Direct Observation of Polaritonic Chemistry by Nuclear Magnetic Resonance Spectroscopy

Polaritonic chemistry is emerging as a powerful approach to modifying the properties and reactivity of molecules and materials. However, probing how the electronics and dynamics of molecular systems change under strong coupling has been challenging due to the narrow range of spectroscopic techniques that can be applied in situ. Here we develop microfluidic optical cavities for vibrational strong coupling (VSC) that are compatible with nuclear magnetic resonance (NMR) spectroscopy using standard liquid NMR tubes. VSC is shown to influence the equilibrium between two conformations of a molecular balance sensitive to London dispersion forces, revealing an apparent change in the equilibrium constant under VSC. In all compounds studied, VSC does not induce detectable changes in chemical shifts, J-couplings, or spin-lattice relaxation times. This unexpected finding indicates that VSC does not substantially affect molecular electron density distributions, and in turn has profound implications for the possible mechanisms at play in polaritonic chemistry under VSC and suggests that the emergence of collective behavior is critical.

Effect of Plyometric Jump Training on Skeletal Muscle Hypertrophy in Healthy Individuals: A Systematic Review With Multilevel Meta-Analysis

Objective: To examine the effect of plyometric jump training on skeletal muscle hypertrophy in healthy individuals.

Methods: A systematic literature search was conducted in the databases PubMed, SPORTDiscus, Web of Science, and Cochrane Library up to September 2021.

Results: Fifteen studies met the inclusion criteria. The main overall finding (44 effect sizes across 15 clusters median = 2, range = 1–15 effects per cluster) indicated that plyometric jump training had small to moderate effects [standardised mean difference (SMD) = 0.47 (95% CIs = 0.23–0.71); p < 0.001] on skeletal muscle hypertrophy. Subgroup analyses for training experience revealed trivial to large effects in non-athletes [SMD = 0.55 (95% CIs = 0.18–0.93); p = 0.007] and trivial to moderate effects in athletes [SMD = 0.33 (95% CIs = 0.16–0.51); p = 0.001]. Regarding muscle groups, results showed moderate effects for the knee extensors [SMD = 0.72 (95% CIs = 0.66–0.78), p < 0.001] and equivocal effects for the plantar flexors [SMD = 0.65 (95% CIs = −0.25–1.55); p = 0.143]. As to the assessment methods of skeletal muscle hypertrophy, findings indicated trivial to small effects for prediction equations [SMD = 0.29 (95% CIs = 0.16–0.42); p < 0.001] and moderate-to-large effects for ultrasound imaging [SMD = 0.74 (95% CIs = 0.59–0.89); p < 0.001]. Meta-regression analysis indicated that the weekly session frequency moderates the effect of plyometric jump training on skeletal muscle hypertrophy, with a higher weekly session frequency inducing larger hypertrophic gains [β = 0.3233 (95% CIs = 0.2041–0.4425); p < 0.001]. We found no clear evidence that age, sex, total training period, single session duration, or the number of jumps per week moderate the effect of plyometric jump training on skeletal muscle hypertrophy [β = −0.0133 to 0.0433 (95% CIs = −0.0387 to 0.1215); p = 0.101–0.751].

Conclusion: Plyometric jump training can induce skeletal muscle hypertrophy, regardless of age and sex. There is evidence for relatively larger effects in non-athletes compared with athletes. Further, the weekly session frequency seems to moderate the effect of plyometric jump training on skeletal muscle hypertrophy, whereby more frequent weekly plyometric jump training sessions elicit larger hypertrophic adaptations.

Multiple Discrimination and Its Consequences for the Mental Health of Ethnic Minorities

