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Studies the infrared absorption spectrum of the v[sub 3] fundamental band of HBBr ion using a tunable diode laser and velocity modulation spectroscopy. Formation of the ion; Band origins; Rotational constants; Internuclear distances.

Objectives Social isolation and loneliness have been associated with ill health and are common in the developed world. A clear understanding of their implications for morbidity and mortality is needed to gauge the extent of the associated public health challenge and the potential benefit of intervention. Study design A systematic review of systematic reviews (systematic overview) was undertaken to determine the wider consequences of social isolation and loneliness, identify any differences between the two, determine differences from findings of non-systematic reviews and to clarify the direction of causality. Methods Eight databases were searched from 1950 to 2016 for English language reviews covering social isolation and loneliness but not solely social support. Suitability for inclusion was determined by two or more reviewers, the methodological quality of included systematic reviews assessed using the a measurement tool to assess systematic reviews (AMSTAR) checklist and the quality of evidence within these reviews using the grading of recommendations, assessment, development and evaluations (GRADE) approach. Non-systematic reviews were sought for a comparison of findings but not included in the primary narrative synthesis. Results Forty systematic reviews of mainly observational studies were identified, largely from the developed world. Meta-analyses have identified a significant association between social isolation and loneliness with increased all-cause mortality and social isolation with cardiovascular disease. Narrative systematic reviews suggest associations with poorer mental health outcomes, with less strong evidence for behavioural and other physical health outcomes. No reviews were identified for wider socio-economic or developmental outcomes. Conclusions This systematic overview highlights that there is consistent evidence linking social isolation and loneliness to worse cardiovascular and mental health outcomes. The role of social isolation and loneliness in other conditions and their socio-economic consequences is less clear. More research is needed on associations with cancer, health behaviours, and the impact across the life course and wider socio-economic consequences. Policy makers and health and local government commissioners should consider social isolation and loneliness as important upstream factors impacting on morbidity and mortality due to their effects on cardiovascular and mental health. Prevention strategies should therefore be developed across the public and voluntary sectors, using an asset-based approach. [ABSTRACT FROM AUTHOR]

Objectives: Responsibility for the commissioning of sexual and reproductive health (SRH) services transferred from the National Health Service to local authorities in England in 2013. This transfer prompted many local authorities to undertake new procurements of these SRH services. This study was undertaken to capture some of the lessons learnt in order to inform future commissioning and system redesign. Study design: A qualitative study was carried out involving semi-structured interviews. Methods: Interviews were conducted with 13 local authority sexual health commissioners in Yorkshire and the Humber from 11 interviews. Thematic analysis was used to identify themes from transcripts of the interviews with the 13 participants. Results: Key themes identified were as follows: the challenge and complexity to those new to clinical commissioning; the prerequisites of robust infrastructural inputs to undertake the process, including technical expertise, a dependable project team, with clarity over the timescales and the budget; the requirement for good governance, stakeholder engagement and successful management of relationships with the latter; and the need to focus on the outcomes, aiming for value for money and improved system performance. Conclusions: Several key issues emerged from our study that significantly influenced the outcome of the redesign and commissioning process for sexual health services. An adapted model of the Donabedian evaluation framework was developed to provide a tool to inform future system redesign. Our model helps identify the key determinants for successful redesign in this context which is essential to both mitigate potential risks and maximize the likelihood of successful outcomes. Our model may have wider applications. [ABSTRACT FROM AUTHOR]

Purpose: The popliteus tendon is crucial to postero-lateral stability and prone to iatrogenic injury intra-operatively. Its role in the stability of the replaced knee remains contentious. The aim of this study was to use computer navigation to quantify the effect of popliteus sectioning on the 'envelope of laxity' (EoL) offered by a posterior-stabilised (PS) total knee arthroplasty (TKA) and compare with that of the native knee. Methods: Loaded cadaveric legs were mounted on a purpose built rig. EoL was measured in 3 degrees of freedom using computer navigation. Knees were subjectively stressed in varus/valgus, internal/external rotation and anterior draw. This was performed preoperatively, during TKA and after sectioning of the popliteus tendon. Real-time data were recorded at 0°, 30°, 60° and 90° of flexion as the operating surgeon stressed the knee in 3 degrees of freedom to its subjective endpoint. Mixed-effect modelling was used to quantify the effects of intervention on degree of laxity. Results: In all conditions, there was an increase in laxity with knee flexion. Insertion of a PS TKA resulted in increased constraint, particularly in rotation. Sectioning of the popliteus did not result in a significant increase in knee laxity to 90º of knee flexion. However, at deeper flexion angles, tendon sectioning overcame the constraints of the implant resulting in a significant increase in rotatory and varus/valgus laxity towards the native condition. Conclusion: These findings support the view that certain current designs of PS knee replacement can constrain the knee in flexion in the absence of postero-lateral deficiency. For this implant, isolated sectioning of the popliteus tendon did not substantially generate abnormal knee laxity. [ABSTRACT FROM AUTHOR]

