72 Evaluation of digital images of bovine embryos

Bovine embryo transfer is an assisted reproductive technology that enables cattle producers to reach their reproductive, genetic, and financial goals. Proper evaluation of embryo quality and developmental stage is key to the success of the embryo transfer industry and is often acquired “on the job” as there are few embryo evaluation training opportunities. The goals of this project were to develop a bank of digital images of invivo-produced bovine embryos, and to evaluate interrater reliability and variation of grade and stage scores and the assessment of the integrity of the zona pellucida (ZP) using an online platform. Frozen/thawed bovine embryos (Day 7) were placed in a commercially available holding medium, and images were captured using a high-resolution camera (112× magnification). Survey participants (n=89) responded to questions on demographic and embryo evaluation experience and assigned grades and stages and evaluated the integrity of the ZP in 58 embryo images (the IETS embryo evaluation rubric was provided). The variation among raters within and between demographic categories was analysed using the “kappaetc” package with weights for ordinal variables (grade and stage) in Stata version 14.2 (StataCorp). The Kruskal–Wallis test was used to assess whether variation [measured as interquartile range (IQR)] in grade and stage ratings within individual were significantly different (P=0.05) by demographic factors. Overall, interrater reliability (measured by Cohen’s Kappa, κ) for stage was moderate (κ=0.57), whereas identification of grade and the ZP was substantial (κ=0.69 and 0.73, respectively). Interrater reliability for grade was significantly lower among those with ≤2 years (n=17) of experience (κ=0.44) compared with those having 3–9 years (n=29; κ=0.57) and ≥10 years (n=43; κ=0.64). Similarly, interrater agreement for stage was significantly lower for those with ≤2 years of experience (κ=0.58) compared with those having 3–9 years (κ=0.68) and ≥10 years (κ=0.75). Interrater agreement for stage was higher for those who did not use the IETS rubric compared with those who did (κ=0.73 vs. κ=0.63, respectively), and the variability was highest for Stage 6 and lowest for Stage 4 embryos. No demographic variables were significantly associated with interrater reliability for the integrity of the ZP. The variability of stage ratings (IQR) within individual significantly increased with more years of experience, with greatest IQR among those with ≥10 years of experience. The IQR within individual for grade decreased with increasing length of time rating, with the lowest IQR for the longest duration spent on rating the embryos. Overall, there was a moderate to substantial interrater agreement in embryo evaluation, which increased with experience. Further, evaluation of bovine embryo digital images may be a useful training tool instead of or in conjunction with a “hands-on” experience. Future surveys will involve multiple images of the same embryo and video to enhance the evaluation process and increase interrater reliability.

12 Artificial insemination and embryo transfer results in ewes during a long daylength period

Sheep are polyestrous, short-day breeders (∼11h of daylength), and exhibit oestrus approximately every 16–17 days during the breeding season, usually in late September to late December in the Northern Hemisphere. Progressive sheep producers often use assisted reproductive techniques such as laparoscopic AI and ovarian hyper-stimulation, embryo collection, and embryo transfer (ET) to increase genetic gain, and strive to have early December lambs to target specific show markets, which dictates AI or ET during the late summer. This field trial compared pregnancy rates following AI or ET in July and August (∼14h of daylength) in southwest Virginia (36–38′12″ N). Ewes (AI, n=83; ET recipients, n=33) were synchronized using a modified Ovsynch protocol involving intravaginal progesterone implants for 14 days, prostaglandin F2α (intramuscular) 48h before expected oestrus, and PG600 (IM) and gonadotrophin-releasing hormone (intramuscular) 52 to 54h and 16h before AI, respectively. Ewes were subjected to AI (frozen/thawed semen) regardless of whether they displayed signs of oestrus, and ewes selected as embryo recipients were subjected to a similar protocol but instead received 1 or 2 embryos (based upon the number of viable embryos produced per embryo donor) 6 days following the AI of the embryo donors. Ovarian hyper-stimulation of the embryo donors (n=13) was enabled by twice-daily FSH injections [totalling 350–455IU of Folltropin V (10–13mL)] for the 4 days before AI. Six days following AI, embryos were recovered surgically from the embryo donors (n=13) and yielded an average (±s.e.m.) of 6.6±1.2 total ova, 4.7±1.1 transferable quality embryos, and 1.9±0.8 unfertilized ova per collection. Pregnancy was detected using transrectal ultrasonography at ∼30 days of gestation and the pregnancy rates were analysed using Chi-squared. There was a tendency (P=0.092) for more pregnancies to be established following ET (22/33; 66%) compared with AI (41/83; 49%). There was no statistical relationship between AI ewes or ET recipient ewes that became pregnant relative to whether they displayed signs of oestrus or not. Embryo transfer was a more successful approach to produce pregnancies in ewes compared with AI during long daylength periods in this field trial. Further, ova from hyper-stimulated embryo donor ewes experienced a very high fertilization rate. Future studies will evaluate the ova capability directly via laparoscopic aspiration of ovarian follicles and IVF and evaluation of hyper- and non-hyper-stimulated follicular waves (using transrectal ultrasonography) and endocrine dynamics during different long and short daylength periods. Extending the opportunity to generate embryos and offspring regardless of daylength will assist aggressive sheep producers in reaching their reproductive, financial, and genetic goals.

