Ethnic density and first episode psychosis in the British Pakistani population: findings from the East Lancashire Early Intervention Service

BACKGROUND

Elevated risk of psychosis for ethnic minority groups has generally been shown to be mitigated by high ethnic density. However, past survey studies examining UK Pakistani populations have shown an absence of protective ethnic density effects, which is not observed in other South Asian groups.

AIMS

To assess the ethnic density effect at a local neighbourhood level, in the UK Pakistani population in East Lancashire.

METHOD

Data was collected by the East Lancashire Early Intervention Service, identifying all cases of first episode psychosis (FEP) within their catchment area between 2012 and 2020. Multilevel Poisson regression analyses were used to compare incidence rates between Pakistani and White majority groups, while controlling for age, gender and area-level deprivation. The ethnic density effect was also examined by comparing incidence rates across high and low density areas.

RESULTS

A total of 455 cases of FEP (364 White, 91 Pakistani) were identified. The Pakistani group had a higher incidence of FEP compared to the White majority population. A clear effect of ethnic density on rates of FEP was shown, with those in low density areas having higher incidence rates compared to the White majority, whereas incidence rates in high density areas did not significantly differ. Within the Pakistani group, a dose-response effect was also observed, with risk of FEP increasing incrementally as ethnic density decreased.

CONCLUSIONS

Higher ethnic density related to lower risk of FEP within the Pakistani population in East Lancashire, highlighting the impact of local social context on psychosis incidence.

Safety and tolerability of transcranial magnetic and direct current stimulation in children: Prospective single center evidence from 3.5 million stimulations

BACKGROUND

Non-invasive brain stimulation is being increasingly used to interrogate neurophysiology and modulate brain function. Despite the high scientific and therapeutic potential of non-invasive brain stimulation, experience in the developing brain has been limited.

OBJECTIVE

To determine the safety and tolerability of non-invasive neurostimulation in children across diverse modalities of stimulation and pediatric populations.

METHODS

A non-invasive brain stimulation program was established in 2008 at our pediatric, academic institution. Multi-disciplinary neurophysiological studies included single- and paired-pulse Transcranial Magnetic Stimulation (TMS) methods. Motor mapping employed robotic TMS. Interventional trials included repetitive TMS (rTMS) and transcranial direct current stimulation (tDCS). Standardized safety and tolerability measures were completed prospectively by all participants.

RESULTS

Over 10 years, 384 children underwent brain stimulation (median 13 years, range 0.8-18.0). Populations included typical development (n = 118), perinatal stroke/cerebral palsy (n = 101), mild traumatic brain injury (n = 121) neuropsychiatric disorders (n = 37), and other (n = 7). No serious adverse events occurred. Drop-outs were rare (<1%). No seizures were reported despite >100 participants having brain injuries and/or epilepsy. Tolerability between single and paired-pulse TMS (542340 stimulations) and rTMS (3.0 million stimulations) was comparable and favourable. TMS-related headache was more common in perinatal stroke (40%) than healthy participants (13%) but was mild and self-limiting. Tolerability improved over time with side-effect frequency decreasing by >50%. Robotic TMS motor mapping was well-tolerated though neck pain was more common than with manual TMS (33% vs 3%). Across 612 tDCS sessions including 92 children, tolerability was favourable with mild itching/tingling reported in 37%.

CONCLUSIONS

Standard non-invasive brain stimulation paradigms are safe and well-tolerated in children and should be considered minimal risk. Advancement of applications in the developing brain are warranted. A new and improved pediatric NIBS safety and tolerability form is included.

Phosphorus export at the paddock, farm-section, and whole farm scale on an irrigated dairy farm in south-eastern Australia

Phosphorus (P) exported from agricultural land contributes to the eutrophication of inland water systems. Although P export has been extensively researched at the paddock scale, our understanding of farm-scale export is limited. This paper presents the results of a 3-year monitoring project that investigated P export at the paddock, farm-section, and whole farm scales on an irrigated dairy farm in south-eastern Australia. Annual average concentrations of 2.2–11 mg P/L, and annual loads of 2.5–23 kg P/ha were measured at the paddock and farm-section scale over the 3 years, with the quality of irrigation water applied having no significant effect on P export in surface runoff. At the farm scale, effective management of the water reuse system significantly reduced phosphorus export by up to 98%. During the 3-year period, P concentrations and loads exported in surface runoff consistently decreased between the paddock and farm-section scales (e.g. P-28 exported 13.8 kg P/ha, whereas S-4 exported 6.7 kg/ha in 2001), with the decrease in P export described using a scaling factor. Our results suggest that data on paddock-scale P export can rarely be proportionally assigned to predict section- or farm-scale export, at least on irrigated dairy farms in south-eastern Australia.