Discrimination is a violation of human rights. The Universal Declaration of Human Rights proclaims in Art. 1 the equality of all human beings without distinction as to race, colour, sex, sexual orientation, religion, age or health. International law assigns three main characteristics to discrimination: disadvantageous treatment, based on unlawful grounds, and lack of reasonable and objective justification. Thus, it must be based on an unlawful characteristic: Ethnicity, religion, national or social origin, language, physical appearance, descent, gender, sexual orientation, age or disability. A growing body of literature has recognized health disparities and has investigated the relationship between discrimination and poor health outcomes. Ethnic minority groups across the world face social and psychological challenges linked to their minority status, often involving discrimination. Furthermore, cumulative exposure to racial discrimination has incremental negative long-term effects on the mental health of ethnic minority people.Studies that examine exposure to discrimination only at one point in time may underestimate the contribution of racism to poor health. Lower patient-centered care was associated with higher perceptions of discrimination, despite experiences of continuous discrimination or discrimination experienced as different types. Further, dissatisfaction with care was associated with discrimination, particularly when experienced in various forms. These findings reinforce a need for patient-provider communication that is inclusive and eliminates perceptions of discrimination and bias, increases patient-centeredness, and improves overall clinical care. Additionally, these results stress the need for more research investigating the relationship between discrimination and outcomes in patients, as perceived discrimination manifests as a significant barrier to effective disease management.

Disclosure

No significant relationships.

Manchester Intermittent versus Daily Diet App Study (MIDDAS): A pilot randomized controlled trial in patients with type 2 diabetes

AIMS

To test the feasibility and potential efficacy of remotely supported intermittent low-energy diets (ILEDs) and continuous low-energy diets (CLEDs) in people with type 2 diabetes (T2D) and the feasibility of a randomized controlled trial comparing the two approaches.

MATERIALS AND METHODS

Seventy-nine adults with overweight/obesity and T2D (≤8 years duration) were randomized 1:1 to CLED (8 weeks/56 days of daily Optifast 820 kcal (3430 kJ) diet) or isoenergetic ILED (2 days of Optifast and 5 days of a Mediterranean diet/week for 28 weeks). Weight maintenance/continued weight loss was undertaken for the remainder of the 52 weeks. Both groups received frequent telephone or the Oviva app support. Feasibility outcomes included study uptake, retention, app usage, dietary adherence, weight loss and change in glycated haemoglobin (HbA1c) at 52 weeks.

RESULTS

We enrolled 39 ILED and 40 CLED participants and 27 (69%) ILED and 30 CLED (75%) attended the 52-week follow-up. Eighty-nine per cent (70 of 79) started using the app and 86% (44 of 51) still used the app at 52 weeks. Intention-to-treat analysis at 52 weeks showed percentage weight loss was mean (95% confidence interval) -5.4% (-7.6, -3.1%) for ILED and -6.0% (-7.9, -4.0%) for CLED. HbA1c <48 mmol/mol was achieved in 42% of both groups. Mean (95% confidence interval) changes in the T2D medication effect score were 0.0008 (-0.3, 0.3) for ILED and -0.5 (-0.8, -0.3) for CLED.

CONCLUSION

The study shows the feasibility and potential efficacy of remotely delivered ILED and CLED programmes for weight loss and HbA1c reduction, and the feasibility of a randomized controlled trial comparing the two approaches.

108 COMBATTING CONFUSION: SIMULATION-BASED MEDICAL EDUCATION FOR DEALING WITH DELIRIUM

Background

Delirium is a complex, costly, and common clinical syndrome. Simulation-based medical education has been shown to be effective in enhancing the confidence, knowledge and skills of healthcare professionals in the management of delirium. We piloted an inter-professional education simulation on delirium in an acute hospital setting. The session’s design was informed by participating in ‘Sim Stars’, a regional simulation development competition.

Methods

We iteratively developed a low-fidelity simulation scenario on the recognition, prevention and management of delirium. The resulting simulation was piloted during an hour-long multidisciplinary departmental teaching session in a lecture hall setting. A candidate was asked to review an acutely confused patient (played by a ‘confederate’) on call. The candidate was expected to screen for delirium using the 4AT tool; assess for possible causes of delirium; and implement an appropriate management plan. After the session, qualitative feedback from the participants and audience was sought.

Results

This pilot simulation included one candidate (medical Senior House Officer); two confederates (Consultant Geriatrician, Advanced Nurse Practitioner); two facilitators (Consultant Geriatrician, Advanced Nurse Practitioner); and an audience of 17 members. Feedback indicated that learners and trainers found this a helpful and enjoyable pedagogical method. Areas for improvement were highlighted, including providing advance notice for learners of the topic to be simulated; a more structured introduction defining the learning outcomes and declaring a ‘blame free’ environment; improved script for the patient confederate; and that having a team of learners (rather than specialists) to play ‘confederates’ may help improve team-building and reduce learner anxiety.