An evaluation of the EOLAS psychoeducation programme for service users: An innovative approach to collaboration between clinicians and ‘experts by experience’

Introduction

Psychoeducation for service users has been shown in several recent meta-analyses to improve adherence with treatment, decrease rehospitalization rates and improve various measures of quality of life. The 8-week EOLAS Programme for service users with schizophrenia or bipolar disorder is unique in being designed, co-facilitated and evaluated collaboratively by both clinician and peer representatives. EOLAS forms part of the service plan of the national Health Service in Ireland.

Aims and objectives

To evaluate the impact of the EOLAS programme on participants’ perceived knowledge, confidence, advocacy, recovery attitudes and hope.

Methodology

Anonymised questionnaires were administered to participants before and after completion of the EOLAS Programme.

All survey participants were invited to attend for interview to examine qualitatively their experience of the programme. Interviews were recorded and subjected to thematic analysis.

Results

Forty-five subjects completed pre- and post-programme questionnaires (participation rate = 55%).

Significant improvements (P < 0.05) were identified across each of the 5 domains examined (i.e. perceived knowledge, confidence, advocacy, recovery attitudes, hope). Expressed satisfaction with the programme was high (95%).

At interview, participants (n = 12) particularly valued:

– the opportunity to ask questions of the psychiatrist e.g. about medication;

– improving self-care skills e.g. monitoring early warning signs of relapse;

– co-facilitation by a peer, which provided extra credibility and inspired hope;

– sharing experiences with peers.

Conclusions

The EOLAS programme succeeds in meeting the needs of the participants across the target domains. This success depends on the unique collaboration between clinicians and peer experts on which EOLAS is based.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

The future of scattered trees in agricultural landscapes

Mature trees scattered throughout agricultural landscapes are critical habitat for some biota and provide a range of ecosystem services. These trees are declining in intensively managed agricultural landscapes globally. We developed a simulation model to predict the rates at which these trees are declining, identified the key variables that can be manipulated to mitigate this decline, and compared alternative management proposals. We used the initial numbers of trees in the stand, the predicted ages of these trees, their rate of growth, the number of recruits established, the frequency of recruitment, and the rate of tree mortality to simulate the dynamics of scattered trees in agricultural landscapes. We applied this simulation model to case studies from Spain, United States, Australia, and Costa Rica. We predicted that mature trees would be lost from these landscapes in 90-180 years under current management. Existing management recommendations for these landscapes--which focus on increasing recruitment--would not reverse this trend. The loss of scattered mature trees was most sensitive to tree mortality, stand age, number of recruits, and frequency of recruitment. We predicted that perpetuating mature trees in agricultural landscapes at or above existing densities requires a strategy that keeps mortality among established trees below around 0.5% per year, recruits new trees at a rate that is higher than the number of existing trees, and recruits new trees at a frequency in years equivalent to around 15% of the maximum life expectancy of trees. Numbers of mature trees in landscapes represented by the case studies will decline before they increase, even if strategies of this type are implemented immediately. This decline will be greater if a management response is delayed.

A radical approach to minimally invasive total hip replacement: surgical technique and pre-clinical test data

Currently total hip replacement surgery using minimally invasive techniques is a fast developing field. However, all reports concern adaptations of surgical techniques with adapted instruments using conventional implants. These conventional implants limit the minimal invasiveness to some extent. In this paper a new system is reported featuring a new surgical approach, new instrumentation and a new implant design. The purpose of this study was to introduce the system and to assess the feasibility of the system in terms of stability, range of motion and wear characteristics. The pre-clinical tests indicated that the factor of safety for this type of design is smaller than for conventional implants. However, the results show adequate performance of the system, which suggests that further development and testing is justified to advance the system for clinical use.

