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Background: Widespread use of automated sensitive assays for thyroid hormones and thyroid-stimulating hormone (TSH) has increased identification of mild thyroid dysfunction, especially in elderly patients. The clinical significance of this dysfunction, however, remains uncertain, and associations with cognitive impairment, depression, and anxiety are unconfirmed. Objective: To determine the association between mild thyroid dysfunction and cognition, depression, and anxiety in elderly persons. Design: Cross-sectional study. Associations were explored through mixed-model analyses. Setting: Primary care practices in central England. Patients: 5865 patients 65 years of age or older with no known thyroid disease who were recruited from primary care registers. Measurements: Serum TSH and free thyroxine ([T.sub.4]) were measured. Depression and anxiety were assessed by using the Hospital Anxiety and Depression Scale (HADS), and cognitive functioning was established by using the Middlesex Elderly Assessment of Mental State and the Folstein Mini-Mental State Examination. Comorbid conditions, medication use, and sociodemographic profiles were recorded. Results: 295 patients met the criteria for subclinical thyroid dysfunction (127 were hyperthyroid, and 168 were hypothyroid). After confounding variables were controlled for, statistically significant associations were seen between anxiety (HADS score) and TSH level (P = 0.013) and between cognition and both TSH and free [T.sub.4] levels. The magnitude of these associations lacked clinical relevance: A 50-mlU/L increase in the TSH level was associated with a 1-point reduction in the HADS anxiety score, and a 1-point increase in the Mini-Mental State Examination score was associated with an increase of 50 mlU/L in the TSH level or 25 pmol/L in the free [T.sub.4] level. Limitations: Because of the low participation rate, low prevalence of subclinical thyroid dysfunction, and other unidentified recruitment biases, participants may not be representative of the elderly population. Conclusions: After the confounding effects of comorbid conditions and use of medication were controlled for, subclinical thyroid dysfunction was not associated with depression, anxiety, or cognition.

Abstract:This essay examines Dada in its performative and theatrical form as practised in Zurich from 1916 by Cabaret Voltaire and subsequently by Tristan Tzara in post-war Paris from 1920. Amongst Cabaret Voltaire personnel, Hugo Ball's 'sound poetry' performances and Richard Huelsenbeck's political variation of Dada in Berlin are also considered, alongside the influence of F. T. Marinetti and Futurism on Dada in its early phases. Tzara's 'Dada Manifesto 1918' is analysed as an exercise in non-determination of Dada as a coherent movement, even as it functioned as a calculated piece of self-promotion. As Tzara took Dada to Paris, his association with André Breton and Francis Picabia is traced through notable Dada 'manifestations' and selected publications, with the legacy of Alfred Jarry's Ubu Roi commemorated by both Tzara and Breton. Dada was a short-lived sensation in the Parisian avant-garde; the fracturing of the collaboration between Tzara and Breton is detailed in the mock-trial of Maurice Barrès and the disastrous second performance of Tzara's The Gas Heart in 1923. Breton's subsequent ‘Manifesto of Surrealism‘ of 1924 has often been seen to override Dada, with Breton's tight definition and policing of the movement demonstrating very different priorities from Tzara's. In conclusion, Antonin Artaud is considered as a proponent of surrealism in theatre with The Spurt of Blood (1925), and it is suggested that a combination of Artaud's and Tzara's versions of Dada still speaks to and influences many forms of contemporary performance.

Improved diagnostic accuracy is important in dyspepsia EDITOR--Delaney et al's trial of Helicobacter pylori testing and endoscopy for dyspepsia in primary care surely misses the point of medical consultations for [...]

Obtaining individual consent may hinder studies EDITOR--The editorial by Al-Shahi and Warlow is timely and well argued.[1] The implications of a strict requirement for written consent from patients in observational [...]

Although over 90% of patient contacts within the NHS occur in primary care, many of the interventions used in this setting remain unproved.[1] The relevance of research undertaken in secondary [...]

Abstract Objective To identify and qualitatively synthesise the findings from all studies that have examined the performance and effect of near patient tests in the primary care setting. Design Systematic [...]

Focuses on the growing number of minibars in United States hotel rooms. Use of outside companies, including Minibar Systems, Room Systems International, and Bartech, to manage minibars; Computerization of the honor bar system, in an effort to prevent theft; Best-selling items commonly stocked in minbars, including water, candy, and beer.

There are times when watching the news becomes an act of faith. I know what's coming: the violence in Iraq, the tensions between the Israelis and Palestinians, the suffering in [...]

Reports on the large number of toy guns that are found in the offices of high-technology firms that are used in office play. How toy guns are used in the office environment; Why many companies are reluctant to confirm or deny reports of interoffice warfare; Problems that some employees have with the toy guns.

How much I appreciated Cathy Cavanaugh's article 'The Evolving Online Landscape' (April 2010). As our school district has studied online learning opportunities both for students and staff over the past [...]

This book offers a basic introduction to foundations for Catholic moral theology and presents a discernment process for making moral decisions. The author also highlights the critical nature of the [...]

