Say Yes to Life: A Pilot Study

In an attempt to assess whether there are any characteristics which a majority of ordinary people regard as life-affirming or life-denying, a questionnaire was given to a pilot group of 167 respondents, representing three different age and social categories. Five life-affirming and five life-denying characteristics were mentioned by more than 10% of respondents. Of the former, Drive, Sociability, Happiness and Optimism were endorsed by 15–20%. Of the latter, Unsociability and Poor Coping were mentioned by 22%, making them distinctly more frequent than the following categories of Pessimism, Lack of Drive and Unhappiness (11–14%). It is suggested that a number of these subjectively determined characteristics, which the general public perceive as being life-affirming or denying, do indeed influence physical or mental health, illness or illness behaviour. It may therefore be of value to utilize this set of public perceptions in future programmes of health education.

Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT RCT study--Corrigendum

The author regrets to announce that affiliation 8, in the above article (Gardner-Sood et al. 2015), contained an error in the author affiliation address and author surname, which were published in the approved article. The correct surname and affiliation address are given below. J. Eberhard, Clinical Psychiatric Research Center, Lund University, Skåne, Sweden

Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial

BACKGROUND

The aims of the study were to determine the prevalence of cardiometabolic risk factors and establish the proportion of people with psychosis meeting criteria for the metabolic syndrome (MetS). The study also aimed to identify the key lifestyle behaviours associated with increased risk of the MetS and to investigate whether the MetS is associated with illness severity and degree of functional impairment.

METHOD

Baseline data were collected as part of a large randomized controlled trial (IMPaCT RCT). The study took place within community mental health teams in five Mental Health NHS Trusts in urban and rural locations across England. A total of 450 randomly selected out-patients, aged 18-65 years, with an established psychotic illness were recruited. We ascertained the prevalence rates of cardiometabolic risk factors, illness severity and functional impairment and calculated rates of the MetS, using International Diabetes Federation (IDF) and National Cholesterol Education Program Third Adult Treatment Panel criteria.

RESULTS

High rates of cardiometabolic risk factors were found. Nearly all women and most men had waist circumference exceeding the IDF threshold for central obesity. Half the sample was obese (body mass index ≥ 30 kg/m2) and a fifth met the criteria for type 2 diabetes mellitus. Females were more likely to be obese than males (61% v. 42%, p < 0.001). Of the 308 patients with complete laboratory measures, 57% (n = 175) met the IDF criteria for the MetS.

CONCLUSIONS

In the UK, the prevalence of cardiometabolic risk factors in individuals with psychotic illnesses is much higher than that observed in national general population studies as well as in most international studies of patients with psychosis.

The Met Office Hadley Centre climate modelling capability: the competing requirements for improved resolution, complexity and dealing with uncertainty

Predictions of future climate change require complex computer models of the climate system to represent the full range of processes and interactions that influence climate. The Met Office Hadley Centre uses 'families' of models as part of the Met Office Unified Model Framework to address different classes of problems. The HadGEM family is a suite of state-of-the-art global environment models that are used to reduce uncertainty and represent and predict complex feedbacks. The HadCM3 family is a suite of well established but cheaper models that are used for multiple simulations, for example, to quantify uncertainty or to test the impact of multiple emissions scenarios.

Photoperiod and social cues influence the medial amygdala but not the bed nucleus of the stria terminalis in the Siberian hamster

We investigated whether the posterodorsal nucleus of the medial amygdala (MePD) and the posteromedial nucleus of the bed nucleus of the stria terminalis (BSTpm) undergo structural changes in response to photoperiod or social environment in the Siberian hamster, a seasonally breeding rodent. Adult male hamsters were either kept in long days (LD; 15:9 h light:dark) from birth or were transferred at 12-16 weeks of age to short days (SD; 8:16) and housed with a male conspecific for 11 weeks. Other males were transferred to SD but were housed with an unrelated female conspecific from LD. Males transferred to SD without a female cagemate displayed testicular regression, but males transferred to SD with a female cagemate did not. The regional volume and average soma size of the BSTpm and the MePD were estimated using Nissl-stained brain sections. Neither photoperiod nor social condition modified either of the BSTpm measures. Among males housed in same-sex groups, the average soma size in the MePD was significantly smaller in SD males than in LD males. Cohabitation with a female resulted in MePD volumes indistinguishable from LD males. These results indicate that the MePD, a nucleus implicated in socio-sexual behavior, can respond to photoperiodic as well as to social cues.