Changes in AMPA receptor binding in an animal model of inborn paroxysmal dystonia

Previous pharmacological studies suggested that glutamatergic overactivity contributes to manifestation of dystonic attacks in mutant hamsters (dt(sz)), a model of idiopathic paroxysmal dystonia in which episodes of dystonia occur in response to stress. In the present study, [(3)H]AMPA (alpha-amino-3-hydroxy-5-methylisoxazole-4-propionate) receptor binding was determined by autoradiographic analyses in 41 brain (sub)regions of dt(sz) hamsters under basal conditions, i.e., in the absence of dystonia, and in a group of mutant hamsters that exhibited severe stress-induced dystonic attacks immediately prior to sacrifice. In comparison to nondystonic control hamsters the basal [(3)H]AMPA binding was significantly higher in the ventromedial and ventrolateral caudate putamen, the anterior cingulate cortex, the hippocampus, and the lateral septum of dystonic brains. During dystonic attacks the [(3)H]AMPA binding was significantly lower in the dorsomedial, dorsolateral, and posterior caudate putamen; the ventromedial thalamus; and the frontal cortex of mutant hamsters compared with control animals that were exposed to the same external stimulation. The basal increase in AMPA receptor density within limbic structures may contribute to the susceptibility of stress-inducible dystonic episodes in mutant hamsters. Since AMPA receptor activation is known to cause a fast reduction of the affinity and an internalization of postsynaptic AMPA receptors, the latter finding could reflect a glutamatergic overactivity within the striato-thalamo-cortical circuit during the expression of dystonia, which is in line with previous neurochemical and pharmacological data in dt(sz) hamsters.

Investigating structural stability using the soil water characteristic curve

Soil physical properties, including infiltration, strength, water storage and aeration, affect the productivity of agricultural land. This paper investigated the stability of soil structure to chemical disruption, using the soil water characteristic curve. The soil water characteristic was determined twice on intact soil cores of an acidic mesotrophic, red Ferrosol (Gn4.11) and an acidic, eutrophic, grey Dermosol (Gn4.51). Saturated NaCl or deionised water was used to wet the soil cores between each determination. Despite the variability associated with undisturbed soil cores, significant differences were detected in the soil water characteristic curves both within and between soil types. The ability to detect differences in the soil structure of the Ferrosol and Dermosol, both Emerson class 8, suggests this technique could be used to determine the chemical stability of soils with minimal mechanical disruption of the structure.

Drug-induced receptor occupancy: substantial differences in measurements made in vivo vs ex vivo

RATIONALE

The number of receptors occupied by a given drug is a central construct in understanding drug action in the brain. Two techniques have been commonly used to measure drug receptor occupancy. In one method, the drug and the radioligand used to measure occupancy compete in vivo while in the other method, the drug is injected into the living animal, the animal killed and the radioligand competes for available receptors ex vivo. While these methods are often used interchangeably, there has been no systematic comparison of their sensitivities and consistency.

OBJECTIVES

In this study, we performed a systematic within-animal comparison of drug-induced receptor occupancy as measured by the in vivo vs the ex vivo methods.

METHODS

We examined the occupancy of dopamine Do receptors by different doses of the drug raclopride using the in vivo and ex vivo autoradiographic methods in the same rat with 11C-raclopride and 3H-raclopride as radioligands, respectively.

RESULTS

The in vivo method showed a significantly greater sensitivity and internal consistency while the ex vivo method was less sensitive, and increasingly so as a function of longer incubation times. The lack of sensitivity was accounted for by the unidirectional dissociation of the drug from the receptors in the incubation medium.

