Deep brain stimulation in ireland for Parkinson's disease and essential tremor

Deep brain stimulation (DBS) is highly effective neurosurgery for idiopathic Parkinson's disease (IPD), essential tremor (ET) and primary dystonia. DBS involves stereotactic surgical implantation of a battery-operated stimulator into deep brain nuclei. Irish patients are referred abroad for DBS and have to travel repeatedly for pre and post-operative care resulting in stress, anxiety and hardship. Safe pre and post-operative care of these complex, ageing patients is compromised by the absence of a DBS service in Ireland. Moreover, both DBS surgery and the subsequent post-operative care abroad incurs substantial cost to the state. The Dublin Neurological Institute at the Mater Misericordiae University Hospital (DNI) is a non-profit institute for the care of patients with neurological diseases. The DNI developed, in collaboration with the Mater Private Hospital (MPH) and the Walton Centre, Liverpool, a DBS programme in 2008/2009. We performed DBS at the Mater Campus on three carefully selected patients from a cohort of movement disorder patients attending the DNI and continue to provide pre-operative assessment and post operative care for patients following DBS in Ireland and abroad.

A rare event sampling method for diffusion Monte Carlo using smart darting

We identify a set of multidimensional potential energy surfaces sufficiently complex to cause both the classical parallel tempering and the guided or unguided diffusion Monte Carlo methods to converge too inefficiently for practical applications. The mathematical model is constructed as a linear combination of decoupled Double Wells [(DDW)(n)]. We show that the set (DDW)(n) provides a serious test for new methods aimed at addressing rare event sampling in stochastic simulations. Unlike the typical numerical tests used in these cases, the thermodynamics and the quantum dynamics for (DDW)(n) can be solved deterministically. We use the potential energy set (DDW)(n) to explore and identify methods that can enhance the diffusion Monte Carlo algorithm. We demonstrate that the smart darting method succeeds at reducing quasiergodicity for n ≫ 100 using just 1 × 10(6) moves in classical simulations (DDW)(n). Finally, we prove that smart darting, when incorporated into the regular or the guided diffusion Monte Carlo algorithm, drastically improves its convergence. The new method promises to significantly extend the range of systems computationally tractable by the diffusion Monte Carlo algorithm.

Environmental Applications of Xanes: Speciation of Tc In Cement After Chemical Treatment and Se After Bacterial Uptake

XANES (X-ray Absorption Near Edge Spectroscopy) has been employed to evaluate the efficacy of a process designed to encapsulate and reduce TcO4-in cement matrices, thereby immobilizing Tc. The oxidation state of Se following bioremediation of Se by bacteria has also been determined by XANES. The XANES measurements were performed at the Stanford Synchrotron Radiation Laboratory (SSRL) and the National Synchrotron Light Source (NSLS) at the respective K edges of Tc (21.0 keV) and Se (12.7 keV). Comparison of the XANES spectra of Tc in untreated cement to Tc in slag treated cement and to the chemical shifts of reference materials, shows that the oxidation state of Tc is the same in both cements. Thus, the addition of a reducing agent to the cement formulation does not significantly reduce the TcO4-. The common soil bacterium,Bacillus subtilis, is known to incorporate Se on or within the cell wall when exposed to a Se(IV) solution. The Se XANES spectra ofB. subtilis, as well as bacillus isolated from selenium rich soil, show that the organisms reduce selenite to the red allotrope of elemental Se.

Exploring the needs and expectations of women presenting for hysterosalpingogram examination following a period of subfertility: a qualitative study

AIMS

This study examines women's experience of healthcare following the referral for hysterosalpingography (HSG) after a period of subfertility. These otherwise fit and healthy women enter the healthcare system and their only problem is a failure to become pregnant. They find themselves trying to negotiate a system designed for sick people. Previous research in this field consists mainly of studies comparing HSG to other diagnostic studies. The study aims to address the underlying issues that women have at the start of their subfertility investigations.

METHODS

This qualitative study uses grounded theory methodology. Interviews with women were undertaken immediately prior to their HSG examination. Ten women were interviewed using 12 core questions. Each woman had a diagnosis of primary subfertility. Each was asked how they were coping with the uncertainty of their fertility. They were asked about their expectations of the HSG examination, the importance of HSG and what methods were available to them to reduce any anxiety experienced. Data analysis was undertaken after each interview.

RESULTS

Presently, HSG is seen by healthcare providers as a routine outpatient examination at the start of subfertility investigations. In contrast to this, it was discovered at interview that HSG was seen by the women as a defining moment that would signpost their future treatment options to become pregnant. Women reported receiving little support from health care providers, and that written information given did not fulfil all of their needs. Often written information alone heightened anxiety, and this written information needs to be tailored to a specific set of circumstances. The literature review noted that anxiety can lead to mental health issues, but that properly focused, correctly given, timely information can reduce anxiety.

CONCLUSIONS

The implications of the findings are that if anxiety relating to treatment at this early stage can be managed effectively, it could minimise the possible physical and emotional trauma to the woman as her subfertility journey continues, thus at the same time preventing future anxiety related illness.