Video-based computer-assisted learning

As a relevant exemplar of MPEG-1 and MPEG-2 digital video use, a multimedia computer-assisted learning (CAL) application dealing with Critical Communication Issues in medicine was developed. The application allowed the student to navigate through a series of high-quality digital video and audio clips that were delivered in near real-time from an Intranet server. This paper gives a brief background to the MPEG-2 video compression system and discusses the use of digital video in a CAL environment.

Critical incident: reflection on the process of terminal weaning

The article uses critical incident analysis to reflect on the process of terminal weaning. Terminal weaning is defined in the context of withdrawing ventilatory support when the expected outcome is the patient's death. Basic ethical concepts are identified, and the role of the nurse in ethical decision making is discussed in relation to the associated professional and legal issues. Conflict exists between professional and legal accountability in relation to advocacy. Caution is advised with regard to nurses becoming involved in the decision to terminally wean, and its practice.

Continuous positive airway pressure (CPAP) in the intensive care unit--uses and implications for nursing management

CPAP therapy has several clinical uses and offers the potential for numerous benefits to selected patients. Extensive literature is available on medical application of CPAP, but very little can be found on the nursing implications. There exists a potential to increase the nurse's role in the assessment, application, management and evaluation of CPAP therapy. Established psychological implications of CPAP therapy exist. Research is required to investigate and develop the nursing role with regard to CPAP therapy.

Effects of a drug overdose in a television drama on presentations to hospital for self poisoning: time series and questionnaire study

OBJECTIVES

To determine whether a serious paracetamol overdose in the medical television drama Casualty altered the incidence and nature of general hospital presentations for deliberate self poisoning.

DESIGN

Interrupted time series analysis of presentations for self poisoning at accident and emergency departments during three week periods before and after the broadcast. Questionnaire responses collected from self poisoning patients during the same periods.

SETTING

49 accident and emergency departments and psychiatric services in United Kingdom collected incidence data; 25 services collected questionnaire data.

SUBJECTS

4403 self poisoning patients; questionnaires completed for 1047.

MAIN OUTCOME MEASURES

Change in presentation rates for self poisoning in the three weeks after the broadcast compared with the three weeks before, use of paracetamol and other drugs for self poisoning, and the nature of overdoses in viewers of the broadcast compared with non-viewers.

RESULTS

Presentations for self poisoning increased by 17% (95% confidence interval 7% to 28%) in the week after the broadcast and by 9% (0 to 19%) in the second week. Increases in paracetamol overdoses were more marked than increases in non-paracetamol overdoses. Thirty two patients who presented in the week after the broadcast and were interviewed had seen the episode-20% said that it had influenced their decision to take an overdose, and 17% said it had influenced their choice of drug. The use of paracetamol for overdose doubled among viewers of Casualty after the episode (rise of 106%; 28% to 232%).

CONCLUSIONS

Broadcast of popular television dramas depicting self poisoning may have a short term influence in terms of increases in hospital presentation for overdose and changes in the choice of drug taken. This raises serious questions about the advisability of the media portraying suicidal behaviour.

Performance of a PCR assay for detection of Pneumocystis carinii from respiratory specimens

This study evaluates the performance of a PCR assay for the detection of Pneumocystis carinii from respiratory specimens that has been designed for use in the clinical microbiology laboratory. The test includes a simple method for nucleic acid extraction and amplification, a colorimetric probe hybridization technique for detection of amplicons, and an internal control to evaluate for the presence of inhibitors of amplification. Two hundred thirty-two clinical specimens (120 induced-sputum [IS] and 112 bronchoalveolar lavage [BAL] specimens) from 168 patients were tested by both immunofluorescent (direct fluorescent-antibody [DFA]) staining and PCR. Of the 112 BAL specimens, 17 were positive for P. carinii by DFA staining and PCR. An additional two specimens were DFA negative and PCR positive. For BAL specimens, the sensitivity and specificity of PCR compared to DFA were 100 and 98%, respectively. Eighteen IS specimens were positive for P. carinii by DFA, and 27 were positive by PCR. One of the 18 DFA-positive IS specimens was negative by PCR; this patient had just completed therapy for P. carinii pneumonia. Of the 10 specimens that were PCR positive and DFA negative, 4 were from patients who had a subsequent BAL specimen that was positive by DFA and PCR. For IS specimens, the sensitivity of DFA and PCR was 82 and 95%, respectively. The specificity of PCR for IS specimens was 94%. Due to the high sensitivity of PCR for the detection of P. carinii from IS specimens, a PCR-based diagnostic test may be a useful screening test and may alleviate the need for bronchoscopy in some patients.

