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Dieulafoy lesions (DL) are an uncommon cause of gastrointestinal bleeding which is often difficult to diagnose due to the rarity of the condition and varying clinical presentations. This case describes an unusual presentation of upper gastrointestinal bleeding in an 85-year-old female with findings on two separate gastroscopies of both a gastric ulcer and duodenal DL. The pathophysiology of DL remains poorly understood and despite shared risk factors, these two pathologies are rarely reported concurrently. The presence of a concomitant gastric ulcer further complicated the diagnosis and treatment of the duodenal DL in this case. This highlights the importance of clinician awareness of this pathology and its presentation and the need for early repeat endoscopy. [ABSTRACT FROM AUTHOR]

Background: The relationship between major depressive disorder (MDD) and personality disorders is complex, with implications for diagnosis and treatment. We sought to explore the relationship between these disorders quantitatively in an inpatient setting. Methods: We conducted a structured observational study exploring symptoms of depression and selected neurocognitive functions over the span of an inpatient admission in those with depression and personality disorders. Sixty inpatients presenting with symptoms of depression completed ratings of mood and neurocognitive function. Diagnosis was confirmed by structured clinical interview (SCID-5-RV) at discharge and used to allocate patients to one of the two groups for analysis: those with MDD-only and those with a personality disorder (with or without MDD). Results: On admission, observer-based ratings of depression were significantly higher in the MDD-only group while subjective ratings were higher in the personality disorder group. Depression rating scores lessened in both groups during the admission, but at discharge, the personality disorder group continued to report higher subjective ratings. The personality disorder group also rated themselves as more cognitively impaired than the MDD-only group and unlike the MDD-only group, they did not report subjective improvements in cognitive function over the course of admission. Objective assessment of cognitive function demonstrated improvements in both groups. Conclusions: In this study, the presence of a personality disorder was associated with greater subjective severity of depressive symptomatology and selected neurocognitive functioning, despite similar or lower objective severity in comparison with those with MDD. This finding has implications for understanding the patient journey through health care settings. [ABSTRACT FROM AUTHOR]

Acute pancreatitis (AP) is a rare complication in the post-operative period and the incidence following colorectal surgery is unknown. Although benign hyperamylasaemia following colonic resection is a documented phenomenon, clinically significant AP in the post-operative setting is poorly described in the literature and little is understood about the underlying pathophysiology. Additionally, while gastrointestinal fistulae are a well-recognized complication of bowel surgery, nil previous reports discuss the possible contribution of post-operative AP to their development. We present a case of AP complicated by enterocutaneous fistula following extended right hemicolectomy and describe the possible mechanisms leading to these conditions. [ABSTRACT FROM AUTHOR]

Background: Those with serious mental illness (SMI) including both psychotic and affective disorders are recognized to have a premature mortality compared to the general population, at least in part due to elevated cardiovascular risk profile. Aim: To examine the effect of a 12‐week, pragmatic, sustainable, low‐cost intervention involving community activity, nutritional advice and exercise that could be accessible to patients attending a community clinic. Methods: Participants (N = 35) with SMI attending a community mental health service who were considered at risk of metabolic syndrome were referred by their clinical teams to a specialized healthy activity and nutritional programme. The intervention involved participation in exercise, dietary education and targeted lifestyle advice focused on community activities. Data on physical health and clinical parameters were collected pre‐ and post‐intervention. Results: Physical activity increased following the intervention along with a statistically significant increase in self‐esteem scores. There was no significant reduction in body mass index or lowering of anxiety and depression scores. Conclusions: It is feasible to develop a relatively low‐cost, community‐based physical activity programme, integrating both nutritional advice and healthy activities. This may lead to improved outcomes in cardiovascular risk profile and improved life expectancy. [ABSTRACT FROM AUTHOR]

Objective: To determine the relationship between language abnormalities and broader cognitive impairment and thought disorder by examining language and cognition in schizophrenia and aphasia (a primary language disorder). Methods: Cognitive and linguistic profiles were measured with a battery of standardised tests, and compared in a clinical population of n = 50 (n = 30 with schizophrenia and n = 20 with aphasia) and n = 61 non-clinical comparisons (n = 45 healthy controls and n = 16 non-affected first-degree relatives of patients with schizophrenia). Results: Both clinical groups showed linguistic deficits. Verbal impairment was more severe in participants with aphasia, whereas non-verbal performance was more affected in participants with schizophrenia. In schizophrenia, but not in aphasia, verbal and non-verbal performance were associated. Formal thought disorder was associated with impairment in executive function and in grammatical, but not naming, tasks. Conclusion: While patients with schizophrenia and aphasia showed language impairments, the nature and cognitive basis of these impairments may be different; language performance disassociates from broader cognitive functioning in aphasia but may be an intrinsic expression of a broader cognitive impairment in schizophrenia. Thought disorder may represent a core malfunction of grammatical processing. Results suggests that communicative ability may be a valid target in cognitive remediation strategies in schizophrenia. [ABSTRACT FROM AUTHOR]

Objectives: To explore cognitive performance in chronic fatigue syndrome (CFS) examining two cohorts. To establish findings associated with CFS and those related to co-morbid depression or autonomic dysfunction. Methods: Identification and recruitment of participants was identical in both phases, all CFS patients fulfilled Fukuda criteria. In Phase 1 (n = 48) we explored cognitive function in a heterogeneous cohort of CFS patients, investigating links with depressive symptoms (HADS). In phase 2 (n = 51 CFS & n = 20 controls) participants with co-morbid major depression were excluded (SCID). Furthermore, we investigated relationships between cognitive performance and heart rate variability (HRV). Results: Cognitive performance in unselected CFS patients is in average range on most measures. However, 0–23% of the CFS sample fell below the 5th percentile. Negative correlations occurred between depressive symptoms (HAD-S) with Digit-Symbol-Coding (r = -.507, p = .006) and TMT-A (r = -.382, p = .049). In CFS without depression, impairments of cognitive performance remained with significant differences in indices of psychomotor speed (TMT-A: p = 0.027; digit-symbol substitution: p = 0.004; digit-symbol copy: p = 0.007; scanning: p = .034) Stroop test suggested differences due to processing speed rather than inhibition. Both cohorts confirmed relationships between cognitive performance and HRV (digit-symbol copy (r = .330, p = .018), digit-symbol substitution (r = .313, p = .025), colour-naming trials Stroop task (r = .279, p = .050). Conclusion: Cognitive difficulties in CFS may not be as broad as suggested and may be restricted to slowing in basic processing speed. While depressive symptoms can be associated with impairments, co-morbidity with major depression is not itself responsible for reductions in cognitive performance. Impaired autonomic control of heart-rate associates with reductions in basic processing speed. [ABSTRACT FROM AUTHOR]