Conclusion

This pilot simulation received positive appraisals from the team, and plans are underway to incorporate simulation more regularly into departmental teaching. Suggestions to improve future simulations were welcomed. Given its low-fidelity, this scenario can easily be used at any site for simulation-based training.

A landscape classification map of Ireland and its potential use in national land use monitoring

This study presents a novel landscape classification map of the Republic of Ireland and is the first to identify broad landscape classes by incorporating physiographic and land cover data. The landscape classification responds to commitments to identify and classify the Irish landscape as a signatory to the European Landscape Convention. The methodology applied a series of clustering iterations to determine an objective multivariate classification of physiographic landscape units and land cover datasets. The classification results determined nine statistically significant landscape classes and the development of a landscape classification map at a national scale. A statistical breakdown of land cover area and diversity of each class was interpreted, and a comparison was extended using independent descriptive variables including farmland use intensity, elevation, and dominant soil type. Each class depicts unique spatial and composition characteristics, from coastal, lowland and elevated, to distinct and dominating land cover types, further explained by the descriptive variables. The significance of individual classes and success of the classification is discussed with particular reference to the wider applicability of the map. The transferability of the methodology to other existing physiographic maps and environmental datasets to generate new landscape classifications is also considered. This novel work facilitates the development of a strategic framework to efficiently monitor, compare and analyse ecological and other land use data that is spatially representative of the distribution and extent of land cover in the Irish countryside.

Intermittent Versus Continuous Low-Energy Diet in Patients With Type 2 Diabetes: Protocol for a Pilot Randomized Controlled Trial

BACKGROUND

Intensive face-to-face weight loss programs using continuous low-energy diets (CLEDs) providing approximately 800 kcal per day (3347 kJ per day) can produce significant weight loss and remission from type 2 diabetes (T2D). Intermittent low-energy diets (ILEDs) and remotely delivered programs could be viable alternatives that may support patient choice and adherence.

OBJECTIVE

This paper describes the protocol of a pilot randomized controlled trial to test the feasibility and potential efficacy of remotely supported isocaloric ILED and CLED programs among patients with overweight and obesity and T2D.

METHODS

A total of 79 participants were recruited from primary care, two National Health Service hospital trusts, and a voluntary T2D research register in the United Kingdom. The participants were randomized to a remotely delivered ILED (n=39) or CLED (n=40). The active weight loss phase of CLED involved 8 weeks of Optifast 820 kcal/3430 kJ formula diet, followed by 4 weeks of food reintroduction. The active weight loss phase of ILED (n=39) comprised 2 days of Optifast 820 kcal/3430 kJ diet and 5 days of a portion-controlled Mediterranean diet for 28 weeks. Both groups were asked to complete 56 Optifast 820 kcal/3430 kJ days during their active weight loss phase with an equivalent energy deficit. The diets were isocaloric for the remainder of the 12 months. CLED participants were asked to follow a portion-controlled Mediterranean diet 7 days per week. ILED followed 1-2 days per week of a food-based 820 kcal/3430 kJ diet and a portion-controlled Mediterranean diet for 5-6 days per week. Participants received high-frequency (weekly, fortnightly, or monthly depending on the stage of the trial) multidisciplinary remote support from a dietitian, nurse, exercise specialist, and psychologist via telephone or the Oviva smartphone app. The primary outcomes of the study were uptake, weight loss, and changes in glycated hemoglobin at 12 months. An outcome assessment of trial retention was retrospectively added. Secondary outcomes included an assessment of adherence and adverse events. A qualitative evaluation was undertaken via interviews with participants and health care professionals who delivered the intervention.

RESULTS

A total of 79 overweight or obese participants aged 18-75 years and diagnosed with T2D in the last 8 years were recruited to the Manchester Intermittent and Daily Diet Diabetes App Study (MIDDAS). Recruitment began in February 2018, and data collection was completed in February 2020. Data analysis began in June 2020, and the first results are expected to be submitted for publication in 2021.