Detection of Mycobacterium tuberculosis by PCR amplification with pan-Mycobacterium primers and hybridization to an M. tuberculosis-specific probe

Nucleic acid amplification techniques such as the PCR are very useful in the rapid diagnosis of infections by Mycobacterium tuberculosis. However, recent studies have shown that the accuracy of results can vary widely when tests are performed with nonstandardized reagents. We have developed a PCR assay for the detection of M. tuberculosis that is both rapid and accurate. The assay reagents are standardized and quality controlled. False-positive results due to carryover contamination are prevented by the incorporation of dUTP coupled with uracil-N-glycosylase restriction. This assay also employs pan-Mycobacterium amplification primers, allowing for flexibility in the mycobacterial species that can be identified from a single amplification reaction. The amplification is very sensitive; amplification products generated from as few as three bacteria can be detected by agarose gel electrophoresis. DNAs isolated from 33 of 34 mycobacterial species tested were amplified efficiently. Only DNA from Mycobacterium simiae did not amplify. The amplification is also very specific. Amplification products were generated only from the DNAs of bacteria in closely related genera such as Corynebacterium. The nonmycobacterial amplicons do not pose a problem, as they do not hybridize to mycobacterium-specific probes. Hybridization of amplicons to an M. tuberculosis-specific probe allows for the unambiguous identification of M. tuberculosis complex organisms. The clinical performance of this PCR assay was evaluated against that of culture in 662 respiratory specimens. Sensitivities of 100 and 73.1% were obtained from smear-positive and -negative respiratory specimens, respectively. The corresponding specificities were 100 and 99.8%. The high sensitivity and specificity, coupled with the potential for detecting a wide range of mycobacteria, make this assay a useful tool in the clinical management of mycobacterial infections.

Examination of egg number and egg weight variables and their effects on daily management in aviary systems for laying hens

1. Characteristics of egg numbers and mean egg weight were examined for their usefulness in the daily management of aviary systems for laying hens. 2. A number of 3238 brown Isabrown/Warren hens were housed in 1 compartment, a separated part of the house where the hens could move around freely, of a tiered-wired-floor aviary system (TWF-system). An automatic egg weighing and counting system (EWACS) was used to count and weigh eggs daily from 2 tiers of laying nests on 1 side of the compartment and the number of eggs for the whole compartment were counted daily by the farmer. Each tier was divided into 16 blocks of 5 individual laying nests. Two adjoining blocks were called a group. To prevent hens from walking along all the laying nests in a tier, partitions were placed on the perches in front of the laying nests, between nest groups 2-3, 4-5, and 6-7. 3. After the first 3 weeks of the laying period, the distribution of egg numbers over the nest groups within a tier became stable. If egg numbers were counted daily from only 1 nest group the coefficient of variation was 23.1%. If the eggs from the whole compartment were counted daily, the coefficient of variation for the number of eggs was 2.8%. The nest group, presence of a partition and tier level influenced the daily number of eggs. 4. The distribution of the mean egg weight over the different nest groups within a tier was stable for the whole laying period. The coefficient of variation of the daily mean egg weight for a nest group was 3.1%. The difference in mean egg weight between nest groups was small, between 0.1 and 0.6 g, and the level of tiers and the presence of partitions between nest groups had no effect on the mean egg weight. 5. It could be concluded that egg numbers could not be estimated reliably by taking samples from a group of laying nests or a tier, but that it was necessary to count all the eggs from a compartment. The daily mean egg weight, however, could be estimated reliably on the basis of a sample of eggs from a nest group or a tier. By using EWACS frequent samples could be taken, which diminished the coefficient of variation so that the reliability of the data increased.