Summary: Background: This pilot study aimed to gain the perceptions of first‐year students using a wiki as a learning tool for the Bachelor of Radiation Therapy degree in New Zealand. Literature suggests that wikis have great potential as an educational tool for both lecturers and students, because they encourage collaborative learning and resource sharing. In 2015, the ‘Otago Wiki’ platform was introduced as a part of the degree. Methods: The first‐year students were allocated into groups of four. Using the ‘Otago Wiki’ tool, each group created their own wiki page by addressing assigned tasks over the course of the year that related to a fictional patient. At the end of the year they were invited to participate in an online Survey Monkey™ questionnaire, which 15/26 students completed. We used a conventional approach to code the free‐text responses for our content analysis. Results: Three main themes emerged from the qualitative data: group work experience; developing a greater self‐awareness of radiation therapy; and improving the learning experience. Although there is room for improvement, the quantitative data indicate that most students found the wiki to be a valuable group exercise, helping them to understand the patient experience. Conclusion: Overall, the students’ perceptions of the wiki as a learning tool indicated that it was a worthwhile experience. Moving forward, wikis will continue to be used and incorporated into other modules in the first year. Setting clearer goals for each task would enable the students to use their time more efficiently in the future. Literature suggests that wikis have great potential as an educational tool for both lecturers and students [ABSTRACT FROM AUTHOR]

Objectives: The current study examines prevalence of cognitive impairment in four mood disorder samples, using four definitions of impairment. The impact of premorbid IQ on prevalence was examined, and the influence of treatment response. Methods: Samples were: (i) 58 inpatients in a current severe depressive episode (unipolar or bipolar), (ii) 69 unmedicated outpatients in a mild to moderate depressive episode (unipolar or bipolar), (iii) 56 outpatients with bipolar disorder, in a depressive episode, and (iv) 63 outpatients with bipolar disorder, currently euthymic. Cognitive assessment was conducted after treatment in Studies 1 (6 weeks of antidepressant treatment commenced on admission) and 2 (16‐week course of cognitive behaviour therapy or schema therapy), allowing the impact of treatment response to be assessed. All mood disorder samples were compared with healthy control groups. Results: The prevalence of cognitive impairment was highest for the inpatient depression sample (Study 1), and lowest for the outpatient depression sample (Study 2). Substantial variability in rates was observed depending on the definition of impairment used. Correcting cognitive performance for premorbid IQ had a significant impact on the prevalence of cognitive impairment in the inpatient depression sample. There was minimal evidence that treatment response impacted on prevalence of cognitive impairment, except in the domain of psychomotor speed in inpatients. Conclusions: As interventions aiming to improve cognitive outcomes in mood disorders receive increasing research focus, the issue of setting a cut‐off level of cognitive impairment for screening purposes becomes a priority. This analysis demonstrates important differences in samples likely to be recruited depending on the definition of cognitive impairment and begins to examine the importance of premorbid IQ in determining who is impaired. [ABSTRACT FROM AUTHOR]

Background In New Zealand little nursing or medical curricula time, if any, is specifically devoted to the enhancement of empathy. If being empathic is important in the context of patient care, it is a quality that is already present in students or is learned by students during their practicum in the company of experienced clinicians. This study aimed to compare self-reported empathy ratings between different groups of medical students and one cohort of nursing students who were either exposed or not exposed to explicit empathy training or learning in clinical settings in the presence of patients. Methods The Jefferson Scale of Physician Empathy ( JSPE) was completed before and after groups of medical and nursing students had been exposed to various extended periods of practicum. Some medical student cohorts undertook brief empathy training, whereas others had no exposure. The nursing student cohort had no formal, explicit empathy training. Results Irrespective of profession, length of practicum or exposure to specific empathy training, there were no significant differences in the self-reported JSPE scores across the seven different cohorts of students. Discussion If empathy is caught rather than taught, then brief efforts to enhance empathy may be futile. To optimise the inherent empathic qualities of aspirant health professionals, explicit consideration should be given to how empathy is influenced by the practicum experience. [ABSTRACT FROM AUTHOR]

Arylacetonitriles are versatile building blocks for the construction of heterocyclic scaffolds in medicinal chemistry. These intermediates are able to engage in a variety of synthetic transformations, giving rise to diverse biologically active structures. This digest focuses on recent applications of this synthetic methodology by drug discovery teams across several disease areas, with an emphasis on different reaction types. [ABSTRACT FROM AUTHOR]

Objective: Depression is known to negatively impact social functioning, with patients commonly reporting difficulties maintaining social relationships. Moreover, a large body of evidence suggests poor social functioning is not only present in depression but that social functioning is an important factor in illness course and outcome. In addition, good social relationships can play a protective role against the onset of depressive symptoms, particularly in late-life depression. However, the majority of research in this area has employed self-report measures of social function. This approach is problematic, as due to their reliance on memory, such measures are prone to error from the neurocognitive impairments of depression, as well as mood-congruent biases.Method: Narrative review based on searches of the Web of Science and PubMed database(s) from the start of the databases, until the end of 2015.Results: The present review provides an overview of the literature on social functioning in (late-life) depression and discusses the potential for new technologies to improve the measurement of social function in depressed older adults. In particular, the use of wearable technology to collect direct, objective measures of social activity, such as physical activity and speech, is considered.Conclusion: In order to develop a greater understanding of social functioning in late-life depression, future research should include the development and validation of more direct, objective measures in conjunction with subjective self-report measures. Copyright © 2016 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