Time-resolved infrared spectroscopy has been proven to be a powerful tool for investigating the structure, dynamics and reactivity of electronically-excited states of inorganic molecules. As applications drive the production of ever more complex molecules however, experimental tools that can deliver more detailed spectroscopic information, or separate multiple contributions to complex signals will become increasingly valuable. In this Perspective, the extension of ultrafast infrared spectroscopy of inorganic excited states to a second frequency dimension using transient 2D-IR spectroscopy (T-2D-IR) methods is discussed. Following a brief discussion of the experimental methodologies, examples will be given of applications of T-2D-IR ranging from studies of the spectroscopy, structure and dynamics of photochemical intermediates to new tools for correlating vibrational modes in ground and excited electronic states and the investigation of excited state solvation dynamics. Future directions for these experiments are also discussed. [ABSTRACT FROM AUTHOR]

Abstract: Temporal and spatial patterns of relative sea level (RSL) change in the North of Britain and Ireland during the Holocene are examined. Four episodes, each defined by marked changes in the RSL trend, are identified. Each episode is marked by a rise to a culminating shoreline followed by a fall. Episode HRSL-1 dates from the Younger Dryas to early in the Holocene; HRSL-2 to HRSL-4 occurred later in the Holocene. There is extensive evidence for each episode, and on this basis the spatial distribution of the altitude data for three culminating shorelines and a shoreline formed at the time of the Holocene Storegga Slide tsunami (ca 8110 ± 100 cal. BP) is analysed. Ordinary Kriging is used to determine the general pattern, following which Gaussian Trend Surface Analysis is employed. Recognising that empirical measurements of RSL change can be unevenly distributed spatially, a new approach is introduced which enables the developing pattern to be identified. The patterns for the most widely occurring shorelines were analysed and found to be similar and common centre and axis models were developed for all shorelines. The analyses described provide models of the spatial pattern of Holocene RSL change in the area between ca 8100 cal. BP and ca 1000 cal. BP based on 2262 high resolution shoreline altitude measurements. These models fit the data closely, no shoreline altitude measurement lying more than −1.70 m or +1.82 m from the predicted value. The models disclose a similar pattern to a recently published Glacial Isostatic Adjustment model for present RSL change across the area, indicating that the overall spatial pattern of RSL change may not have varied greatly during the last ca 8000 years. [Copyright &y& Elsevier]

Background: Improvised explosive devices (IEDs) pose a significant threat to military personnel, often resulting in lower extremity amputation and pelvic injury. Immediate management is haemorrhage control and debridement, which can involve lengthy surgery. Computed tomography is necessary to delineate the extent of the injury, but it is unclear whether to perform this during or after surgery. Methods: The UK Joint Theatre Trauma Registry was searched to identify all UK service personnel who had a traumatic lower extremity amputation following IED injury between January 2007 and December 2010. Data were collected on injury pattern and survival. Results: There were 169 patients who sustained 278 traumatic lower extremity amputations: 69 were killed in action, 16 died from their wounds and 84 were wounded in action, but survived. The median (interquartile range) Injury Severity Score was 75 (21) for those killed in action, 46 (23) for those who died from wounds and 29 (12) for survivors. There were significantly more severe head, chest and abdominal injuries (defined as a body region Abbreviated Injury Scale score of 3 or more) in patients who were killed in action than in those reaching hospital ( P < 0·001). Hindquarter amputations were the most lethal, with a mortality rate of 95 per cent. Of the 100 casualties who reached hospital alive, there were nine thoracotomies, one craniotomy and 34 laparotomies. All head or torso injuries that required immediate operation were clinically apparent on admission. Conclusion: Higher levels of amputation were associated with greater injury burden and mortality. Intraoperative computed tomography had little value in identifying clinically significant covert injuries. © 2011 Crown copyright Published by John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background Obese children are at high risk of developing co-morbidities, with a prevalence of abnormal tests ranging from 30 to 58%. Recent guidance recommends that all children with a body mass index (BMI) above the 95th centile be investigated. This study aimed to determine the prevalence of abnormal results in an urban paediatric population and to compare local practice against these recommendations. Methods Patient records of children attending either a community or hospital-based obesity clinic were analysed retrospectively to obtain anthropometric data and laboratory results; from this, the frequency of investigation and the prevalence of abnormal results were calculated. Investigations considered were alanine aminotransferase, thyroid-stimulating hormone (TSH), and fasting glucose, insulin and lipid profiles. Results One hundred thirty-six children (75 girls, 61 boys) were identified, with mean BMI z-score of 3.27 and mean age of 11.4 years (range 1.4-20.4). Children with BMI z-score >3 were more likely to be investigated, but otherwise, the frequency was similar for both sex and age. The prevalence of abnormal results was liver function tests, 14.3%; TSH, 0.0%; glucose, 0.0%; insulin, 31.6%; triglycerides, 10.0%; cholesterol, 15.6%. The sample size was small, but there did not appear to be a significant difference in the percentage abnormal results found for sex, age, or BMI z-score. Conclusion The prevalence of abnormal results was less than that identified in another UK study carried out in a tertiary centre, suggesting that the true population-based prevalence is lower than believed. This might be especially so because fewer tests were performed in these clinics than currently recommended and children at highest risk were more likely to be investigated. Therefore, further research is indicated to determine the true figure as well as to identify risk factors for co-morbidity, before costly recommendations to test all children with a BMI above the 95th centile are implemented. [ABSTRACT FROM AUTHOR]