CONCLUSIONS

Our data suggest that these two methods are not interchangeable; the ex vivo method is much less sensitive, lacks internal consistency and hence is best avoided.

Seroconversion to HIV-1 following a needlestick injury despite combination post-exposure prophylaxis

Post-exposure prophylaxis with antiretroviral drugs for at-risk needlestick injuries has become routine practice and is usually empirical. With increasing numbers of treatment-experienced patients, the choice of antiretroviral may need to be individually tailored. Infection can still occur despite attempts to optimize the drug combination used.

Prevalence and precipitants of aggression in psychiatric inpatient units

OBJECTIVE

Aggression is a significant clinical problem in psychiatric facilities. The present study reviews data on aggression collected from psychiatric inpatient units in order to determine prevalence and causal factors.

METHOD

Data on aggressive incidents were gathered from four adult psychiatric units in the Illawarra, Australia. Information obtained included diagnosis, causal factors and patient sociodemographic characteristics.

RESULTS

During the 18-month period, a total of 1269 psychiatric patients were admitted and 174 patients (13.7%) were recorded as being aggressive. Patients with bipolar affective disorder and schizophrenia had a 2.81 and 1.96 significantly increased risk of aggression, respectively, while depression and adjustment disorder conferred a significantly lower risk. Aggression was most likely to occur within 2 days of admission and length of stay was greater for aggressive than non-aggressive patients. The greater number of incidents occurred on day shift. Most patients who displayed aggression did so on one occasion, but a small proportion of total patients (6.0%) accounted for a large number of incidents (71.0%). High-risk patients were identified as those who were under 32 years of age, were actively psychotic, detained and known to have a history of aggression and substance misuse. The most frequent form of aggression was physical and staff were most often the victims.

CONCLUSIONS

These results have important implications for predicting and thereby reducing inpatient aggression. Organisations need to ensure aggression management strategies are in place and periodically identify and assess the level of risk for workers.

Physician relations programs can increase referrals

A physician relations program can enhance an IDS's relationship with both staff and community physicians, leading to an increased referral base and improved physician satisfaction and productivity. A tactical plan is essential for developing such a program. In formulating its plan, the IDS should examine its goals and market opportunities with respect to physicians, as well as its current approach to physician relations and the current status of its relationship with physicians. The IDS then should create a new position for physician representatives to implement the tactical plan. Representatives may be charged with tasks such as increasing referrals to specific clinical services areas and developing relationships with physicians. The IDS's financial management should establish a baseline for financial returns to provide representatives with clear targets for increasing case volume and revenue.

An SNP map of human chromosome 22

The human genome sequence will provide a reference for measuring DNA sequence variation in human populations. Sequence variants are responsible for the genetic component of individuality, including complex characteristics such as disease susceptibility and drug response. Most sequence variants are single nucleotide polymorphisms (SNPs), where two alternate bases occur at one position. Comparison of any two genomes reveals around 1 SNP per kilobase. A sufficiently dense map of SNPs would allow the detection of sequence variants responsible for particular characteristics on the basis that they are associated with a specific SNP allele. Here we have evaluated large-scale sequencing approaches to obtaining SNPs, and have constructed a map of 2,730 SNPs on human chromosome 22. Most of the SNPs are within 25 kilobases of a transcribed exon, and are valuable for association studies. We have scaled up the process, detecting over 65,000 SNPs in the genome as part of The SNP Consortium programme, which is on target to build a map of 1 SNP every 5 kilobases that is integrated with the human genome sequence and that is freely available in the public domain.

The DNA sequence of human chromosome 22

Knowledge of the complete genomic DNA sequence of an organism allows a systematic approach to defining its genetic components. The genomic sequence provides access to the complete structures of all genes, including those without known function, their control elements, and, by inference, the proteins they encode, as well as all other biologically important sequences. Furthermore, the sequence is a rich and permanent source of information for the design of further biological studies of the organism and for the study of evolution through cross-species sequence comparison. The power of this approach has been amply demonstrated by the determination of the sequences of a number of microbial and model organisms. The next step is to obtain the complete sequence of the entire human genome. Here we report the sequence of the euchromatic part of human chromosome 22. The sequence obtained consists of 12 contiguous segments spanning 33.4 megabases, contains at least 545 genes and 134 pseudogenes, and provides the first view of the complex chromosomal landscapes that will be found in the rest of the genome.