In New Zealand undergraduate health professional degrees focus on aspects of indigenous (Maori) health. Formal and informal feedback suggests that for individual students the impact of those components in respect of Maori health varies. Separate and sequential interprofessional groups of students from seven health professions participated in an innovative and immersive Interprofessional programme. All participating students had prior exposure during their respective degrees to theoretical perspectives of indigenous health. At the end of each and every 5-week long programme each cohort of student contributed to a focus group discussion. Analysis revealed that for these groups of students the real-life exposure to an indigenous community was positively regarded and, in some instances, transformative. The students also reported that the 'lived' experience in an indigenous community built upon and in many cases extended prior learning of indigenous health. Whilst the results are encouraging it must be noted that the students who were exposed to this experience represented less than 10% of the entire student population. It is clear that a key challenge for us is to enable more students to be exposed to this powerful learning experience. [ABSTRACT FROM AUTHOR]

Sunspot groups are the main source of solar flares, with the energy to power them being supplied by magnetic-field evolution ( e.g. flux emergence or twisting/shearing). To date, few studies have investigated the statistical relation between sunspot-group evolution and flaring, with none considering evolution in the McIntosh classification scheme. Here we present a statistical analysis of sunspot groups from Solar Cycle 22, focusing on 24-hour changes in the three McIntosh classification components. Evolution-dependent $\ge \mathrm{C}1.0$, $\ge \mathrm{M}1.0$, and $\ge \mathrm{X}1.0$ flaring rates are calculated, leading to the following results: i) flaring rates become increasingly higher for greater degrees of upward evolution through the McIntosh classes, with the opposite found for downward evolution; ii) the highest flaring rates are found for upward evolution from larger, more complex, classes ( e.g. Zurich D- and E-classes evolving upward to F-class produce $\ge \mathrm{C}1.0$ rates of $2.66\pm 0.28$ and $2.31 \pm 0.09$ flares per 24 hours, respectively); iii) increasingly complex classes give higher rates for all flare magnitudes, even when sunspot groups do not evolve over 24 hours. These results support the hypothesis that injection of magnetic energy by flux emergence ( i.e. increasing in Zurich or compactness classes) leads to a higher frequency and magnitude of flaring. [ABSTRACT FROM AUTHOR]

Background It has long been acknowledged that health professionals who retrain as doctors make a significant contribution to the medical profession. Having a background as a health professional sets this group apart from the other medical students, including mature students. It is therefore important to understand more about how health professionals adapt to their role as medical students. Methods A qualitative approach was adopted, in which interviews were conducted with 12 of the possible 30 medical students who met the inclusion criterion: namely that they were or had been registered health professionals. Findings The most common driver to retrain was a desire to seek a fresh challenge, and they described their previous roles as limited; however, returning to student status after life as an autonomous health professional was initially very uncomfortable. Once they loosened their grip on their previous role and embraced life as a medical student the students eventually realised that, irrespective of their previous health profession, they had a set of core professional abilities that they could bring to their role as a doctor. Discussion There has been considerable focus on the support required for mature students, graduate students and students from disadvantaged backgrounds. Little attention has been afforded to the experience of health professionals as medical students. This category of individual already possesses a wealth of experience, knowledge and attitudes relevant to health care work. This experience should be built upon so that the transition from 'expert' to 'novice' is as comfortable as possible for all parties. [ABSTRACT FROM AUTHOR]

Background: Descriptions of interprofessional education (IPE) programs and teacher competencies exist, but limited research has been undertaken about the process of IPE teaching team formation. This research project examined how pedagogically naïve clinicians of different disciplines initially formed an IPE teaching team. Methods and Findings: A case study approach was undertaken with data collected over the first sixteen months of an IPE program. Data included: audio recordings, transcripts, and field notes from nine individual teacher interviews, two teaching team focus groups, five student focus groups, and eight summary reports. Data analysis using a grounded theory constant comparison approach revealed themes relating to the formation, development, and evolving sophistication of the teaching team from functioning, to co-ordinating, to co-operating, and finally to collaborating. These stages were influenced by four external factors: remote rural context, Hauora Māori principles, personal attributes, and teacher development. Conclusions: Formation of interprofessional clinical teaching teams requires educational preparation, time learning to work with each other, and trust development, with a number of local contextual factors influencing this process. Teaching team formation paralleled Wegner's Community of Practice model where shared vision supported the adoption of an increasingly complex IPE pedagogy. [ABSTRACT FROM AUTHOR]

The article presents research which examined the occurrence of childhood trauma in children with bipolar disorder. Topics covered include the impact of stress on the treatment course for the children and the rate of childhood trauma in patients with the condition. Also mentioned is the use of the Childhood Trauma Questionnaire in the study.

Background The undergraduate medical curriculum has earned a reputation for being overcrowded. The dilemma for educationalists is to determine what, if anything, can be jettisoned from a congested curriculum to accommodate new ideas or material. Context We report on a small study that demonstrated that when movies are used innovatively, they enhance students' understanding of medicine and also have a minimal impact on the 'crowded' curriculum. Innovation During a 5-week-long Public Health module students could borrow from the medical school library, free of charge, one or more movies, each with a public health message. In the final week of the module a 1.5-hour-long class was allocated when each student offered a brief synopsis of a movie that they had watched, and then identified key public health issues discussed in the movie. Implications Our study supports the view that the creative use of classroom time not only allows for better use of the timetable, but also proves to be an integrative, stimulating, and fun way for medical students to learn. [ABSTRACT FROM AUTHOR]