Background Obese children are at high risk of developing co-morbidities, with a prevalence of abnormal tests ranging from 30 to 58%. Recent guidance recommends that all children with a body mass index (BMI) above the 95th centile be investigated. This study aimed to determine the prevalence of abnormal results in an urban paediatric population and to compare local practice against these recommendations. Methods Patient records of children attending either a community or hospital-based obesity clinic were analysed retrospectively to obtain anthropometric data and laboratory results; from this, the frequency of investigation and the prevalence of abnormal results were calculated. Investigations considered were alanine aminotransferase, thyroid-stimulating hormone (TSH), and fasting glucose, insulin and lipid profiles. Results One hundred thirty-six children (75 girls, 61 boys) were identified, with mean BMI z-score of 3.27 and mean age of 11.4 years (range 1.4–20.4). Children with BMI z-score >3 were more likely to be investigated, but otherwise, the frequency was similar for both sex and age. The prevalence of abnormal results was liver function tests, 14.3%; TSH, 0.0%; glucose, 0.0%; insulin, 31.6%; triglycerides, 10.0%; cholesterol, 15.6%. The sample size was small, but there did not appear to be a significant difference in the percentage abnormal results found for sex, age, or BMI z-score. Conclusion The prevalence of abnormal results was less than that identified in another UK study carried out in a tertiary centre, suggesting that the true population-based prevalence is lower than believed. This might be especially so because fewer tests were performed in these clinics than currently recommended and children at highest risk were more likely to be investigated. Therefore, further research is indicated to determine the true figure as well as to identify risk factors for co-morbidity, before costly recommendations to test all children with a BMI above the 95th centile are implemented. [ABSTRACT FROM AUTHOR]

Age-related accumulation of cellular damage and death has been linked to oxidative stress. Calorie restriction (CR) is the most robust, nongenetic intervention that increases lifespan and reduces the rate of aging in a variety of species. Mechanisms responsible for the antiaging effects of CR remain uncertain, but reduction of oxidative stress within mitochondria remains a major focus of research. CR is hypothesized to decrease mitochondrial electron flow and proton leaks to attenuate damage caused by reactive oxygen species. We have focused our research on a related, but different, antiaging mechanism of CR. Specifically, using both in vivo and in vitro analyses, we report that CR reduces oxidative stress at the same time that it stimulates the proliferation of mitochonciria through a peroxisome proliferation-activated receptor coactivator lα signaling pathway. Moreover, mitochondria under CR conditions show less oxygen consumption, reduce membrane potential, and generate less reactive oxygen species than controls, but remarkably they are able to maintain their critical ATP production. In effect, CR can induce a peroxisome proliferation-activated receptor coactivator lα-dependent increase in mitochondria capable of efficient and balanced bioenergetics to reduce oxidative stress and attenuate age-dependent endogenous oxidative damage. [ABSTRACT FROM AUTHOR]

This study describes the context for the development of a tool to formatively assess information technology skills of students. The tool provides a reliable and valid assessment of word processing competency, utilizing automation to apply the test instrument via the Microsoft Office package. Tests can be designed directly by tutors, and delivered via a network. Evaluation of the tests suggests that immediate automated testing is preferred by students compared to a traditional written test. There is evidence that the tool improves the IT skills of its users, whereas a traditional written test has no such beneficial effect. [ABSTRACT FROM AUTHOR]

The cellular mechanisms that account for the increase in osteoclast numbers and bone resorption in skeletal breast cancer metastasis are unclear. Osteoclasts are marrow-derived cells which form by fusion of mononuclear phagocyte precursors that circulate in the monocyte fraction. In this study we have determined whether circulating osteoclast precursors are increased in number or have an increased sensitivity to humoral factors for osteoclastogenesis in breast cancer patients with skeletal metastases (± hypercalcaemia) compared to patients with primary breast cancer and age-matched normal controls. Monocytes were isolated and cocultured with UMR 106 osteoblastic cells in the presence of 1,25 dihydroxyvitamin D[SUB3] [1,25(OH)[SUB2]D[SUB3]] and human macrophage colony stimulating factor (M-CSF) on coverslips and dentine slices. Limiting dilution experiments showed that there was no increase in the number of circulating osteoclast precursors in breast cancer patients with skeletal metastases (± hypercalcaemia) compared to controls. Osteoclast precursors in these patients also did not exhibit increased sensitivity to 1,25(OH)[SUB2](D)[SUB3] or M-CSF in terms of osteoclast formation. The addition of parathyroid hormone-related protein and interleukin-6 did not increase osteoclast formation. The addition of the supernatant of cultured breast cancer cell lines (MCF-7 and MDA-MB-435), however, significantly increased monocyte-osteoclast formation in a dose-dependent fashion. These results indicate that the increase in osteoclast formation in breast cancer is not due to an increase in the number/nature of circulating osteoclast precursors. They also suggest that tumour cells promote osteoclast formation in the bone microenvironment by secreting soluble osteoclastogenic factor(s). [ABSTRACT FROM AUTHOR]