CONCLUSIONS

The outcomes of the MIDDAS study will inform the feasibility of remotely delivered ILED and CLED programs in clinical practice and the requirement for a larger-scale randomized controlled trial.

TRIAL REGISTRATION

International Standard Randomized Controlled Trial Number (ISRCTN) 15394285; http://www.isrctn.com/ISRCTN15394285.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/21116.

Participation of Glutamatergic Ionotropic Receptors in Excitotoxicity: The Neuroprotective Role of Prolactin

Glutamate (Glu) is known as the main excitatory neurotransmitter in the central nervous system. It can trigger a series of processes ranging from synaptic plasticity to neurophysiological regulation. To carry out its functions, Glu acts via interaction with its cognate receptors, which are ligand-dependent. Glutamatergic receptors include ionotropic and metabotropic categories. The first allows the passage of ions through the postsynaptic membrane, while the metabotropic subtype activates signaling cascades through second messengers. It is well known that an excess of extracellular Glu concentration induces overstimulation of ionotropic glutamatergic receptors (iGluRs), causing the excitotoxicity phenomenon that leads to neuronal damage and cell death. Excitotoxicity plays a crucial role in different brain pathologies such as brain strokes, epilepsy and neurodegenerative disorders. However, until now, there are no effective neuroprotective compounds to prevent or rescue neurons from excitotoxicity. Thus, the continuous elucidation of the molecular mechanisms underlying excitotoxicity in order to prevent damage or neuronal death is necessary. Therefore, the aim of this review was to summarize the current knowledge regarding iGluRs, while describing their structures and molecular mechanisms of action, including their role in excitotoxicity, as well as the current strategies to reduce excitotoxic damage. Particularly, strategies mediated by prolactin, a somatotropin family-related hormone that displays a significant neuroprotective effect against both Glu and kainic acid-induced excitotoxicity in the hippocampus, are described. Finally, the role of prolactin as a possible molecule in the treatment of excitotoxicity in neurological diseases is discussed.

Tilting a ground-state reactivity landscape by vibrational strong coupling

Many chemical methods have been developed to favor a particular product in transformations of compounds that have two or more reactive sites. We explored a different approach to site selectivity using vibrational strong coupling (VSC) between a reactant and the vacuum field of a microfluidic optical cavity. Specifically, we studied the reactivity of a compound bearing two possible silyl bond cleavage sites—Si–C and Si–O, respectively—as a function of VSC of three distinct vibrational modes in the dark. The results show that VSC can indeed tilt the reactivity landscape to favor one product over the other. Thermodynamic parameters reveal the presence of a large activation barrier and substantial changes to the activation entropy, confirming the modified chemical landscape under strong coupling.

IFT80 mutations cause a novel complex ciliopathy phenotype with retinal degeneration

Ciliopathies, a growing pleotropic class of diseases due to mutations in genes that play an important role in primary cilia function. These highly conserved organelles are key to cell signaling. We now know, that mutations in one gene may lead to more than one ciliopathy phenotype and that one ciliopathy phenotype may be due to mutations in more than one gene. We studied the case of a female child with a novel ciliopathy phenotype and identified two novel mutations in the gene IFT80. Previously, mutations in IFT80 have been associated with a very narrow rib cage and failure of the lungs. Bone anomalies are also part of this IFT80-condition but with no vision problems documented. Our case had none of the features known to be associated with IFT80 mutations and had retinal degeneration (RD). This work broadens the IFT80-phenotype spectrum and also shows RD can be a feature of many ciliopathies.

Health promotion through sport: international sport federations’ priorities, actions and opportunities

Objective

To identify areas of priority and activity for international sportsfederations (IFs) with respect to athlete health and safety, and global health. Results serve to direct the work of the Association of Summer Olympic IF Medical and Scientific Consultative Group, the International Olympic Committee and to influence IFs’ planning and priorities.

Methods

The 28 IFs participating in the Summer Olympic Games (2016) were asked to rank the relative importance of 11 health-related topics and to report their activities or research initiatives on 27 identified topics using an electronic survey. A comparison with a similar survey (2012) was made.