Abstract: Background: Bipolar disorder is associated with both white matter abnormalities and hypothalamo–pituitary–adrenal axis dysfunction. In a post-hoc analysis of diffusion tensor data, the relationship between cortisol levels and white matter structural integrity was explored in healthy controls and in euthymic patients with bipolar disorder. Methods: Healthy control subjects and patients with bipolar disorder, prospectively verified as euthymic, underwent diffusion tensor MRI: fractional anisotropy and mean diffusivity data in fifteen regions of interest were obtained. Morning and evening salivary cortisol levels (SCLs) were measured. Results: Significant negative partial correlations were found between fractional anisotropy and evening SCLs in control subjects in four periventricular regions. This pattern was absent in bipolar patients, possibly due to the presence of an excess of extracellular fluid manifested as a significant increase in mean diffusivity in those regions. Limitations: This is an exploratory, post-hoc analysis of data with relatively small sample sizes. Lithium treatment and past substance abuse in the bipolar group are potentially confounding factors in this study. Conclusions: These preliminary data show an inverse relationship between evening cortisol levels and a measure of periventricular white matter integrity in healthy controls. This relationship appears disrupted in bipolar patients, possibly due to periventricular osmoregulatory dysfunction, the effects of medication or past substance use. Future research should further investigate the influences of cortisol on oligodendrocyte function, white matter integrity and brain osmoregulation in bipolar disorder. [Copyright &y& Elsevier]

Abstract: This paper describes the use of unsaturated Weinreb amides as excellent substrates for the Heck reaction. Subsequent derivatization of the products with organometallic reagents allowed access to a variety of substituted vinyl ketones that could not have been prepared directly via Heck reaction on unsaturated ketone precursors. [Copyright &y& Elsevier]

Background: Learning from experienced doctors in real clinical settings is very important for medical students. However, the busy and at times unpredictable nature of clinical work means that clinical work must take priority over teaching. What clinicians want is to be able to offer quality learning experiences for students without significant disruption to their clinical work. Context: In the context of medical education, students are learning in a variety of physical locations. These various locations require different sets of teaching skills. This article describes how as faculty educational developers we worked with clinicians to enhance their role as teachers within busy clinical contexts. More specifically, we will describe how we augmented an established programme of travelling workshops for clinical teachers by incorporating the key principles associated with the development of the One-Minute Preceptor. Innovation and implications: We combined classroom training with observation of teaching in the clinical area, and by doing so were more able to translate classroom theory into authentic workplace practice. [ABSTRACT FROM AUTHOR]

Background: Deficits in neuropsychological performance are found in patients with bipolar disorder and represent a potential treatment target for novel therapeutic strategies. We have previously demonstrated a beneficial effect on spatial working memory (SWM) of treatment for 1 week with the progesterone and glucocorticoid receptor antagonist mifepristone, evident 2 weeks after the cessation of treatment. Methods: We examined the longer-term efficacy of 600 mg/day of mifepristone as an adjunctive treatment, for 1 week, in a placebo-controlled, randomized, double-blind trial in 60 patients with bipolar depression, with SWM as the primary outcome measure. A comparator group of healthy control subjects was also recruited. Results: At baseline, neuropsychological performance of patients was impaired, but hypothalamic-pituitary-adrenal axis function did not differ from that of control subjects. Mifepristone treatment was associated with a time-limited increase in cortisol awakening response and with a sustained improvement in SWM performance, which was evident 7 weeks after the cessation of treatment. The magnitude of this neuropsychological response was predicted by the magnitude of the cortisol response to mifepristone. The response occurred in the absence of a significant improvement in depressed mood. Conclusions: These data accord with the findings of animal studies and demonstrate that brief treatment with mifepristone is associated with a sustained improvement in SWM, an effect that might be mediated by a persistent enhancement in hippocampal mineralocorticoid receptor function. [ABSTRACT FROM AUTHOR]

Background: The opportunity for students to learn whilst in a clinical placement is a central component of undergraduate medical education and an educationally conducive clinical environment is essential if the student is to optimise learning opportunities. Aim: This study, which was conducted by medical students, and amongst medical students aims to investigate the key conditions that students most value when placed in clinical settings. Methods: A qualitative approach was adopted in which a series of focus group discussions were conducted by senior medical students trained in the facilitation of focus group moderation. In total, 30 students contributed to four separate focus groups. Results: Whilst students identified some factors which were similar to previous studies, other factors considered important to learning in the clinical setting surfaced. Namely, the need for students to be self-motivated and the valuable contribution that other medical students can make to the learning of their peers. Conclusions: Our findings concur with other similar studies. However, our findings were generated by medical students and not subject to influence by university teachers during the data collection and analysis. This not only serves to reinforce previous studies but also supports the use of peer data collection from medical students. [ABSTRACT FROM AUTHOR]

'EIT waves' are large-scale coronal bright fronts (CBFs) that were first observed in 195 Å images obtained using the Extreme-ultraviolet Imaging Telescope (EIT) onboard the Solar and Heliospheric Observatory ( SOHO). Commonly called 'EIT waves', CBFs typically appear as diffuse fronts that propagate pseudo-radially across the solar disk at velocities of 100-700 km s with front widths of 50-100 Mm. As their speed is greater than the quiet coronal sound speed ( c≤200 km s) and comparable to the local Alfvén speed ( v≤1000 km s), they were initially interpreted as fast-mode magnetoacoustic waves ( $v_{f}=(c_{s}^{2} + v_{A}^{2})^{1/2}$). Their propagation is now known to be modified by regions where the magnetosonic sound speed varies, such as active regions and coronal holes, but there is also evidence for stationary CBFs at coronal hole boundaries. The latter has led to the suggestion that they may be a manifestation of a processes such as Joule heating or magnetic reconnection, rather than a wave-related phenomena. While the general morphological and kinematic properties of CBFs and their association with coronal mass ejections have now been well described, there are many questions regarding their excitation and propagation. In particular, the theoretical interpretation of these enigmatic events as magnetohydrodynamic waves or due to changes in magnetic topology remains the topic of much debate. [ABSTRACT FROM AUTHOR]

The article discusses the progress in human life expectancy. It regarded better nutrition, improved sanitation, and better maternal education as factors for the rapid recovery in life expectancy of infants after the mid-nineteenth century. It explores the value of extended human life, noting the income-linked value of survival means. It highlights the changes in the outlook for pro-longevity treatments which extends human life as well as notes scientific discoveries which may prolong human life.