The infrared spectrum of the upsilon3 fundamental band of HBCl+ has been observed using the velocity modulation detection technique. The ion was produced in an ac glow discharge containing a mixture of H2 and BCl3. Thirty-two transitions of the fundamental band of the most naturally abundant isotopomer, H11B35Cl+, between 1105 and 1170 cm-1 have been assigned. The upsilon3 band origin and rotational constants have been determined to be upsilon0 = 1121.5677(20) cm-1, B0 = 0.630 89(23) cm-1 and B1 = 0.626 99(21) cm-1. A second series of lines have been attributed to the H11B37Cl+ isotopomer, although it has not been possible to make an unambiguous J assignment of these lines. [ABSTRACT FROM AUTHOR]

Intravenous injection of t-butyl hydroperoxide rapidly killed Plasmodium vinckei in mice., and caused haemolysis. The same dose seemed harmless to unparasitized mice. Many parasites disintegrated inside circulating erythrocytes. so parasite death was not simply a passive consequence of haemolysis, injection of desferrioxamine. which removes the traces of free iron that promote the dissociation of t-butyl hydroperoxide into radical species, prevented both parasite death and haemolysis. Lipid peroxidation. as measured by accumulation of malonyldialdehyde over 2 h in vitro, occurred in erythrocytes exposed to t-butyl hydroperoxide, and was particularly marked in erythrocytes from parasitized mice. These erythrocytes accumulated appreciable malonyldialdehyde even without exposure to t-butyl hydroperoxide. Desferrioxamine inhibited the accumulation of malonyldialdehyde. but did not prevent depletion of reduced glutathione by t-butyl hydroperoxide. This suggests that t-butyl hydroperoxide damaged parasites and erythrocytes by dissociating into radical species, rather than by decreasing intraerythrocyte anti-oxidant capacity. In earlier experiments we suggested that intraerythrocytic parasite death and haemolysis caused by alloxan were mediated by radical species, and these experiments with t-butyl hydroperoxide add weight to this interpretation. We regard both of these systems as models for macrophage-induced parasite death and host pathology in acute malaria. [ABSTRACT FROM AUTHOR]

This article gives a flavour of the CHIME materials on data handling in Microsoft Excel. It demonstrates the facilities for data validation within Excel. [ABSTRACT FROM AUTHOR]

The high-resolution infrared kinetic spectra of HCCN and DCCN have been recorded, the former between 3395 and 3481 cm-1 and the latter in the 2517–2593 cm-1 region. A total of four dominant Q branches were observed and have been subsequently assigned to the ν[sub 1]+2ν[sub 5][sup ±2]←ν[sub 5][sup ±1], ν[sub 1]+3ν[sub 5][sup ±3]←2ν[sub 5][sup ±2] bands of the two isotopomers. The band origins have been determined to be 3420.666(1), 2544.743(2), 3460.912(2), and 2573.480(1) cm-1 respectively. These new values have been used in conjunction with the previously obtained ν[sub 1]+2ν[sub 5][sup ±2]←2ν[sub 5][sup ±2] band origins of HCCN and DCCN to obtain 2ν[sub 5][sup ±2]←ν[sub 5][sup ±1] vibrational energies of 212.822(1) and 133.106(1) cm-1 for HCCN and DCCN, respectively. Semirigid bender calculations of the energy levels of these molecules have been carried out. By adjusting the height of the barrier to linearity, excellent agreement with experimental data has been attained. © 2001 American Institute of Physics. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Short-term cosmetic orthodontics for general dental practitioners," by A. Maini in the 2013 issue.

By encouraging people to dare to speak its name, the Alzheimer's Society is intent on bringing dementia out of the shadows. Neil Hunt reports. [ABSTRACT FROM AUTHOR]

Objective To describe the gender and ethnic trends of the United Kingdom orthodontic workforce.Design and setting A cross-sectional survey using a postal questionnaire to specialist orthodontic practitioners in the United Kingdom (2006-2007).Subjects All those on the Specialist List in Orthodontics held by the General Dental Council in October 2006.Materials and methods The data collected using the questionnaire included demographic details (gender, ethnicity, current age, place of birth), undergraduate and postgraduate dental schools attended, calendar years in which professional qualifications were achieved, anticipated year of retirement and geographical location of work place.Results The response rate was 81.5%. There are more male (60.2%) than female (39.8%) orthodontists presently working in the United Kingdom. Minority ethnic groups are better represented amongst the orthodontic workforce than they are in the general population, however their distribution throughout the United Kingdom is uneven. The trends in the results indicate that the gender and ethnic balance of the specialist orthodontic workforce has been changing and the proportion of females and those from non-white ethnic groups has increased. In contrast, the majority of those retiring over the next few years will be white males (60%).Conclusion This study suggests that there will be greater ethnic diversity and more female orthodontists in the future workforce. Consequently, working patterns should be kept under regular review so that an optimal orthodontic service can be maintained in the United Kingdom. [ABSTRACT FROM AUTHOR]