The effect of manure and litter handling and indoor climatic conditions on ammonia emissions from a battery cage and an aviary housing system for laying hens

Ammonia emissions from both traditional and new welfare-based housing systems for laying hens must be reduced to prevent detrimental effects on the environment. In a comparative study, the effect of manure handling (variation in drying and removal frequency) in a battery cage and the effect of manure handling (as in battery cage system) and litter treatment (removal of litter) in a Tiered Wire Floor (TWF) aviary system on the emission of ammonia were investigated. Each system housed 6480 hens, treatments were varied in time, and effects were analysed by means of time-series analysis. The hens in the TWF system dropped 22.5% of their excreta in the litter and the remaining part, like all manure in the battery cage system, was dropped on the manure belts. The estimated emission from the manure on the belts in both systems was 18.8 g/h (daily mean, manure removal twice a day), whereas the emission from the litter in the TWF system amounted to 62.5 g/h. Emission from the belt manure on a typical day increased by 14, 39, 109 and 177% from the 1st until the 4th day after manure removal. The effect of increasing temperature and water vapour pressure difference on emission was +17% and -22% per degree and per kPa, respectively. Drying of manure on the belts increased the dry matter content of the manure and showed a tendency towards lower emissions. The dry matter content of the litter varied between 780 and 840 g/kg, the mean total nitrogen content was 3.3% of the dry matter, and the layer thickness varied between 2 and 9 cm. Both the ammonia content, which ranged between 20 and 190 mg/kg, and the layer thickness of the litter influenced the emission from the litter positively.

The 1992 measles epidemic in Cape Town--a changing epidemiological pattern

Over the last 6 years there has been a decline in the incidence of measles in Cape Town. However, during August 1992 an outbreak occurred, with cases reported at many schools in children presumably immunised. The objectives of this study were to characterise the epidemic in Cape Town and to determine possible reasons for the outbreak. The investigation consisted of two components--a description of the epidemic and an investigation of an outbreak at one primary school. Results indicate that during the last 4 months of the year, 757 cases were notified in Cape Town, compared with 144 in the first 8 months. The epidemic affected mainly white and coloured children over 5 years of age (P < 0.001). In contrast, during the period before the epidemic most cases occurred in black children and in those aged less than 1 year (P < 0.001). There was no significant increase in hospitalised cases. Investigation of the outbreak at one school revealed that the attack rate was 7.6% (25/329 children). Immunisation coverage (at least one dose of any measles vaccine) was 91% and vaccine efficacy was estimated to be 79% (95% CI 55-90); it was highest for monovalent measles (100%) and lowest for measles-mumps-rubella (74%). The epidemiology of measles in Cape Town has thus changed as evinced in this epidemic, with an increase in the number of cases occurring in older, previously vaccinated children. The possible reasons for this include both primary and secondary vaccine failure.(ABSTRACT TRUNCATED AT 250 WORDS)

Neuronal expression of regulatory helix-loop-helix factor Id2 gene in mouse

Id-like helix-loop-helix (HLH) proteins, which lack a basic DNA binding domain, have been suggested to serve as general inhibitors of differentiation. We present data that Id2 is expressed in specific cell types during neurogenesis and in the adult. At early stages of neurogenesis, Id2 is expressed in the ventricular zone of neuroepithelium. After the first neuronal populations are born, the expression of Id2 is down regulated in neuroepithelial cells and continues to be high in Purkinje cells of the cerebellum, in mitral cells of the olfactory bulb, and in layers 2, 3, and 5 of the cerebral cortex. In neuronally differentiating cell lines, the Id2 expression is up regulated (PCC7), down regulated (NG108), or unchanged (N18) during differentiation. Analyses of promoter sequences of the Id2 gene identify the region which is responsible for the down regulation of transcription during neuronal differentiation. Our data indicate that Id2 has different functions in different cell types during neurogenesis.