The support of doctors who teach medical students in clinical settings is considered very important. In order to function as effectively as possible in their role as clinical teachers, these clinicians require educational support from faculty members. The most usual form that support takes is university staff offering face-to-face teaching on educational topics. It is estimated that in the course of 1 year, and across the Faculty of Medicine at the University of Otago, there could be up to 600 clinicians actively involved in the direct support of medical students. Many of these clinicians work in locations some considerable distance from the university campus. In 2009 the Medical Education Unit based at the Wellington Campus introduced a series of peripatetic face-to-face workshops for clinical teachers in several different geographical locations. Educational support of this nature is challenging to organise and potentially expensive, which begs the question: are travelling workshops worthwhile? Whereas the subject matter of the workshops was of interest to those who attended, of equal importance was the opportunity the workshops created to interact with colleagues in a relaxed atmosphere. In addition, the workshops were the catalyst for some clinicians to formally pursue their particular educational interests. [ABSTRACT FROM AUTHOR]

Background: An innovative approach to learning public health by using feature-length commercial movies was piloted in the fourth year of a medical degree. We aimed to explore how students responded to this approach and the relative effectiveness of two promotional strategies. Firstly we placed DVDs of 15 movies (with public health-related content) in the medical school library. Then alternating groups of students (total n = 82 students) were exposed to either a brief promotional intervention or a more intensive intervention involving a class presentation. The response rates were 99% at baseline and 85% at follow-up. Findings: The level and strength of support for using movies in public health training increased after exposure to the public health module with significantly more students "strongly agreeing". Student behaviour, in terms of movies viewed or accessed from the library, also suggested student interest. While there were no statistically significant differences in median viewing or library access rates between the two intervention groups, the distribution of viewing patterns was shifted favourably. Those exposed to the more intensive intervention (class presentation) were significantly more likely to have reported watching at least one movie (97% vs. 81%; p = 0.033) or to having accessed at least one movie from the library (100% vs. 70%, p = 0.0001). Conclusions: This pilot study found that the students had very positive attitudes towards viewing public healthrelated commercial movies. Movie access rates from the library were also favourable. [ABSTRACT FROM AUTHOR]

Abstract: The issue of predicting solar flares is one of the most fundamental in physics, addressing issues of plasma physics, high-energy physics, and modelling of complex systems. It also poses societal consequences, with our ever-increasing need for accurate space weather forecasts. Solar flares arise naturally as a competition between an input (flux emergence and rearrangement) in the photosphere and an output (electrical current build up and resistive dissipation) in the corona. Although initially localised, this redistribution affects neighbouring regions and an avalanche occurs resulting in large scale eruptions of plasma, particles, and magnetic field. As flares are powered from the stressed field rooted in the photosphere, a study of the photospheric magnetic complexity can be used to both predict activity and understand the physics of the magnetic field. The magnetic energy spectrum and multifractal spectrum are highlighted as two possible approaches to this. [Copyright &y& Elsevier]

The article posits that, over time, the sense of the World Trade Organization's so-called Single Undertaking has been perverted, and that the current interpretation requiring every WTO member to be obligated by all new Doha Round agreements is a major problem in the stalled negotiations. The authors' preliminary research supports the idea of conducting international trade negotiations in agriculture on the basis of a critical mass framework, where only those WTO members accounting for some nominated major percentage of trade would take on new obligations. The article recounts how this approach has worked before in the General Agreement on Tariffs and Trade (GATT) and the WTO, and suggests areas of further research in order to test the proposition with respect to agricultural trade. [ABSTRACT FROM AUTHOR]

A method for the full three-dimensional (3-D) reconstruction of the trajectories of coronal mass ejections (CMEs) using Solar TErrestrial RElations Observatory (STEREO) data is presented. Four CMEs that were simultaneously observed by the inner and outer coronagraphs (COR1 and 2) of the Ahead and Behind STEREO satellites were analysed. These observations were used to derive CME trajectories in 3-D out to ∼ 15 R⊙. The reconstructions using COR1/2 data support a radial propagation model. Assuming pseudo-radial propagation at large distances from the Sun (15 – 240 R⊙), the CME positions were extrapolated into the Heliospheric Imager (HI) field-of-view. We estimated the CME velocities in the different fields-of-view. It was found that CMEs slower than the solar wind were accelerated, while CMEs faster than the solar wind were decelerated, with both tending to the solar wind velocity. [ABSTRACT FROM AUTHOR]

We identify coronal holes using a histogram-based intensity thresholding technique and compare their properties to fast solar wind streams at three different points in the heliosphere. The thresholding technique was tested on EUV and X-ray images obtained using instruments onboard STEREO, SOHO and Hinode. The full-disk images were transformed into Lambert equal-area projection maps and partitioned into a series of overlapping sub-images from which local histograms were extracted. The histograms were used to determine the threshold for the low intensity regions, which were then classified as coronal holes or filaments using magnetograms from the SOHO/MDI. For all three instruments, the local thresholding algorithm was found to successfully determine coronal hole boundaries in a consistent manner. Coronal hole properties extracted using the segmentation algorithm were then compared with in situ measurements of the solar wind at ∼ 1 AU from ACE and STEREO. Our results indicate that flux tubes rooted in coronal holes expand super-radially within 1 AU and that larger (smaller) coronal holes result in longer (shorter) duration high-speed solar wind streams. [ABSTRACT FROM AUTHOR]