Results

The response rate was 100%. In general, the ‘fight against doping’ had the highest priority followed by ‘image as a safe sport’. The topics with the lowest importance ratings were ‘increasing the number of elite athletes’, and ‘health of the general population’. Despite ranking ‘health of your athletes,’ as a top priority, IFs are not addressing all aspects of athlete health. In comparison with 2012, there was a significant decrease in priority for IFs is ‘health of the general population’.

Conclusion

Despite the widespread knowledge of the importance of the promotion of physical activity (sport) on global health, the decreasing priority and programming of the IFs on physical activity promotion is concerning. Although IFs have prioritised the protection of the health of elite athletes, there are gaps in programming demonstrating that IFs are missing important areas of athlete health. Improving recreational athlete health programming could also benefit population health as well as improve IF fan base and sport participation.

Mechanisms of Stain Formation on Teeth, in Particular Associated with Metal Ions and Antiseptics

Much has been written on the subject of extrinsic tooth discoloration, but, except when the pigment is intentionally applied, the etiologies and mechanisms are poorly understood. Extrinsic stains have been classified as non-metallic or metallic. The pigment usually lies not on or in the dental tissues, but in surface deposits, particularly the acquired pellicle layer and at sites receiving limited cleaning. Whether pigments absorb, adsorb, or chemically interact with dental surfaces is unclear. Some stains merely seem to reflect the color of the apparent source, whereas others have been ascribed to a secondary chemical alteration of a substance at the tooth or pellicle surface. Theories of chromogenic bacteria and formation of metal sulfides are frequently propounded but without clear supportive evidence. Staining by cationic antiseptics and, to a lesser extent, metal salts has attracted research interest. Chlorhexidine and other cationic antiseptics, it is hypothesized, may catalyze browning reactions or facilitate metal sulfide formation in pellicle. Controlled clinical studies have repeatedly shown that dental and mucosal staining associated with the use of chlorhexidine and some metal salts is dependent upon volunteers' imbibing reasonable quantities of chromogenic beverages, such as tea. However, it must be appreciated that cationic antiseptics and polyvalent metals can precipitate chromogenic material from a large range of dietary compounds. The control of dental staining, at least that associated with chlorhexidine, can be achieved both in vitro and in vivo by the use of oxidizing agents which appear to remove the stain physically from the surfaces.

Variation in Responses to Sprint Training in Male Youth Athletes: A Meta-analysis

The trainability of youths and the existence of periods of accelerated adaptation to training have become key subjects of debate in exercise science. The purpose of this meta-analysis was to characterise youth athletes' adaptability to sprint training across PRE-, MID-, and POST-peak height velocity (PHV) groups. Effect sizes were calculated as a measure of straight-line sprinting performance with studies qualifying based on the following criteria: (a) healthy male athletes who were engaged in organised sports; (b) groups of participants with a mean age between 10 and 18 years; (c) sprint training intervention duration between 4 and 16 weeks. Standardised mean differences showed sprint training to be moderately effective (Effect size=1.01, 95% confidence interval: 0.43-1.59) with adaptive responses being of large and moderate magnitude in the POST- (ES=1.39; 0.32-2.46) and MID- (ES=1.15; 0.40-1.9) PHV groups respectively. A negative effect size was found in the PRE group (ES=-0.18; -1.35-0.99). Youth training practitioners should prescribe sprint training modalities based on biological maturation status. Twice weekly training sessions should comprise up to 16 sprints of around 20 m with a work-to-rest ratio of 1:25 or greater than 90 s.

Outbreak of hepatitis A infection associated with the consumption of frozen berries, Ireland, 2013--linked to an international outbreak

In May 2013, a European alert was issued regarding a hepatitis A virus (HAV) outbreak in Italy. In June 2013, HAV subgenotype IA with an identical sequence was identified in Ireland in three cases who had not travelled to Italy. The investigation consisted of descriptive epidemiology, a case-control study, microbiological testing of human and food specimens, molecular typing of positive specimens and food traceback. We identified 21 outbreak cases (14 confirmed primary cases) with symptom onset between 31 January and 11 October 2013. For the case-control study, we recruited 11 confirmed primary cases and 42 matched controls. Cases were more likely than controls to have eaten berry cheesecake (matched odds ratio (mOR): 12; 95% confidence interval (CI): 1.3-114), whole frozen berries (mOR: 9.5; 95% CI: 1.0-89), yoghurt containing frozen berries (mOR: 6.6, 95% CI: 1.2-37) or raw celery (mOR: 4; 95% CI: 1.2-16). Among cases, 91% had consumed at least one of four products containing frozen berries (mOR: 12; 95% CI: 1.5-94). Sixteen food samples tested were all negative for HAV. As products containing frozen berries were implicated in the outbreak, the public were advised to heat-treat frozen berries before consumption.