The Stability of the Femoral Component of a Minimal Invasive Total Hip Replacement System

In this study, the initial stability of the femoral component of a minimal invasive total hip replacement was biomechanically evaluated during simulated normal walking and chair rising. A 20 mm diameter canal was created in the femoral necks of five fresh frozen human cadaver bones and the femoral heads were resected at the smallest cross-sectional area of the neck. The relatively short, polished, taper-shaped prostheses were cemented centrally in this canal according to a standardized procedure. A servohydraulic testing machine was used to apply dynamic loads to the prosthetic head. Radiostereophotogrammetric analysis was used to measure rotations and translations between the prosthesis and bone. In addition, the reconstructions were loaded until failure in a static, displacement-controlled test. During the dynamic experiments, the femoral necks did not fail and no macroscopical damage was detected. Maximal values were found for normal walking with a mean rotation of about 0.2° and a mean translation of about 120 μm. These motions stabilized during testing. The mean static failure load was 4714 N. The results obtained in this study are promising and warrant further development of this type of minimal invasive hip prosthesis.

Fauna-habitat relationships: a basis for identifying key stand structural attributes in temperate Australian eucalypt forests and woodlands

We review a representative sample of the literature concerning fauna-habitat relationships in temperate Australian eucalypt forests and woodlands as a basis for identifying some key stand structural attributes in these ecosystems. Our review identifies 56 studies in south-east and south-west Australia in which the presence or abundance of different fauna were significantly associated with vegetation structural attributes at the scale of a stand. The majority of these studies concern bird, arboreal mammal, and ground mammal habitat requirements, with relatively few studies addressing the habitat requirements of reptiles, invertebrates, bats or amphibians. We identify 34 key structural attributes from these 56 studies, by grouping similar attributes, and then representing each group with a single generic attribute. Relatively few of these attributes are incorporated into indices used to quantify fauna habitat. We highlight the need for a quantitative method for selecting which key attributes should form the basis for an index of structural complexity or other surrogate measure of faunal diversity.

Cleft sternum: case report and literature review

The isolated sternal cleft is a rare congenital anomaly that presents from birth to adulthood. We describe the late presentation and management in a child with this condition. The modern investigative and operative options are reviewed.

Access to health services in Ireland for people with Multiple Sclerosis and Motor Neurone Disease

We conducted a telephone questionnaire to determine the utilisation of hospital and community based services by patients with Motor Neurone Disease and Multiple Sclerosis in Ireland. 94 MND and 188 MS patients participated in the study. MND patients were more likely to have free medical care than MS patients, despite legislation favouring the converse. Severely disabled MND patients were more successful at accessing free community-based services than were severely disabled MS patients. Private medical insurance conferred no advantage when obtaining services or purchasing equipment. Many patients were unaware of the specific roles of the various clinical professionals. There are significant deficiencies in patients' ability to access multidisciplinary services. Voluntary organisations often bridge the gap in service provision. An investment in services for people with chronic neurological disability is urgently required.

Patient positioning and spinal locking for lumbar spine rotation manipulation

High velocity low amplitude (HVLA) thrust techniques are widely used by many manual therapists to treat low back pain. There is increasing evidence that spinal manipulation produces positive patient outcomes for acute low back pain. HVLA thrust techniques are associated with an audible release in the form of a pop or cracking sound that is widely accepted to represent cavitation of a spinal zygapophyseal joint. This audible release distinguishes these techniques from other manual therapy interventions. When using long lever HVLA thrust techniques spinal locking is necessary to localize forces and achieve cavitation at a specific vertebral segment. A critical factor in applying lumbar spine manipulation with minimal force is patient positioning and spinal locking. A knowledge of coupled movements of the lumbar spine aids an understanding of the patient positioning required to achieve spinal locking consistent with maximal patient comfort and cooperation. Excessive rotation can result in pain, patient resistance and failed technique. This masterclass presents a model of patient positioning for the lumbar spine that minimizes excessive use of rotation to achieve spinal locking prior to the application of the thrust.

Intraexaminer and interexaminer reliability for palpation of the cranial rhythmic impulse at the head and sacrum

BACKGROUND

A range of health care practitioners use cranial techniques. Palpation of a cranial rhythmic impulse (CRI) is a fundamental clinical skill used in diagnosis and treatment with these techniques. There has been little research establishing the reliability of CRI rate palpation.