Abstract: Recent pre-clinical and clinical studies have examined the potential use of anti-glucocorticoid drug augmentation – including glucocorticoid receptor (GR) antagonists – as a method of improving treatment response in severe psychiatric illness. However, the direct and persistent effects such drugs exert on the hypothalamic–pituitary–adrenal (HPA) axis are unclear. We examined afternoon cortisol levels in 39 patients (19 with bipolar disorder, 20 with schizophrenia) at baseline, following treatment with mifepristone (600mg/day for 7 days) or placebo and at +21 days. Following treatment with mifepristone (day +7) there was a significant increase in cortisol levels from baseline (mean change=60,434nmol/L×min, 95%CI=44,755–76,112; t =7.803, df=38, p <0.0001) which significantly decreased from this point by day +21 (mean change=−64,487nmol/L×min, 95%CI=−49,974 to −79,001; t =8.995, df=38, p <0.0001). Cortisol levels at day +21 were significantly lower than they were at baseline (mean change=−4054nmol/L×min, 95%CI=−456 to −7652; t =2.281, df=38, p =0.028). No significant changes occurred following placebo. These results provide preliminary evidence that subtle but significant reductions in HPA axis activity (measured by peripheral cortisol levels) are evident 14 days after cessation of treatment with the GR-antagonist mifepristone. This may in part underlie the putative therapeutic effects of such drugs. [Copyright &y& Elsevier]

Coronal Mass Ejections (CMEs) are challenging objects to detect using automated techniques, due to their high velocity and diffuse, irregular morphology. A necessary step to automating the detection process is to first remove the subjectivity introduced by the observer used in the current, standard, CME detection and tracking method. Here we describe and demonstrate a multiscale edge detection technique that addresses this step and could serve as one part of an automated CME detection system. This method provides a way to objectively define a CME front with associated error estimates. These fronts can then be used to extract CME morphology and kinematics. We apply this technique to a CME observed on 18 April 2000 by the Large Angle Solar COronagraph experiment (LASCO) C2/C3 and a CME observed on 21 April 2002 by LASCO C2/C3 and the Transition Region and Coronal Explorer (TRACE). For the two examples in this work, the heights determined by the standard manual method are larger than those determined with the multiscale method by ≈10% using LASCO data and ≈20% using TRACE data. [ABSTRACT FROM AUTHOR]

Summary: The impact of lithium on arginine vasopressin (AVP) release has implications for our understanding of the pathophysiology and treatment of mood disorders and for the interpretation of neuroendocrine studies. In this secondary analysis of neuroendocrine, data from 23 patients with chronic major depressive disorder, 41 patients with bipolar disorder and 18 healthy controls, we examine the relationship between lithium therapy, AVP levels and the cortisol response to the dexamethasone/corticotropin-releasing hormone (dex/CRH) test. These data demonstrate that patients taking lithium have elevated post-dexamethasone AVP levels compared to both healthy controls and patients not on lithium. [Copyright &y& Elsevier]

Objective: Brain-derived neurotrophic factor (BDNF) is stress-responsive and has been implicated in a number of disparate neuropsychiatric disorders. Glucocorticoid antagonists have been shown to have beneficial effects on mood and cognitive function in bipolar disorder but not in schizophrenia. The aim of the present study was to investigate BDNF levels in patients with bipolar disorder and schizophrenia before and after treatment with the glucocorticoid receptor antagonist mifepristone. Methods: Peripheral BDNF levels were measured in patients with bipolar disorder (n=20), schizophrenia (n=20) and 14 matched healthy controls following 7 days of adjunctive mifepristone (600 mg day-1) treatment in a double-blind, placebo-controlled crossover design study. Results: Baseline BDNF values were similar in both patient groups and in healthy controls. Following treatment with mifepristone, cortisol levels were significantly increased and BDNF levels decreased in both schizophrenia and bipolar disorder. A significant correlation existed between change in cortisol level and change in BDNF levels following mifepristone treatment in schizophrenia, but not in bipolar disorder. Conclusion: Differing BDNF responses to increasing cortisol levels between patients with schizophrenia and with bipolar disorder may reflect underlying pathophysiological mechanisms. [ABSTRACT FROM AUTHOR]

Introduction: The placement of left ventricular (LV) leads during cardiac resynchronization therapy (CRT) involves many technical difficulties. These difficulties increase procedural times and decrease procedural success rates. Methods and Results: A total of 50 patients with severe cardiomyopathy (mean LV ejection fraction was 21 ± 6%) and a wide QRS underwent CRT implantation. Magnetic navigation (Stereotaxis, Inc.) was used to position a magnet-tipped 0.014″ guidewire (Cronus™ guidewire) within the coronary sinus (CS) vasculature. LV leads were placed in a lateral CS branch, either using a standard CS delivery sheath or using a “bare-wire” approach without a CS delivery sheath. The mean total procedure time was 98.1 ± 29.1 minutes with a mean fluoroscopy time of 22.7 ± 15.1 minutes. The mean LV lead positioning time was 10.4 ± 7.6 minutes. The use of a delivery sheath was associated with longer procedure times 98 ± 32 minutes vs 80 ± 18 minutes (P = 0.029), fluoroscopy times 23 ± 15 minutes vs 13 ± 4 minutes (P = 0.0007) and LV lead positioning times 10 ± 6 minutes vs 4 ± 2 minutes (P = 0.015) when compared to a “bare-wire” approach. When compared with 52 nonmagnetic-assisted control CRT cases, magnetic navigation reduced total LV lead positioning times (10.4 ± 7.6 minutes vs 18.6 ± 18.9 minutes; P = 0.005). If more than one CS branch vessel was tested, magnetic navigation was associated with significantly shorter times for LV lead placement (16.2 ± 7.7 minutes vs 36.4 ± 23.4 minutes; P = 0.004). Conclusions: Magnetic navigation is a safe, feasible, and efficient tool for lateral LV lead placement during CRT. Magnetic navigation during CRT allows for control of the tip direction of the Cronus™ 0.014″ guidewire using either a standard CS delivery sheath or “bare-wire” approach. Although there are some important limitations to the 0.014″ Cronus™ magnetic navigation can decrease LV lead placement times compared with nonmagnetic-assisted control CRT cases, particularly if multiple CS branches are to be tested. [ABSTRACT FROM AUTHOR]