Comparison of comorbidities in patients with pre-diabetes to those with diabetes mellitus type 2

A cross sectional study performed on 309 pre-diabetes and 309 type 2 diabetes patients, selected from General Practices in Cork. The prevalence of complications was calculated and the data analysed to determine is there a statistically significant difference in prevalence of complications. The prevalence of co-morbidities in the type 2 diabetic group are Ischaemic Heart Disease 55 (17.8%), Chronic Kidney Disease 17 (5.5%), cerebrovascular disease 16 (5.2%), peripheral vascular disease 40 (12.9%), eye disease 20 (6.5%), peripheral neuropathy 27 (8.7%) and autonomic neuropathy 11 (3.6%). The prevalence of co-morbidities in the pre-diabetic group are Ischaemic Heart Disease 64 (20.6%), Chronic Kidney Disease 12 (3.9%), cerebrovascular disease 11 (3.5%), PVD 24 (7.7%), eye disease 1 (0.3%), peripheral neuropathy 8 (2.6%) and autonomic neuropathy 17 (5.5%). The prevalence of many of the co-morbidities assessed is statistically the same in pre-diabetes patients with only peripheral vascular disease, eye disease and cerebrovascular disease having a statistically significant higher prevalence in type 2 diabetes.

Physician-assessment and physician-enhancement programs in Canada

In the mid-1980s, the licensing authorities in Quebec, Ontario and Manitoba have introduced programs to conduct in-depth assessments of the clinical skills and abilities of physicians with suspected deficiencies. These assessments are intended to supplement the provincial licensing authorities' existing peer review or patient-complaint mechanisms by confirming the physicians' overall level of competence and identifying specific clinical strengths and weaknesses. An "educational prescription", based on the results of the assessment, focuses on aspects of clinical practice in which the physicians need or wish to enhance their skills. In some situations, licensure decisions are based on the assessment information. This article describes the programs in Quebec, Ontario and Manitoba. Each program comprises a different process of personal assessment and individualized continuing medical education to help physicians improve their clinical competence, and each is built on sound principles of clinical competence assessment and educational planning.

Decline in influenza vaccine effectiveness with time after vaccination, Navarre, Spain, season 2011/12

Binary file ES_Abstracts_Final_ECDC.txt matches

Effectiveness of 2010/2011 seasonal influenza vaccine in Ireland

We conducted a case-control study to estimate the 2010/2011 trivalent influenza vaccine effectiveness (TIVE) using the Irish general practitioners' influenza sentinel surveillance scheme. Cases were influenza-like illness (ILI) patients with laboratory-confirmed influenza. Controls were ILI patients who tested negative for influenza. Participating sentinel general practitioners (GP) collected swabs from patients presenting with ILI along with their vaccination history and other individual characteristics. The TIVE was computed as (1 - odds ratiofor vaccination) x100%. Of 60 sentinel GP practices, 22 expressed interest in participating in the study and 17 (28%) recruited at least one ILI patient. In the analysis, we included 106 cases and 85 controls. Seven controls (8.2%) and one influenza case (0.9%) had been vaccinated in 2010/2011. The estimated TIVE against any influenza subtype was 89.4% [95% CI: 13.8; 99.8%], suggesting a protective effect against GP-attended laboratory confirmed influenza. This study design could be used to monitor influenza vaccine effectiveness annually but sample size and vaccination coverage should be increased to obtain precise and adjusted estimates.