New guidelines have been released to help the 750,000 people with dementia who live in the UK. Alzheimer's Society chief executive Neil Hunt discusses how older people's nurses can help turn the guidelines into reality. [ABSTRACT FROM AUTHOR]

This paper discusses the introduction, development and utility of post-mortem imaging relating specifically to conflict-related and terrorist-related deaths and considers the use of computed tomography (CT) in the investigations. We demonstrate how a multi-disciplinary approach involving direct communication between forensic pathologist and radiologist can maximise evidential yield, reduce the need for unnecessary dissection and further our understanding of such injuries. This summarises our shared experience of hundreds of cases, each having been individually discussed and reviewed, and has helped shape our understanding of conflict injury as well as contributing to the development of mitigation strategies and adaptations to protective equipment. A series of clinical cases are presented to demonstrate some of the strengths and weaknesses of the process. • Development of post-mortem CT in forensic radiology by UK military. • Collaborative learning and working between radiology, pathology and police. • What the forensic pathologist and police want from CT. • What radiology can answer from a pragmatic PMCT study. • Strengths and weaknesses of the technique through case scenarios. [ABSTRACT FROM AUTHOR]

Clozapine is a uniquely effective antipsychotic, but is very toxic in clozapine-naïve subjects. A 34-year-old male patient in a mental health facility, who was not prescribed clozapine, took 350 mg clozapine obtained from another patient at night. He was found dead the next morning. The presence of cardiomegaly related to obesity may have increased the risk of suffering an acute cardiac event after ingestion of clozapine. The medication prescribed to the patient was not thought to have contributed to the fatal outcome. Post mortem femoral blood clozapine and norclozapine concentrations were 0.48 and 0.20mg/L, respectively. By way of comparison, audit of 104,127 plasma samples (26,796 patients) assayed for therapeutic drug monitoring purposes 1993-2007, showed plasma clozapine 0.35 mg/L or more in 57.5% samples (8.4% 1mg/L or more). Those involved in the investigation of clozapine-associated deaths need to be aware that that death in an adult may occur after a single 'therapeutic' dose. A diagnosis of fatal clozapine poisoning cannot be made solely on the basis of a post mortem blood clozapine measurement. [ABSTRACT FROM AUTHOR]

Orthodontic treatment is not without risk. This article aims to look at some of the dento-legal issues surrounding orthodontic treatment, the risks to both the clinician and the patient, and how some of these risks can be mitigated. [ABSTRACT FROM AUTHOR]

Orthodontic treatment is not without risk. This article aims to look at some of the dento-legal issues surrounding orthodontic treatment, the risks to both the clinician and the patient, and how some of these risks can be mitigated. [ABSTRACT FROM AUTHOR]

Immunohistochemistry staining for β-amyloid precursor protein (β-APP) is a sensitive method to detect early axonal damage in traumatic brain injury, which was previously estimated to be of minimum 60–90 min after head injury. We present seven cases of well-documented posttraumatic survival of 35–60 min where β-APP detects early axonal damage. Cases were selected from routine work where documentation about survival is judged to be accurate. These are divided into three groups: group 1: severe head injury ( n = 7) with documented survival between 35 and 60 min. Group 2: severe head injury ( n = 4) with documented survival of less than 30 min. Group 3: cases ( n = 4) where death was not due to head injury but survival is documented between 45 and 109 min. The brains were fixed in formalin for 4 weeks and six regions (frontal lobe with anterior corpus callosum, parietal lobe with deep white matter, basal ganglia with posterior limb of internal capsule, cerebellum with white matter and middle cerebellar peduncle and pons with basis pontis and superior cerebellar peduncle) were sampled. All blocks were stained for haematoxylin and eosin and β-APP and selected ones for CD68, using antigen retrieval method. In group 1 sections revealed β-APP immunoreactivity in forms of small globules and granules and occasionally as thin and short filaments. These were detected in the pons, corpus callosum, internal capsule and cerebral white matter, with some variation in localization and intensity. In groups 2 and 3 all the sections were negative for β-APP staining. None of the cases showed evidence of severe brain swelling, increased intracranial pressure, ischaemia or infection. Using the antigen retrieval method, β-APP immunohistochemistry can detect axonal damage within 35 min after severe head injury. These results may have an implication in the consideration of minimal survival time after traumatic head injury in medico-legal practice. [ABSTRACT FROM AUTHOR]

In October 2003 the British Association of Psychopharmacology (BAP) published evidence-based guidelines on the management of bipolar disorder. The aim of this study was to assess whether the guidelines could provide the basis for examining clinical decisions and the extent to which practice accords with these guidelines. Case notes of out patients with bipolar disorder were reviewed. Demographic details, and treatment recommendations were determined. The management of affective episodes was evaluated and compared with BAP guidelines. In 84 subjects, 224 affective episodes were identified. Treatment was consistent with BAP guidelines in 72% of episodes. Mania was more likely to be managed in accordance with guidelines than depression or mixed episodes. The use of antidepressant medication was the most likely intervention to deviate from recommendations. Reasons for treatments at odds with the guidelines were identified. Our study demonstrates that clinical practice among a range of psychiatrists broadly reflects the guidelines that have been issued by the British Association of Psychopharmacology (BAP). The BAP guidelines offer a practical and auditable basis for the short- and long-term treatment of bipolar affective disorder. [ABSTRACT FROM AUTHOR]