OBJECTIVE

This study aimed to establish the intraexaminer and interexaminer reliability of CRI rate palpation and to investigate the "core-link" hypothesis of craniosacral interaction that is used to explain simultaneous motion at the cranium and sacrum.

DESIGN

Within-subjects, repeated-measures design.

SUBJECTS

Two registered osteopaths, both with postgraduate training in diagnosis and treatment, using cranial techniques, palpated 11 normal healthy subjects.

METHODS

Examiners simultaneously palpated for the CRI at the head and the sacrum of each subject. Examiners indicated the "full flexion" phase of the CRI by activating silent foot switches that were interfaced with a computer. Subject arousal was monitored using heart rate. Examiners were blind to each other's results and could not communicate during data collection.

RESULTS

Reliability was estimated from calculation of intraclass correlation coefficients (2,1). Intrarater reliability for examiners at either the head or the sacrum was fair to good, significant intraclass correlation coefficients ranging from +0.52 to +0.73. Interexaminer reliability for simultaneous palpation at the head and the sacrum was poor to nonexistent, ICCs ranging from -0.09 to +0.31. There were significant differences between rates of CRI palpated simultaneously at the head and the sacrum.

CONCLUSIONS

The results fail to support the construct validity of the "core-link" hypothesis as it is traditionally held by proponents of craniosacral therapy and osteopathy in the cranial field.

Inter-examiner and intra-examiner agreement for assessing sacroiliac anatomical landmarks using palpation and observation: pilot study

Despite the paucity of research into the reliability of static palpation, it is still employed extensively as a diagnostic tool by manual medicine practitioners. This study tested the inter- and intra-examiner agreement of ten senior osteopathic students using static palpation on ten asymptomatic subjects. Four assessments of the posterior superior iliac spine (PSIS), sacral sulcus (SS), and the sacral inferior lateral angle (SILA) on every subject by all examiners resulted in 1200 assessments in total. Kappa (Kg) yielded intra-examiner agreement that ranged between less-than-chance to substantial for the SILA (Kg=-0.05 to 0.69; mean Kg=0.21), and slight to moderate for the PSIS (Kg=0.07 to 0.58; mean Kg=0.33) and the SS (Kg=0.02 to Kg=0.60; mean Kg=0.24), with 50% significant beyond the 0.05 level. Inter-examiner agreement was slight (PSIS Kg=0.04; SILA Kg=0.08; SS Kg=0.07) and significant at the 0.01 level. Intra-examiner agreement was greater than inter-examiner agreement, which was consistent with existing palpation reliability studies. The poor reliability of clinical tests involving palpation may be partially explained by error in landmark location.

Hollow formation in eucalypts from temperate forests in southeastern Australia

We examined factors associated with the occurrence of tree hollows in four eucalypt species from temperate forest in southeastern New South Wales and East Gippsland. A total of 1 256 standing trees and 328 felled trees was examined. The proportion of trees containing hollows with small entrances (2-5 cm) was significantly negatively associated with dbh, while the proportion of trees containing hollows with medium (5-10 cm) and large (>10 cm) entrances was positively associated with dbh. There was a significant, but weak, relationship between hollow depth and minimum entrance width that was improved with the addition to the model of the variables branch diameter and branch health. Trees of all sizes and ages contained hollows, although larger and older trees had a higher probability of doing so. For two tree species (Brown Barrel or Cuttail Eucalyptus fastigata and Messmate E. obliqua), the probability of live trees containing hollows remained below 0.5 for stems less than 180 years of age. Un logged forest supported, on average, 22.0 hollowbearing trees per ha ? 18.5% of which were dead trees. For all values of dbh, trees were more likely to contain hollows if either dead or in poor physiological condition, indicating the potential for hollow development to be accelerated in eucalypts by killing or injuring suitably-sized trees.