Expansion of the Spectrum of FLNA Mutations Associated with Melnick-Needles Syndrome

Melnick-Needles syndrome (MNS) is a rare X-linked bone dysplasia characterised by facial dysmorphology and radiographic abnormalities [Melnick and Needles, 1966;97:39-48]. Previously, all published cases of MNS were associated with only 4 mutations [Robertson et al., 2003;33:487-491; Santos et al., 2010;152A:726-731], all localised within exon 22 of FLNA, the gene encoding the cytoskeletal protein filamin A. Here we report 3 new mutations in FLNA that are associated with MNS. One affected member of the first family with the mutation p.Y1229S presented with a stroke while this patient's daughter, previously known to be affected from a young age, developed multiple sclerosis. A second unrelated patient with a typical phenotype is shown to have the mutation c.1054G>T (p.G352W) within exon 7 of FLNA. A third individual with an atypical presentation but radiological findings very similar to those seen in classic MNS has a deletion likely to affect residues within repeat domain 14. These findings indicate that the mutational spectrum for MNS is wider than previously appreciated and has implications for genetic testing strategies employed to confirm a diagnosis of this rare disorder.

Needle exchange services: a profile of service users in community pharmacies and other settings

Objective

To compare client profiles and activity data from the pharmacy needle exchanges (PNEXs) with other needle exchanges (NEXs) in a UK city.

Method

Routinely collected data from four types of needle exchange services were used to analyse levels of activity and user profiles. Simple descriptive statistics with 95% confidence intervals (95% CI) were calculated.

Setting

In Glasgow, Scotland, at the time of the study NEX was provided at four key facilities: (1) PNEXs; (2) drug treatment service sites (Glasgow Drug Problem Service, GDPS); (3) a drop-in service for female prostitutes (Base 75); and (4) a service based in a 24-hour crisis assessment and treatment centre (Glasgow Drug Crisis Centre, GDCC).

Key findings

A total of 1074 455 needles/syringes were issued during the study period. Over half of all needles and syringes were issued from PNEXs (52%; 558 176) compared with 15% (162431) from GDPS, 5% (59 348) from the Base 75 exchange and 27% (294 500) from the GDCC. The return rate at PNEXs was 86% (95% confidence interval (CI) 85.90–86.10%) and was significantly higher than both GDCC (70%, 95% CI 69.80–70.19%) and Base 75 (25%, 95% CI 24.31–25.69%). A significantly greater proportion of needles and syringes were returned to the GDPS (94%, 95% CI 93.88–94.12%) than to PNEXs (86%). A significantly greater proportion of female clients attended GDCC (30%, 95% CI 27.41–32.59%) than the PNEXs (25%, 95% CI 23.80–26.20%).

Conclusion

PNEXs attract large numbers of injectors to use the service and have a high return rate of needles and syringes issued. A diverse population uses PNEXs. In order to meet the needs of different groups of injecting drug users, a variety of NEX facilities is needed, including out of hours services and exchanges for women, especially those in crisis or involved in prostitution.

What factors affect medication-storage practice among patients on methadone maintenance treatment?

Objectives

Medication storage in patients' homes is an important safety issue. Safe storage of methadone oral solution is of particular concern. Previous studies have suggested that only about half of patients store methadone appropriately. The aims of this study were to describe medication-storage practice in a sample of patients receiving methadone maintenance treatment (MMT), and to identify factors associated with safe storage.

Methods

The setting was a primary health care centre in Edinburgh, Scotland. One hundred and four consecutive patients on MMT completed a self-administered questionnaire covering medication-storage practice, together with clinical and demographic variables. Storage of medication was classified as ‘acceptable’ if medication was out of sight and out of reach of children, and ‘optimal’ if it was also kept in a secure container.

Key findings

Percentages (95% confidence intervals) for acceptable and optimal storage were as follows: methadone 80% (71–86%) and 33% (24-12%); other prescribed medication 69% (59–78%) and 27% (19–37%); purchased medication 64% (50–76%) and 28% (17–42%). Safe storage of methadone was more common in patients taking higher doses of methadone (P = 0.004 for acceptable storage, and P = 0.012 for optimal storage), and in those with children in the house (P = 0.007 and 0.061). Safe storage of prescribed and purchased medication was strongly associated with safe storage of methadone (P < 0.01 in both cases).

Conclusions

Medication-storage practice was better than in previous surveys of patients on MMT. This may reflect the high profile given to safety issues for children of drug-using parents in Scotland, as well as local initiatives. Some aspects of prescribing and dispensing practice could be improved further.

What factors affect medication-storage practice among patients on methadone maintenance treatment?

Objectives

Medication storage in patients' homes is an important safety issue. Safe storage of methadone oral solution is of particular concern. Previous studies have suggested that only about half of patients store methadone appropriately. The aims of this study were to describe medication-storage practice in a sample of patients receiving methadone maintenance treatment (MMT), and to identify factors associated with safe storage.

Methods

The setting was a primary health care centre in Edinburgh, Scotland. One hundred and four consecutive patients on MMT completed a self-administered questionnaire covering medication-storage practice, together with clinical and demographic variables. Storage of medication was classified as ‘acceptable’ if medication was out of sight and out of reach of children, and ‘optimal’ if it was also kept in a secure container.

Key findings

Percentages (95% confidence intervals) for acceptable and optimal storage were as follows: methadone 80% (71–86%) and 33% (24-12%); other prescribed medication 69% (59–78%) and 27% (19–37%); purchased medication 64% (50–76%) and 28% (17–42%). Safe storage of methadone was more common in patients taking higher doses of methadone (P = 0.004 for acceptable storage, and P = 0.012 for optimal storage), and in those with children in the house (P = 0.007 and 0.061). Safe storage of prescribed and purchased medication was strongly associated with safe storage of methadone (P < 0.01 in both cases).

Conclusions

Medication-storage practice was better than in previous surveys of patients on MMT. This may reflect the high profile given to safety issues for children of drug-using parents in Scotland, as well as local initiatives. Some aspects of prescribing and dispensing practice could be improved further.