Estimating the correct nail length for solid tibial nails can be problematic. Most techniques reported in the literature for determining tibial nail length are not accurate. In a retrospective study of 16 patients in our unit, only three had ideal nail sizes. In these patients, as part of phase I of our study, we measured their normal leg’s length from knee joint line to ankle joint line. An ideal nail length for each of these patients was estimated from a whole length radiograph of the nailed tibia. Comparing these two data, we found that deducting 20 mm from the leg measurement gave appropriate nail lengths. We also compared this with three other anthropometric measurements; tibial tuberosity to medial malleolus, joint line to medial malleolus and olecranon to head of V metacarpal head distance. The joint line to joint line measurement was the most reliable and showed the best correlation with ideal nail lengths (0.982).In phase II, a prospective study on 15 patients, we used the joint line to joint line measurement to determine nail sizes. A postoperative review of the radiographs showed all the nails to be of adequate length. This strengthened the fact that the joint line to joint line measurement is the most accurate and easy method to determine tibial nail lengths. [Copyright &y& Elsevier]

Successful adaptation of craniofacial skeletal muscle is dependent upon the connective tissue component of the muscle. This is exemplified by procedures such as distraction histo/osteogenesis. The mechanisms underlying remodelling of intramuscular connective tissue are complex and multifactorial and involve extracellular matrix (ECM) molecules, receptors for the ECM (integrins) and enzymes that remodel the ECM (MMPs). This review discusses the current state of knowledge and clinical implications of connective tissue biology as applied to craniofacial skeletal muscle. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The effectiveness of lithium in preventing recurrences of bipolar disorder was examined prospectively for 2 years in two representative samples of bipolar I patients being treated in a comprehensive program following recommended guidelines. METHOD: One hundred and twenty patients were recruited from consecutive admissions to two catchment area psychiatric services (one in the United Kingdom, the other in New Zealand). They were seen at 3-monthly intervals by a member of the research team. Treatment was adjusted according to clinical needs. RESULTS: Overall, two-thirds of the patients had a recurrence. Of the 57 on lithium as sole treatment, 39 (68%) had a further episode; 17 after stopping lithium. The 42 on other mood stabilisers and/or an antipsychotic, with or without lithium, did no better. By contrast, only eight (38%) of the 21 who were taking no prophylactic medication had a recurrence. CONCLUSIONS: Lithium is much less effective in clinical practice than would be expected from clinical trial results. A major reason for this is poor compliance. Alternative treatment strategies are needed to improve the outcome for bipolar disorder patients. [ABSTRACT FROM AUTHOR]

- The aim of this study was to determine the prevalence of traumatised permanent teeth among sensory (visual (VI) and hearing (HI)) impaired children attending special schools in Riyadh, Saudi Arabia. All the dental injuries involved incisor teeth, and trauma was noted in 33 (6.7%) children attending government schools (control group) compared to 7 (9%) VI children and 24 (11.4%) HI children. Differences in the dental trauma only reached statistical significance between the HI and control group (P < 0.05). Gender differences were only apparent in the HI group, with males having higher levels of traumatised teeth. In addition, HI children aged 11-12 years were more prone to trauma than children in the control group of the same age (P < 0.05). In conclusion, sensory impaired children do have a tendency for more dental trauma. However, this was only statistically significant for HI children. Whereas a gender difference was most noticeable for the HI group, with males having higher levels of trauma, this was noticeable by its absence among VI children. [ABSTRACT FROM AUTHOR]

The United States Navy uses a visual feedback system for pilots, named 'the Greenie Board', to improve flight manoeuvres on aircraft carriers. Given that increased compliance with enhanced recovery after surgery protocols reduces postoperative complications, we decided to apply a similar feedback system to our institutional enhanced recovery programme. We undertook a prospective 12-month audit of 194 patients assigned to our enhanced recovery programme and evaluated adherence to the anaesthesia-related components of our protocol, before and after implementing a Greenie Board. A compliance score was calculated by summing points for adherence to: intra-operative antibiotic prophylaxis; temperature management; goal-directed intravenous fluid therapy; postoperative nausea and vomiting prophylaxis; and postoperative fluid restriction. The score for each patient was then colour-coded and anonymously displayed for each anaesthetist on a Greenie Board within the operating theatre suite. Protocol adherence improved significantly following introduction, with 'Green' scores (acceptable compliance) increasing from 33% to 72% of patients (p < 0.0001). The greatest improvement was seen with anti-emetic prophylaxis (49% to 70%, p = 0.004) with a consequent reduction in postoperative nausea and vomiting (OR 0.42, 95% CI 0.19-0.88, p = 0.021). We did not observe a decrease in other postoperative complications nor hospital length of stay. We conclude that this US Navy-inspired feedback system is an easily implemented, low-cost quality improvement tool that significantly improved adherence to intra-operative components of our enhanced recovery protocol. The system lends itself to global scaling to drive quality improvement in healthcare delivery and would be suited to institutions without electronic medical records, including low-resource countries. [ABSTRACT FROM AUTHOR]

The article presents research on skull-brain modeling to simulate injury patterns from bullets. Topics include the representation of impact fractures caused by bullets, the optimisation of modeling for the creation of military helmets to prevent head injuries, and the filming of ballistic impacts on helmets using high speed cameras.