Inter-examiner and intra-examiner reliability of the standing flexion test

The practice of musculoskeletal medicine requires the use of a wide variety of clinical examination procedures to establish a diagnosis, plan treatment, and monitor patient progress. Many of these examination procedures constitute a significant part of daily practice. Despite their extensive use, the reliability and validity of many of these assessment procedures remains questionable. The aim of this study was to determine the inter- and intra-examiner reliability of palpatory findings for the standing flexion test; one test for sacroiliac joint (SIJ) dysfunction. Nine examiners performed the standing flexion test on nine asymptomatic subjects. Inter-examiner reliability data, with a mean percentage agreement of 42% and a kappa coefficient of 0.052, demonstrated statistically insignificant reliability. Intra-examiner reliability data demonstrated a mean percentage agreement of 68% and a kappa coefficient of 0.46 indicating moderate reliability. These results suggest that the reliability of the standing flexion test as an indicator of SIJ dysfunction still remains questionable. Before this test can be relied upon as an accurate indicator of SIJ dysfunction it must undergo further research. This research must not only further standardize the procedure, but also ascertain reliability and validity.

Guilty but insane: the insanity defence in Ireland, 1850-1995

BACKGROUND

This is a retrospective study describing sociodemographic and clinical characteristics of an almost complete sample of insanity acquittees in Ireland between 1850-1995.

METHOD

Case records and legal files were examined for each of the 437 patients admitted to the Central Mental Hospital under guilty but insane criteria, and a profile of sociodemographic, forensic and clinical data completed in each.

RESULTS

The number of insanity acquittees has fallen five-fold since the 19th century. Acquittees were usually single males from rural areas, aged in their 30s, who had committed a violent crime while suffering from a major psychiatric illness. Female insanity acquittees were relatively few in number and were equally likely to have been charged with violent crime, especially against their own children. The mean length of detention was 14.5 years.

CONCLUSIONS

The insanity defence is rarely used in Ireland, is largely confined to serious offences (especially homicide), and generally results in prolonged detention.

A study of aggression among referrals to a community-based psychiatry of old age service

OBJECTIVE

The aims of the study were to examine the prevalence of aggressive behaviour in a non-selected community-based population, to identify clinical and sociodemographic variables associated with aggression and to examine the relationship between aggression and outcome at 2-year follow-up.

DESIGN

Case series, using the Ryden Aggression Scale as a retrospective measure of aggression.

SETTING

A community-based specialist psychiatry of old age service.

PARTICIPANTS

All referrals to the service over a 3-month period.

RESULTS

Of the 42 subjects included in the study, 25-patients had a diagnosis of dementia. Aggressive behaviour was reported in 18 patients, this being verbal only in nine cases and both verbal and physical in nine cases. Sexual aggression and self-injurious behaviour were each reported in one case only. Aggression was found to be positively associated with a diagnosis of dementia and high physical dependency but was not found to be associated with age, sex, physical illness or the use of psychotropic medication. At 2-year follow-up, aggressive patients were found to have a higher rate of admission to psychiatric inpatient or residential care and tended to have a higher use of neuroleptic drugs.

CONCLUSIONS

These findings suggest that aggression is a significant problem for community-based elderly people and their carers, may increase the likelihood of admission into long-term care and that a reliable instrument to measure aggression would be useful in the clinical assessment of this population.

Mechanisms of recovery of swallow after supraglottic laryngectomy

This study examines oropharyngeal swallow disorders and measures of pharyngeal and laryngeal movement during deglutition from videofluorographic studies of oropharyngeal swallow in 9 patients who had undergone supraglottic laryngectomy and 9 age-matched normal subjects. The swallows of surgical patients were examined at 2 weeks and 3 months postoperatively. Two critical factors in recovery of swallowing were identified: (a) airway closure at the laryngeal entrance, that is, the space between the arytenoid cartilage and the base of the tongue, and (b) the movement of the tongue base to make complete contact with the posterior pharyngeal wall. When patients achieved these two functions, they returned to normal swallowing. The duration of tongue base contact to the posterior pharyngeal wall and extent of anterior movement of the arytenoid increased significantly from 2 weeks to 3 months in the surgical patients. At 2 weeks postsurgery, patients who had undergone supraglottic laryngectomy exhibited significantly shorter airway closure and tongue base to pharyngeal wall contact, reduced laryngeal elevation, increased width of cricopharyngeal (CP) opening, and later onset of airway closure and tongue base movement than normal subjects. These significant differences remained at 3 months postoperatively, although swallow measures were moving toward normal in the patients who had undergone supraglottic laryngectomy. Comparison of patients not eating at 2 weeks with patients at the time of first eating revealed significantly longer duration of tongue base contact to the pharyngeal wall, longer duration of airway closure, and greater movement of the arytenoid in patients who were eating. Results indicate that the focus of swallowing therapy after supraglottic laryngectomy should be on improvement of posterior movement of the tongue base and anterior tilting of the arytenoid to close the airway entrance and improve bolus propulsion (in the case of the tongue base).