ME1 and GE1: basic helix-loop-helix transcription factors expressed at high levels in the developing nervous system and in morphogenetically active regions

Several class A basic helix-loop-helix (bHLH) transcription factors have been cloned from the developing mouse and chick nervous system. The cloned cDNAs (ME1, ME2, ME3, ME4, in the mouse and GE1, GE2 in the chick) have HLH coding regions highly homologous to other known class A bHLH genes. The genes corresponding to ME1 and GE1 are abundantly expressed during development of the central nervous system. ME1 and GE1 are expressed in proliferating neuroblasts and in cells at the initial stages of differentiation (for example in the external granule cell layer of the cerebellum and in the lateral region of the ventricular zone in the developing neural tube and cortex). They are also expressed at high levels in morphogenetically active regions such as limb buds, somites and mesonephric tubules. The expression of ME1 and GE1 decreases once cellular differentiation is over. Based on the expression of ME1 and GE1 in regions of active cellular proliferation and differentiation and on the known role of other bHLH factors in development, we suggest that ME1 and GE1 play important roles during development of the nervous system as well as in other organ systems.

Multiple mutation in an extended Duchenne muscular dystrophy family

We have investigated an extended pedigree with three cousins affected by Duchenne muscular dystrophy with apparent transmission through the male line. However, molecular studies have shown that one boy has a de novo duplication, another has a deletion, and the molecular mutation has yet to be defined in the third boy. All three X chromosomes in the affected boys appear to have a different origin. We speculate on the mechanisms by which the Duchenne locus may be particularly prone to mutation in this family and the possible involvement of transposons is discussed. Whatever the mechanism involved, the occurrence of three different mutations in one pedigree is a rare event.

The placental lactogen receptor in maternal and fetal sheep liver: regulation by glucose and role in the pathogenesis of fasting during pregnancy

To clarify the roles of glucose and insulin in the regulation of the PL receptor in fetal and maternal sheep liver, we administered iv glucose to pregnant ewes during a 72-h fast. The binding of ovine PL (oPL) to hepatic membranes from glucose-infused ewes and their fetuses was compared with the binding of oPL to tissues of fasted, saline-infused sheep and sheep fed normally ad libitum. Fasting of pregnant ewes caused a 58-70% reduction in the number of PL receptors in fetal and maternal liver. Intravenous administration of glucose during fasting increased the number of PL receptors in fetal liver by 137.4%. In contrast, glucose administration during fasting had no effect on the number of PL receptors in maternal liver. The number of PL binding sites in fetal liver correlated positively with fetal weight (r = 0.59) and length (r = 0.54) and with fetal plasma glucose (r = 0.69) and insulin (r = 0.55) concentrations. In contrast, PL binding was inversely related to fetal plasma oPL concentrations (r = -0.70). These findings suggested that glucose, insulin, and/or oPL may regulate PL binding in the ovine fetus. To determine whether glucose or insulin exert direct effects on the PL receptor in ovine fetal tissues, we examined the binding of radiolabeled oPL to ovine fetal hepatocytes and fibroblasts in culture. The specific binding of oPL to fetal hepatocytes was low and variable (1.0 +/- 0.5%) and it was not possible to assess reliably the effects of glucose or insulin supplementation. The specific binding of oPL to fetal fibroblasts (5.4 +/- 0.6%/mg) was unaffected by variations in media glucose concentrations (5.5-16.5 mM) or by pretreatment with insulin (10-1000 ng/ml). The results of these studies demonstrate that glucose and other nutritional factors regulate the expression of the PL receptor in fetal and maternal sheep liver. Alterations in PL binding play roles in the metabolic adaptation of the mother and fetus to nutritional deprivation and stress.

Measurement of serum folate by 75Se-selenofolate radioassay. Results of a multi-institutional clinical trial

The authors report the multi-institutional evaluation of a radioassay for serum folate utilizing a gamma-labeled folate analog (75Se-pteroyl-L-methylselenocysteine). The assay is run as a one-step simultaneous addition at ambient temperature and is completed within 45 minutes. The assay data were reproducible within four study centers and correlated with both the Lactobacillus casei diagnostic groups and the clinical pictures.

Polyethylene glycol purification of influenza virus with respect to aggregation and antigenicity

Influenza virus may be precipitated and aggregated by polyethylene glycol into clusters comprising ten to many hundred virions per aggregate. These aggregates are sparingly soluble and may be freed of contaminating polymer by washing in the appropriate buffer at room temperature or by precipitation in 30% (v/v) ethanol at subzero temperatures.Immunogenic studies in guinea-pigs of the virus in different states of dispersion revealed that the aggregated virus is the superior antigen to the virus in the monomeric form or in the dissociated state following treatment with ether.