Background The potential tissue replication sites and specific cell types that support in vivo virus survival beyond the acute phase of bovine ephemeral fever virus ( BEFV) infection have not been fully defined in cattle. To clarify the knowledge gap, tissue specimens were tested after collection from an adult steer necropsied 1 week after acute BEF. Case report Significant necropsy findings included fibrinoproliferative synovitis in the stifle joints and fibrin clot-laden fluid in serous body cavities. Moderate numbers of infiltrating neutrophils were demonstrated in sections of the prefemoral lymph nodes and haemal node, and lymphoid hyperplasia in the spleen, haemal node and prefemoral lymph nodes. Viral RNA was detected by qRT-PCR in fresh spleen, haemal node, prefemoral lymph node, synovial fluid and in several spleen-derived cell cultures. BEFV was isolated from autogenously derived splenic primary cell cultures 6 days after cessation of viraemia, and characteristic bullet-shaped virions were confirmed by electron microscopy of an ultrathin haemal node section. In sections of the spleen, haemal node and other tissues, immunohistochemistry demonstrated BEFV antigens that were intracellularly associated with probable histiocytic cells. Conclusion BEFV has preferential tropism for bovine lymphoid tissues and the spleen and haemal node may be potential sites for post-viraemic virus replication. [ABSTRACT FROM AUTHOR]

Objective This study assessed the neurotropism of bovine ephemeral fever (BEF) virus (BEFV) and described histomorphological abnormalities of the brain, spinal cord and peripheral nerves that may causally contribute to paresis or paralysis in BEF. Methods Four paralysed and six asymptomatic but virusinfected cattle were monitored, and blood and serum samples screened by qRT-PCR, virus isolation and neutralisation tests. Fresh brain, spinal cord, peripheral nerve and other tissues were qRT-PCR-tested for viral RNA, while formalin-fixed specimens were processed routinely and immunohistochemically evaluated for histomorphological abnormalities and viral antigen distribution, respectively. Results The neurotropism of BEFV was immunohistochemically confirmed in the brain and peripheral nerves and peripheral neuropathy was demonstrated in three paralysed but not the six aneurological but virus-infected animals. Wallerian degeneration (WD) was present in the ventral funicular white matter of the lumbar spinal cord of a paralysed steer and in cervical and thoracic spinal cord segments of three paralysed animals. Although no spinal cord lesions were seen in the steer euthanased within 7 days of illness, peripheral neuropathy was present and more severe in nerves of the brachial plexuses than in the gluteal or fibular nerves. The only steer with WD in the lumbar spinal cord also showed intrahistiocytic cell viral antigen that was spatially distributed within areas of moderate brain stem encephalitis. Conclusion The data confirmed neurotropism of BEFV in cattle and documented histomorphological abnormalities in peripheral nerves and brain which, together with spinal cord lesions, may contribute to chronic paralysis in BEFV-infected downer cattle. [ABSTRACT FROM AUTHOR]

The British Association for Psychopharmacology guidelines specify the scope and targets of treatment for bipolar disorder. The third version is based explicitly on the available evidence and presented, like previous Clinical Practice Guidelines, as recommendations to aid clinical decision making for practitioners: it may also serve as a source of information for patients and carers, and assist audit. The recommendations are presented together with a more detailed review of the corresponding evidence. A consensus meeting, involving experts in bipolar disorder and its treatment, reviewed key areas and considered the strength of evidence and clinical implications. The guidelines were drawn up after extensive feedback from these participants. The best evidence from randomized controlled trials and, where available, observational studies employing quasi-experimental designs was used to evaluate treatment options. The strength of recommendations has been described using the GRADE approach. The guidelines cover the diagnosis of bipolar disorder, clinical management, and strategies for the use of medicines in short-term treatment of episodes, relapse prevention and stopping treatment. The use of medication is integrated with a coherent approach to psychoeducation and behaviour change. [ABSTRACT FROM AUTHOR]

Background/Aims: This study assessed the validity, internal consistency, responsiveness and floor-ceiling effects of the Norwich Patellar Instability (NPI) score for a cohort of conservatively managed people following first-time patellar dislocation (FTPD). Methods: Fifty patients were recruited, providing 130 completed datasets over 12 months. Patient NPI score, Lysholm Knee score, Tegner Level of Activity score and isometric knee extension strength were assessed at baseline, 6 weeks, 6 and 12 months post-injury. Results: There was high convergent validity with a statistically significant correlation between NPI and Lysholm Knee score (p<0.001), Tegner Level of Activity score (p<0.001) and isometric knee extension strength (p<0.002). Principal component analysis revealed the NPI demonstrated good concurrent validity, with four components accounting for 70.4% of the variability. While the NPI demonstrated a floor effect for 13 of the 19 items, no ceiling effect was reported. There was high internal consistency, with a Cronbach a value of 0.93 (95% CI 0.91-0.93). NPI score was responsive to change over the 12-month period, with an effect size of 1.04 from baseline to 12 months post-injury. Conclusions: The NPI can be considered a valid and responsive outcome measure to assess patellar instability symptoms for people conservatively managed following FTPD. The high floor effects reported in this study need further exploration to improve the ability of the NPI to detect people with lower perceived instability symptoms. [ABSTRACT FROM AUTHOR]