Abstract: Hypercortisolaemia is a feature of many severe psychiatric illnesses and has been suggested to be both a causal and exacerbating factor of clinical symptoms and neurocognitive impairment. The adrenal steroid dehydroepiandrosterone (DHEA) has antiglucocorticoid properties that may have regulatory effects on glucocorticoid action in the brain. However, there is a paucity of data on these steroids and their ratio in schizophrenia and bipolar disorder. We therefore sought to assess cortisol and DHEA levels and the cortisol-DHEA ratio in patients with schizophrenia (n =20) and bipolar disorder (n =20), on stable medication for a minimum of 6 weeks, and healthy age- and sex-matched control subjects (n =20). Steroid levels were measured from plasma samples collected at 30 min intervals from 1:00 p.m. to 4:00 p.m. Cortisol levels were found to be significantly elevated in both patient groups compared with controls. DHEA levels were elevated in schizophrenic patients compared with bipolar patients and controls, but there was no evidence of a difference in the cortisol-DHEA ratio of the groups. These data suggest that afternoon hypercortisolaemia is evident in symptomatic bipolar and schizophrenic patients compared to controls. However, an elevation in DHEA levels may represent a specific endocrine marker in schizophrenia. [Copyright &y& Elsevier]

Objective: Neurocognitive deficits have been widely reported in patients with mood disorders. However, relatively little is known of the short-term trajectory of neurocognitive improvement once treatment has been initiated. Method: A neurocognitive test battery was administered to unipolar depressed (major depressive disorder, MDD) patients (aged 18-65 years) who had been medication-free for at least 6 weeks, and to healthy controls. Patients were then treated according to clinical need, predominantly with standard pharmacotherapy, and all participants were followed up within 6 months. Results: Of the 25 MDD patients who returned at follow up, 11 were defined as remitted and 14 as not remitted. Significantly less baseline psychomotor dysfunction was observed in patients who remitted compared to those who did not (effect size, d =0.78, 95% confidence interval (CI) =0.07-1.44). Analysis of the change scores between assessments revealed a significantly greater improvement in verbal memory in patients who remitted compared to those who did not (d =0.73, 95%CI =0.03-1.39). Conclusions: This preliminary report suggests that there may be distinct temporal trajectories of neurocognitive improvement following remission in MDD. Aspects of neurocognitive functioning should be examined further as a means of providing a useful objective marker of treatment response. [ABSTRACT FROM AUTHOR]

Reduced serotonin (5-HT) function and abnormalities in the hypothalamic-pituitary-adrenal (HPA) axis are thought to play a role in the aetiology of major depression. We sought to examine this issue in the elderly by assessing the effects of lowering brain 5-HT on salivary and plasma cortisol in elderly patients who had recovered from at least one episode of major depression and in a healthy, age matched comparison group. A double-blind, cross-over design involving administration of two nutritionally balanced amino acid mixtures (with or without tryptophan) was used. Salivary cortisol was measured at intervals before and after the drink. There was no effect of acute tryptophan depletion (ATD) on salivary cortisol (ATD by time; F=0.97, df= 7,210, p=0.454) but a significant interaction between group and time (F=3.91, df=7,210, p=0.010). Healthy subjects showed a marked increase in cortisol levels 2-3 hours into the procedure regardless of drink composition while recovered depressed subjects did not. In elderly patients who had recovered from depression there was no evidence of greater vulnerability of hypothalamic 5-HT pathways to 5-HT depletion. However, they demonstrated reduced reactivity of the HPA axis compared to healthy subjects. [ABSTRACT FROM AUTHOR]

Background: New evidence is emerging regarding abnormalities of hypothalamic-pituitary-adrenal (HPA) axis function in subtypes of affective disorders. Adverse effects of HPA axis dysregulation may include dysfunction of monoaminergic transmitter systems, cognitive impairment and peripheral effects. Newer treatments specifically targeting the HPA axis are being developed. Objective: To review these developments focusing particularly on the glucocorticoid receptor (GR) antagonist mifepristone. Method: A selective review of the literature. Results: The function of GRs is increasingly being defined. The role of corticotrophin-releasing hormone (CRH) and dehydroepiandrosterone (DHEA) in the brain is also increasingly understood. HPA axis function is particularly likely to be abnormal in psychotic depression and bipolar disorder, and it is in these conditions that trials of the GR antagonist mifepristone are being focused. CRH antagonists and DHEA are also being investigated as potential treatments. Conclusion: Initial studies of mifepristone and other HPA-axis-targeting agents in psychotic depression and bipolar disorder are encouraging and confirmatory studies are awaited. [ABSTRACT FROM AUTHOR]

Abstract: Previously it has been reported that female performance on the recall of objects and their locations in a spatial array is superior to that of males. This may reflect underlying information-processing biases whereby males organize information in a self-referential manner while females adopt a more comprehensive approach. The known female advantage in verbal memory may, however, account for this sex difference. In an initial experiment we found no overall sex differences in object or object-location memory. The inclusion of a verbal distracter task revealed gender-congruent biases in performance. A final study examined some methodological issues associated with the design of item arrays. After controlling for differences in item distinctiveness, performance on object-location was found to be substantially influenced by the distance that items were displaced in the array. These findings demonstrate that certain methodological factors can significantly affect the attentional and mnemonic processes that operate when performing tasks of this nature and can negate underlying sex differences in performance. [Copyright &y& Elsevier]

An increasing number of studies are utilizing saliva sampling as a method of assessing adrenal steroid secretion. Saliva samples have certain advantages over plasma, being non-invasive and easily collected. However, some methods of collection may compromise the accuracy of the assay, particularly those which employ aids to stimulate saliva production. We sought to compare the accuracy of cortisol and dehydroepiandrosterone (DHEA) measurement by examining the association between plasma levels, saliva and saliva collected using a citric acid-treated salivette device. Twenty six healthy mate volunteers were recruited for the study. To increase the range of steroid levels in the samples collected, half the subjects were pre-treated with hydrocortisone (20 mg, twice a day for 7 days) and half with placebo. Saliva samples were then collected from each subject using both a 'passive drool' method and a citric acid-treated salivette. A plasma sample was also collected. Cortisol and DHEA levels were measured by radioimmunoassay. For cortisol levels, both methods of saliva collection correlated highly with plasma levels and with each other (r > 0.85; R² > 0.72 for all). For DHEA levels, only saliva samples collected using the unstimulated collection method correlated with plasma levels. DHEA collected using the salivette device did not correlate significantly with either plasma or the unstimulated saliva (r < -0.2;R² < 0.04). It is crucial that future studies are aware of these issues and are cognizant of the effects of the method of collection when examining steroid levels in saliva. [ABSTRACT FROM AUTHOR]