Natural history of blue sclerae in osteogenesis imperfecta

Scleral hue is an important sign which distinguishes 2 broad groupings of patients, those with and those without blue sclerae with nonlethal osteogenesis imperfecta (OI). Individuals with OI type I have distinctly blue sclerae which remain intensely blue throughout life. In OI type III and OI type IV the sclerae may also be blue at birth and during infancy, but the intensity fades with time such that these individuals have sclerae of normal hue by adolescence and adult life.

What is life?

All that science can do is to look into processes which, apparently first began to operate four billion years ago before any scientists were present to observe or comment. These processes fall into three categories--energetics, chemistry and life. Energetics and chemistry have been documented but what about life.

Prediction of maximal effort bicycle ergometer endurance performance

Fifteen competitive cyclists and 15 subjects not involved in competitive cycling were studied to determine the relationship between VO2max, lactate threshold (LT), fixed blood lactate concentrations, body composition parameters, and maximal effort bicycle ergometer performance. The subjects were assessed for VO2max, LT, VOLT, and VO2 associated with blood lactate concentrations of 3, 4, 5, and 6 mM/l (VO2 3 mM-VO2 6 mM/l), using an incremental protocol on the bicycle ergometer. Body composition was determined by underwater weighing. Subjects also completed two 10-min drop-off performance tests (starting at 70 rpm) at the same absolute power output (4.5 kg resistance, 1890 kgm/min) (ABS) and at the same relative power output (the highest power output completed for 3 min on the VO2max test) (REL). Metabolic measures and revolution scores were collected on a minute-by-minute basis during the performance tests. The results indicated that the competitive cyclists had higher VO2max (4.25 +/- 0.39 vs 3.50 +/- 0.54 l/min); VO2 LT (2.91 +/- 0.55 vs 1.66 +/- 0.49 l/min); VO2 3 mM, VO2 4 mM, VO2 5 mM, VO2 6 mM, VO2 LT/VO2max (68.5 +/- 11.2 vs 47.2 +/- 10.9 %); max resistance (5.70 +/- 0.56 vs 4.63 +/- 0.67 kg); and resistance at LT (3.57 +/- 0.70 vs 1.93 +/- 0.68 kg) as compared to the noncompetitive subjects (P less than 0.05). Correlational analysis revealed poor prediction between metabolic measures and the homogeneous cumulative rpm scores during the REL test.2+ subjects (r = 0.60 to 0.90).(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of training at and above the lactate threshold on the lactate threshold and maximal oxygen uptake

Thirty-three college women (mean age = 21.8 years) participated in a 5 d X wk-1, 12 week training program. Subjects were randomly assigned to 3 groups, above lactate threshold (greater than LT) (N = 11; trained at 69 watts above the workload associated with LT), = LT (N = 12; trained at the work load associated with LT) and control (C) (N = 10). Subjects were assessed for VO2max, VO2LT, VO2LT/VO2max, before and after training, using a discontinuous 3 min incremental (starting at 0 watts increasing 34 watts each work load) protocol on a cycle ergometer (Monark). Respiratory gas exchange measures were determined using standard open circuit spirometry while LT was determined from blood samples taken immediately following each work load from an indwelling venous catheter located in the back of a heated hand. Body composition parameters were determined before and after training via hydrostatic weighing. Training work loads were equated so that each subject expended approximately 1465 kJ per training session (Monark cycle ergometer) regardless of training intensity. Pretraining, no significant differences existed between groups for any variable. Post training the greater than LT group had significantly higher VO2max (13%), VO2LT (47%) and VO2LT/VO2max (33%) values as compared to C (p less than .05). Within group comparisons revealed that none of the groups significantly changed VO2max as a result of training, only the greater than LT group showed a significant increase in VO2LT (48%) (p less than .05), while both the = LT and greater than LT group showed significant increases in VO2LT/VO2max (= LT 16%, greater than LT 42% (p less than .05)).(ABSTRACT TRUNCATED AT 250 WORDS)