A capillary absorption spectrometer for stable carbon isotope ratio (13C∕12C) analysis in very small samples

A capillary absorption spectrometer (CAS) suitable for IR laser isotope analysis of small CO(2) samples is presented. The system employs a continuous-wave (cw) quantum cascade laser to study nearly adjacent rovibrational transitions of different isotopologues of CO(2) near 2307 cm(-1) (4.34 μm). This initial CAS system can achieve relative isotopic precision of about 10 ppm (13)C, or ∼1 per thousand (per mil in delta notation relative to Vienna Pee Dee Belemnite) with 20-100 picomoles of entrained sample within the hollow waveguide for CO(2) concentrations ∼400-750 ppm. Isotopic analyses of such gas fills in a 1-mm ID hollow waveguide of 0.8 m overall physical path length can be carried out down to ∼2 Torr. Overall (13)C∕(12)C ratios can be calibrated to ∼2 per thousand accuracy with diluted CO(2) standards. A novel, low-cost method to reduce cw-fringing noise resulting from multipath distortions in the hollow waveguide is presented, which allows weak absorbance features to be studied at the few ppm level (peak-to-rms) after 1000 scans are co-added in ∼10 s. The CAS is meant to work directly with converted CO(2) samples from a laser ablation-catalytic combustion micro-sampler to provide (13)C∕(12)C ratios of small biological isolates currently operating with spatial resolutions ∼50 μm.

De novo CNV analysis implicates specific abnormalities of postsynaptic signalling complexes in the pathogenesis of schizophrenia

A small number of rare, recurrent genomic copy number variants (CNVs) are known to substantially increase susceptibility to schizophrenia. As a consequence of the low fecundity in people with schizophrenia and other neurodevelopmental phenotypes to which these CNVs contribute, CNVs with large effects on risk are likely to be rapidly removed from the population by natural selection. Accordingly, such CNVs must frequently occur as recurrent de novo mutations. In a sample of 662 schizophrenia proband-parent trios, we found that rare de novo CNV mutations were significantly more frequent in cases (5.1% all cases, 5.5% family history negative) compared with 2.2% among 2623 controls, confirming the involvement of de novo CNVs in the pathogenesis of schizophrenia. Eight de novo CNVs occurred at four known schizophrenia loci (3q29, 15q11.2, 15q13.3 and 16p11.2). De novo CNVs of known pathogenic significance in other genomic disorders were also observed, including deletion at the TAR (thrombocytopenia absent radius) region on 1q21.1 and duplication at the WBS (Williams-Beuren syndrome) region at 7q11.23. Multiple de novos spanned genes encoding members of the DLG (discs large) family of membrane-associated guanylate kinases (MAGUKs) that are components of the postsynaptic density (PSD). Two de novos also affected EHMT1, a histone methyl transferase known to directly regulate DLG family members. Using a systems biology approach and merging novel CNV and proteomics data sets, systematic analysis of synaptic protein complexes showed that, compared with control CNVs, case de novos were significantly enriched for the PSD proteome (P=1.72 × 10⁻⁶. This was largely explained by enrichment for members of the N-methyl-D-aspartate receptor (NMDAR) (P=4.24 × 10⁻⁶) and neuronal activity-regulated cytoskeleton-associated protein (ARC) (P=3.78 × 10⁻⁸) postsynaptic signalling complexes. In an analysis of 18 492 subjects (7907 cases and 10 585 controls), case CNVs were enriched for members of the NMDAR complex (P=0.0015) but not ARC (P=0.14). Our data indicate that defects in NMDAR postsynaptic signalling and, possibly, ARC complexes, which are known to be important in synaptic plasticity and cognition, play a significant role in the pathogenesis of schizophrenia.

Assisted admissions? A national survey of general practitioner experience of involuntary admissions

The 2001 Mental Health Act introduced in 2006, changed how a patient is admitted involuntarily to a psychiatric unit. This paper reports on a national survey of general practitioners' experience implementing the Act. Five hundred and sixty eight (568) GPs completed the survey. Twenty five percent (25%) of respondants had not used it. When used, twenty four percent (24%) report that it takes seven hours or more to complete an admission. Fifty percent (50%) of respondents are confident to complete the necessary paperwork. Overall GPs are dissatisfied with arrangements for transport of patients (mean Likert score 3.5), primarily due to the time delay. GPs believe this places risk on the patient, family and GP. Only thirty-three percent (33%) of respondents feel that the Mental Health Act has improved the patient, GP and family experience of involuntary admission.