Five-year follow-up study of the fat clearance technique in colorectal carcinoma

PURPOSE

The aim of our study was to determine the five-year survival of patients with colorectal carcinoma whose Dukes classification had changed following fat clearance of the mesocolon or mesorectum.

METHODS

One hundred three patients with colorectal carcinoma were followed up at a special clinic for at least five years after surgery. The tumors from these patients had previously been given a Dukes classification before and after fat clearance.

RESULTS

Four of the five patients whose Dukes status changed from B to C as a result of fat clearance died of malignant disease during the five-year follow-up period. After fat clearance it was apparent that Dukes B patients survived, on average, 11 months longer than Dukes C patients. A significantly increased mean number of positive nodes was found after fat clearance in Dukes C cases, both in those who were alive at five years and those who died of their malignant disease.

CONCLUSIONS

The fat clearance technique is a useful aid to improving the accuracy of the Dukes classification and has prognostic significance. It should be used in specimens of colorectal carcinoma, which on initial examination appear to be Dukes B cases.

Effects of maneuvers on swallowing function in a dysphagic oral cancer patient

This study examined the effects of three swallow maneuvers: (1) the supraglottic swallow (voluntary closure of the vocal folds prior to the swallow); (2) the super-supraglottic swallow (airway closure at the level of the arytenoid to base of epiglottis); and (3) the Mendelsohn maneuver (voluntary prolongation of laryngeal elevation and cricopharyngeal opening during swallow) on swallow functioning in a 47-year-old patient who underwent right composite resection for a squamous cell carcinoma of the right retromolar trigone. All maneuvers were employed during the same videofluorographic (VFG) swallow study conducted 6 months after the patient's surgery. Biomechanical analysis of 3-mL swallows defined the extent and timing of tongue base retraction to the posterior pharyngeal wall, laryngeal elevation, laryngeal closure and cricopharyngeal opening during swallows with and without maneuvers. Airway closure duration was prolonged during supraglottic and super-supraglottic swallows, but aspiration was not eliminated. Use of the Mendelsohn maneuver improved coordination and timing of pharyngeal swallow events, including timing of posterior movement of the tongue base to the pharyngeal wall in relation to airway closure and cricopharyngeal opening, with elimination of aspiration. The Mendelsohn maneuver compensated for anatomic and physiologic changes in the oropharyngeal swallow and enabled reinstatement of safe oral intake in this surgically treated head and neck cancer patient who was previously unable to take nutrition orally.

Food intake by maneuver; an extreme compensation for impaired swallowing

We report two young patients able to exist on exclusively oral intake despite an absent pharyngeal swallow response. Videofluoroscopic swallowing studies showed that both patients used a sequence of devised maneuvers rather than a coordinated pharyngeal swallow to move the bolus, protect the airway, and open the upper esophageal sphincter during bolus ingestion. We conclude that it is possible for young, highly motivated individuals to maintain oral intake despite ablation of neurologic elements crucial for the normal swallow response.

Committal procedures in Ireland

The study aims to describe current committal practice in an Irish public psychiatric service and to establish the role of 'dangerousness' in determining practice. A six month retrospective review was undertaken using casenotes and original temporary forms of all patients committed to St Brendan's Hospital, Dublin within a six month period in 1990. A total of 136 cases were examined. In 65% of cases the application for detention was initiated by a spouse or relative. The recommending physician was identified as a General Practitioner in 80% of cases, although most were locum GP's. The number of male and female patients were almost equal. There was a wide age range with the largest group (42%) in the range 26-40 years. Previous contact with the psychiatric service was found in 89% of cases. There was a wide range of diagnoses with the largest category (56%) suffering from schizophrenia. Of those not admitted with alcohol or drug related illness 66% showed evidence of acute psychotic symptoms. Length of admission was relatively short with 84% of patients being discharged within three months. A total of 43% showed evidence of being a danger to themselves or others. Significant differences were found between these patients and the non-dangerous group, the latter being more likely to be older and to suffer from a major psychotic illness. These findings indicate that a committal law based purely on 'dangerousness' criteria would be likely to significantly affect committal practice in Ireland. These findings are discussed in relation to proposed changes in mental health legislation in Ireland.