Children who have taken psychostimulants long term for attention deficit/hyperactivity disorder (ADHD) are now presenting at adult psychiatry clinics at an age at which bipolar disorder and schizophrenia may first appear and at which pregnancy is a possibility. Doctors who may have little experience in the management of ADHD or use of psychostimulants are faced with decisions on whether to continue or withdraw medication. A literature search conducted to clarify these issues revealed that, although psychostimulants are generally efficacious in ADHD, the risks of withdrawal reactions and of possible long-term effects such as drug addiction, psychosis and depression, or effects in pregnancy, have not been adequately investigated. In particular, there is little information on the effects of withdrawal and no firm guidelines on methods of psychostimulant discontinuation. There is a need for further research to clarify the pharmacological issues involved in the drug treatment of ADHD and for overlapping arrangements between child and adult psychiatry clinics in the management of ADHD. [ABSTRACT FROM AUTHOR]

Summary: The dexamethasone suppression test (DST), frequently abnormal in mood disorder patients, is considered to measure glucocorticoid receptor-mediated negative feedback. We examined the hypothesis that the, apparently more sensitive, dexamethasone/corticotrophin-releasing-hormone (dex/CRH) test unveils subtle hypothalamic–pituitary–adrenal axis disturbance not detected by the DST in 82 patients with mood disorders and 28 controls. There was a close correlation between the cortisol responses on the two tests (r s=0.73, p<0.0005). However, ROC analysis revealed that the dex/CRH test had better diagnostic performance than the DST (p=0.031). The sensitivity of delta cortisol (from the dex/CRH) was 61.9% and the specificity 71.4%. The sensitivity of 1500h cortisol (the DST) was 66.6% and the specificity was 47.6%. This suggests that the two tests measure common pathology but that the dex/CRH test has better diagnostic utility. [Copyright &y& Elsevier]

Abstract: There appears to be an allostatic shift in the hypothalamic-pituitary-adrenal (HPA) axis of animals exposed to chronic stress, such that vasopressinergic regulation of the HPA axis becomes critical for sustaining corticotroph responsiveness in the presence of high circulating glucocorticoid levels. It has been hypothesised that this is also a feature of patients with mood disorders and is mediated by a shift in hypothalamic drive in favour of arginine vasopressin (AVP) rather than corticotrophin releasing hormone (CRH), by up-regulation of AVP receptors in the pituitary and by a relatively reduced impact of glucocorticoid induced negative feedback on AVP release. We examined the latter, by comparing AVP levels after pretreatment with the glucocorticoid, dexamethasone in 41 bipolar patients (21 of whom were in full remission), 23 patients with chronic major depressive disorder and 21 healthy controls. We found that, as hypothesised, post-dexamethasone AVP levels were significantly elevated in patients with bipolar disorder and chronic depression compared with controls and also that there was no difference between symptomatic and remitted bipolar patients. The data shows that post-dexamethasone AVP levels are a sensitive measure of HPA axis function, that HPA axis dysfunction persists into euthymia in bipolar disorder and that, in contrast to previous reports, patients with chronic depression have a dysfunctional HPA axis. [Copyright &y& Elsevier]

The finitary power semigroup of a semigroup S, denoted Pf(S), is the set of finite subsets of S with respect to the usual set multiplication. Semigroups with finitely generated finitary power semigroups are characterised in terms of three other properties. From this statement there are drawn several corollaries. It follows that Pf(S) is not finitely generated if S is infinite and in any of the following classes: commutative; Bruck-Reilly extensions; inverse semigroups that contain an infinite group; completely zero-simple; completely regular. [ABSTRACT FROM AUTHOR]

We present an automated approach to active region extraction from full-disc MDI longitudinal magnetograms. This uses a region-growing technique in conjunction with boundary-extraction to define a number of enclosed contours as belonging to separate regions of magnetic significance on the solar disc. This provides an objective definition of active regions and areas of plage on the Sun. A number of parameters relating to the flare potential of each region are discussed. [ABSTRACT FROM AUTHOR]

Background: It has been suggested that hypercortisolemia may cause or exacerbate both neurocognitive impairment and symptoms in schizophrenia. We hypothesized that antiglucocorticoid treatments, particularly glucocorticoid receptor (GR) antagonists, would improve neurocognitive functioning and clinical symptoms in this disorder. Method: Twenty patients with schizophrenia were treated with 600 mg/day of the GR-antagonist mifepristone (RU-486) or placebo for 1 week in a double-blind, crossover design. Neurocognitive function was evaluated at baseline and 2 weeks after each treatment. Neuroendocrine profiling was performed at these times and also immediately after each treatment. Symptoms were evaluated weekly. Results: Mifepristone administration resulted in a temporary two- to threefold increase in plasma cortisol levels (p < .0001). No significant effects were observed on any measure of neurocognitive function, including the primary outcome measures of spatial working memory and declarative memory. Minor changes in symptoms occurred in both arms of the study and were indicative of a general improvement over time, irrespective of treatment. Conclusions: In contrast to our earlier report of positive effects in bipolar disorder, these data suggest that the GR-antagonist mifepristone has no effect on neurocognitive function or symptoms in this group of patients with schizophrenia. Future studies in schizophrenia should examine patients with demonstrable hypothalmic-pituitary-adrenal axis dysfunction. [Copyright &y& Elsevier]

This paper highlights the main issues that are present in the field of child and adolescent mental health services with regard to strategic development. It identifies the major themes that have emerged concerning the commissioning and delivery of services, and also highlights the difficulties faced by particular groups of children. The authors present their views of the developments within this field from the perspective of their professional experiences. [ABSTRACT FROM AUTHOR]