greater that 90% seen in those patients with low-risk MRD and this was associated with TEL/AML1 rearrangement, high hyperdiploidy (HH) karyotype and female gender.

CONCLUSION

Both MRD and karyotype are powerful determinants of outcome in childhood ALL. Therefore, it is reasonable to conclude that the majority of children cured by Pinkel et al. in the late 1960s were most likely composed of low-risk MRD, TEL/AML1 and HH patients.

Reconstruction of the pelvis and perineum with a free latissimus dorsi myocutaneous flap: a case report

Reconstruction of the perineum and pelvic cavity in continuity is an uncommon and difficult challenge. This case describes a 66-year-old man who presented following recurrence of a Dukes' B rectosigmoid adenocarcinoma that had been treated nine years previously by anterior resection, 5-fluorouracil and radiotherapy. His recurrent disease was treated with radical pelvic exenteration with formation of an end colostomy and urinary ileal conduit. A post-operative pelvic collection necessitated incisional drainage via the perineum. This resulted in a perineal defect in continuity with the pelvic cavity, neither of which healed in spite of alternate day packing with antiseptic dressings. The perineum and cavity were reconstructed successfully with a microvascular transfer of the latissimus dorsi using the primary gracilis pedicle as recipient donor vessels.

A pain in the neck--medical student attitudes to the Orthopaedic spine

Considerable deficiencies exist in the teaching of Orthopaedic medicine. This study aimed (i) to determine if spinal surgery was the Orthopaedic specialty that students found most difficult, (ii) to appraise attitudes towards teaching of the spine, and (iii) to suggest ways teaching might be improved. A questionnaire on Orthopaedic teaching was given to 238 final year medical students in Ireland. Perceived difficulties with spinal surgery were compared to seven other Orthopaedic sub-specialties. Suggestions made on how to maximise teaching potential included 69 (29%) for more tutorials, 43 (18%) for more lectures, 26 (11%) suggested a more structured training programme and 17 (7%) for increased use of online resources. The spine is one of the least popular Orthopaedic subspecialties and considerable deficiencies exist in its education.

Flux noise probed with real time qubit tomography in a Josephson phase qubit

We measure the dependence of qubit phase coherence and flux noise on inductor loop geometry. While wider inductor traces change neither the flux noise power spectrum nor the qubit dephasing time, increased inductance leads to a simultaneous increase in both. Using our new tomographic protocol for measuring low frequency flux noise, we make a direct comparison between the flux noise spectrum and qubit phase decay, finding agreement within 10% of theory.

Exploring the sensitivity of the zone of inhibition test for leachable biocides from paper and board food contact materials, and improvements thereof

The zone of inhibition method to test the release of biocides from paper and board food contact materials was evaluated. The method tests the paper by placing a small specimen directly onto culture plates of Bacillus subtilis and Aspergillus niger. The principle is that any extractable biocide will diffuse from the paper into the surrounding nutrient medium and so inhibit growth of the microorganism in the vicinity. The test was found to have insufficient sensitivity for assuring food safety, where detection limits for migration at or below the mg l(-1) (parts per million) level are needed. Also, the test does not mimic the actual or foreseeable conditions of use since most paper/board materials are not intended for direct contact with an aqueous medium for up to 3 days at 30°C (B. subtilis) or 25°C (A. niger), which are the incubation conditions used. The sensitivity of the test was increased approximately 100-fold by preparing a concentrated extract of the paper to be tested and applying this extract to the assay via a blank paper carrier. This was done using methanol as a good solvent for most biocides, as a proof of principle. Other solvents or food simulants could be used to mimic the conditions of use intended for the particular paper/board samples under examination, e.g. contact with dry, fatty, aqueous or acidic foods, hot or cold. Twenty-four plain (unconverted) paper and board samples and 100 food packaging samples were evaluated using the modified procedure. The results revealed that the method has been developed to the stage where background cytotoxic action of normal paper constituents gives a weak response. Unlike the original method, therefore, the modified method with its improved sensitivity and the facility to link with the intended food contact conditions may be considered a suitable bioassay screening test to complement chemical analysis of paper/board for composition and migration.