Colopleural fistula due to strangulated Bochdalek hernia in an adult

An elderly patient presented with a right sided pneumothorax due to strangulation of part of the colon through a congenital Bochdalek hernia. Congenital posterolateral diaphragmatic hernia of Bochdalek is rare in an adult and strangulation with pneumothorax has not been reported before.

Chemotaxis to chitin oligosaccharides by Vibrio furnissii, a chitinivorous marine bacterium

We have reported that Vibrio furnissii, a chitinivorous marine bacterium, expresses a complex apparatus for adhesion/deadhesion to chitin analogues (1). In the present studies, we show that this organism exhibits a chemotactic response (swarming) to chitin oligosaccharides at concentrations as low as 10 microM. In contrast, V. furnissii exhibits slight to no chemotaxis to other utilizable compounds (glycerol, lactate, amino acids), with the exception of L-glutamic acid. V. furnissii may lack the tar (aspartate) receptor of Escherichia coli.

Developing an instrument for eliciting children's description of pain

Expanding on the work of Melzack, Schultz, Scott, and Eland and Anderson, we devised an instrument that would elicit from school age children a description of their pain experience. After three stages of testing the pain questionnaire, high agreement was achieved on 45 measured responses that were not influenced by the children's sex. Although the instrument would need further refinement before use in the assessment of pain, the results show that children can remember and identify a wide range of events that have caused them pain and can describe specific painful situations, using suggested words as well as their own.

A comparison of the effects of flurazepam 30 mg and triazolam 0.5 mg on the sleep of insomniacs

The effects of oral, bedtime triazolam 0.5 mg and flurazepam 30 mg, on the laboratory sleep of 12 insomniacs were compared in a double blind, crossover study. A 22 consecutive night schedule was used: Nts. 1--2 placebo; 3--6 first drug; 7--8 placebo; 9--14 no drugs; 15--16 placebo; 17--20 second drug; 21--22 placebo. In 6 Ss first drug was triazolam and second drug was flurazepam. In the other 6 Ss the drug order was reversed. Effects on sleep were assessed objectively by conventional EEG/EOG/EMG sleep recordings and subjectively by questionnaires administered each morning. Side or toxic effects were assessed by physical exams, clinical lab tests, and twice daily questionnaires. During their administration the two drugs were practically indistinguishable in their effects. Both significantly reduced objective and subjective measures of insomnia, such as total wake time and sleep latency. On discontinuation the drugs differentially affected sleep, e.g., on the first post flurazepam night total sleep time was significantly more than baseline whereas on first post triazolam night, total sleep time was significantly less than baseline. There were no remarkable side or toxic effects with either drug.

REM sleep reduction effects on depression syndromes

Thirty-four endogenous and 18 reactive, depressed patients (hospitalized and nonschizophrenic) were treated in a double-blind, crossover study of the hypothesis that rapid eye movement (REM) sleep reduction (by awakenings) relieves depression. In the endogenous group-but not in the reactive group-subjects deprived of REM sleep for three weeks improved significantly more than control subjects awakened from non-REM sleep. Therapeutic efficacy of REM sleep reduction appeared similar to reported efficacy of imipramine hydrochloride treatment of depression. Eight of nine endogenous patients, unimproved by REM sleep deprivation, did not improve with imipramine. Results suggested (1) that substantial REM sleep reduction has antidepressant activity, and (2) since imipramine and other drug antidepressants reduce REM sleep much more so than nonantidepressant drugs, that an antidepressant "mechanism" of drugs resides in their capacity to substantially reduce REM sleep.

The effect of triazolam on the sleep of insomniacs

The effects of three oral doses of bedtime triazolam (0.25 mg, 0.5 mg, and 1.0 mg) a new benzodiazepine, on the laboratory sleep of insomniacs were studied in a double blind design which used the following 14 consecutive night schedule: 1-4 placebo; 5-11 drug; 12-14 placebo. Effects on sleep were measured objectively by conventional EEG/EOG/EMG sleep recordings and subjectively by questionnaires administered each morning. Side or toxic effects were assessed by screening physicals and questionnaires administered each morning and each evening and by a comparison of the prestudy vs. end-study physical exams and clinical lab tests. At the 0.5 mg dose triazolam significantly reduced several objective and subjective measures of insomnia. It had lesser effects at the 0.25 mg dose and equal or greater effects at 1.0 mg dose. There were no remarkable side or toxic effects at any dose.