Background/Aims: This study assessed the validity, internal consistency, responsiveness and floor-ceiling effects of the Norwich Patellar Instability (NPI) score for a cohort of conservatively managed people following first-time patellar dislocation (FTPD). Methods: Fifty patients were recruited, providing 130 completed datasets over 12 months. Patient NPI score, Lysholm Knee score, Tegner Level of Activity score and isometric knee extension strength were assessed at baseline, 6 weeks, 6 and 12 months post-injury. Results: There was high convergent validity with a statistically significant correlation between NPI and Lysholm Knee score (p<0.001), Tegner Level of Activity score (p<0.001) and isometric knee extension strength (p<0.002). Principal component analysis revealed the NPI demonstrated good concurrent validity, with four components accounting for 70.4% of the variability. While the NPI demonstrated a floor effect for 13 of the 19 items, no ceiling effect was reported. There was high internal consistency, with a Cronbach a value of 0.93 (95% CI 0.91-0.93). NPI score was responsive to change over the 12-month period, with an effect size of 1.04 from baseline to 12 months post-injury. Conclusions: The NPI can be considered a valid and responsive outcome measure to assess patellar instability symptoms for people conservatively managed following FTPD. The high floor effects reported in this study need further exploration to improve the ability of the NPI to detect people with lower perceived instability symptoms. [ABSTRACT FROM AUTHOR]

Background: We aimed to define whether distal vastus medialis (VM) muscle strengthening improves functional outcomes compared to general quadriceps muscle strengthening following first-time patellar dislocation (FTPD).Methods: Fifty patients post-FTPD were randomised to either a general quadriceps exercise or rehabilitation programme (n=25) or a specific-VM exercise and rehabilitation regime (n=25). The primary outcome was the Lysholm knee score, and secondary outcomes included the Tegner Level of Activity score, the Norwich Patellar Instability (NPI) score, and isometric knee extension strength at various knee flexion ranges of motion. Outcomes were assessed at baseline, six weeks, six months and 12months.Results: There were statistically significant differences in functional outcome and activity levels with the Lysholm knee score and Tegner Level of Activity score at 12months in the general quadriceps exercise group compared to the VM group (p=0.05; 95% confidence interval (CI): -14.0 to 0.0/p=0.04; 95% CI: -3.0 to 0.0). This did not reach a clinically important difference. There was no statistically significant difference between the groups for the NPI score and isometric strength at any follow-up interval. The trial experienced substantial participant attrition (52% at 12months).Conclusions: Whilst there was a statistical difference in the Lysholm knee score and Tegner Level of Activity score between general quadriceps and VM exercise groups at 12months, this may not have necessarily been clinically important. This trial highlights that participant recruitment and retention are challenges which should be considered when designing future trials in this population.Level Of Evidence: Therapeutic study, Level I. [ABSTRACT FROM AUTHOR]

Abstract: Background: Injection drug use is a skill learned in social settings. Change the Cycle (CTC), a peer-delivered, one-session intervention, is designed to reduce among people who inject drugs (PIDs) injection initiation-related behaviours (i.e., speaking positively about injecting to non-injectors, injecting in front of non-injectors, explaining or showing a non-injector how to inject) and initiation of non-injectors. We hypothesized that participation in CTC would lead to reductions in initiation-related behaviours six months later. Methods: Using respondent driven sampling (RDS), 98 PIDs were recruited in Toronto, Canada to participate in pilot testing of CTC. The baseline session consisted of a structured interview, the peer-delivered CTC intervention, instructions regarding RDS coupon distribution, and an invitation to return in six months for a follow-up interview. For the 84 PIDs completing the six-month interview, we compared initiation-related behaviours at baseline with six-month follow-up. Results: The proportion of PIDs offering to initiate a non-injector was reduced from 8.4% (95% CI: 2.5, 15.9) at baseline to 1.59% (95% CI: 0.4, 3.7) at 6-month follow-up. The prevalence of speaking positively about injection to non-injectors also decreased significantly. The proportion of PIDs who helped a non-injector with a first injection at baseline was 6.2% (95% CI: 2.1, 11.3) and at follow-up was 3.5% (95% CI: 0.8, 7.1). Paired analyses of initiator baseline versus follow-up data showed a 72.7% reduction in initiation (95%CI: 47.7, 83.1). Conclusions: While further refinements remain to be tested, pilot study results suggest that CTC holds promise as a prevention intervention. [Copyright &y& Elsevier]