Editor's note: Travel Weekly received several letters and e-mails from travel agents protesting Princess Cruises' selection of media mogul and convicted felon Martha Stewart as godmother of the line's newest […]

The article focuses on closed system of colonics in which differs from the Open System by having a therapist present during the whole procedure and also mentions how the bladder is emptied. Topics discussed include use of inlet hose to bring the filtered water into the colon and outlet hose to remove waste, how water is introduced into the colon which encourages peristalsis, and systems including digestive system, lymphatic system and nervous system to be taken care.

Several letters to the editor are presented in response to articles in previous issues including one on the gardens in central Canada, one on a plant blooming in Southwestern Ontario in Canada, and one on the irrigation of very large spruce trees.

EDITOR--Thornley and Adams surveyed the content and quality of trials relating to the care of those with schizophrenia.[1] They found that studies were of short duration (only 19% with six [...]

Bread-machine yeast is a specially-designed strain of yeast that is more porous and finely-granulated than active dry yeast. Baking soda and baking powder are used in producing tiny bubbles of carbon dioxide, which cause baked goods to rise.

The healthcare establishment generally ignores mundane important issues, preferring to consider popular (sexy) topics. Who wants to assess the cost effectiveness of different management strategies for sprained ankles when you [...]

In rodents 5-hydroxytryptamine type 7 (5-HT(7)) receptor blockade has been shown to be effective in models of depression and to increase the latency to rapid eye movement (REM) sleep and decrease REM duration. In the clinic, the REM sleep reduction observed with many antidepressants may serve as a biomarker. We report here the preclinical and clinical evaluation of a 5-HT(7) receptor antagonist, (3-(4-chlorophenyl)-1,4,5,6,7,8-hexahydro-1-(phenylmethyl)pyrazolo[3,4-d]azepine 2-hydroxy-1,2,3-propanetricarboxylate) (JNJ-18038683). In rodents, JNJ-18038683 increased the latency to REM sleep and decreased REM duration, and this effect was maintained after repeated administration for 7 days. The compound was effective in the mouse tail suspension test. JNJ-18038683 enhanced serotonin transmission, antidepressant-like behavior, and REM sleep suppression induced by citalopram in rodents. In healthy human volunteers JNJ-18038683 prolonged REM latency and reduced REM sleep duration, demonstrating that the effect of 5-HT(7) blockade on REM sleep translated from rodents to humans. Like in rats, JNJ-18038683 enhanced REM sleep suppression induced by citalopram in humans, although a drug-drug interaction could not be ruled out. In a double-blind, active, and placebo-controlled clinical trial in 225 patients suffering from major depressive disorder, neither treatment with pharmacologically active doses of JNJ-18038683 or escitalopram separated from placebo, indicating a failed study lacking assay sensitivity. Post hoc analyses using an enrichment window strategy, where all the efficacy data from sites with an implausible high placebo response [placebo group Montgomery-Åsberg Depression Rating Scale (MADRS) < = 12] and from sites with no placebo response (MADRS > = 28) are removed, there was a clinically meaningful difference between JNJ-18038683 and placebo. Further clinical studies are required to characterize the potential antidepressant efficacy of JNJ-18038683.

AbstractThe growing emphasis on sustainability in school curricula in Australia reflects international trends in education. Teacher education is a vital strategy for the incorporation of Education for Sustainability (EfS) in school curricula. Research to identify drivers and barriers to embedding EfS across a primary teacher education program in an Australian university is the focus of this article. Using a mixed methods approach, data were gathered through document and unit outline audits, a self-efficacy pre-service teacher (PST) survey, and staff and PST focus group interviews. The audits identified a foundation of EfS principles and content across units. Lecturers identified societal and personal drivers and blockers to embedding EfS across the course, with lack of time considered the biggest blocker, which is also consistent with existing school-based research on the nature of teachers' work. PST responses described successful learning outcomes; however, confidence towards teaching sustainability varied. PST reported that the incorporation of community networks in their course provided enriching experiences. Embedding EfS involves values, sustainability concerns and appropriate knowledge and skills. Successful implementation will depend on the development of appropriate understandings of teacher educators.

Insomnia is a major cause of distress due to fatigue and poor daytime performance. In our Drug review the authors discuss how to distinguish insomnia from other sleep disorders and the available treatment options and their properties, followed by an analysis of prescription data. Copyright © 2011 Wiley Interface Ltd

The article offers information related to fiddle music and fiddlers in Cape Breton Island, New South Wales. It states that Cape Breton fiddle music has retained its age-old functional kinship along with the social dancing, its propulsive momentum and rock-steady tempos, and its powerful rhythmic drive. It emphasizes the innovation and experimentation done by fiddlers including Cape Breton fiddle queen Natalie MacMaster, artist Kimberley Fraser, and fiddler Colin Grant. INSETS: GLENN GRAHAM;NATALIE MACMASTER.

The genetic basis of many common, multi-factorial conditions is increasingly being understood but use of the knowledge created, raises major dilemmas for primary care. Identification of individuals that may be genetically predisposed to serious medical conditions provides the opportunity to offer screening or prophylactic treatment, for early detection or prevention and delay in disease onset in many complex conditions. We describe a new pilot service development to introduce genetic risk assessment for a wide range of conditions to primary care, and discuss the findings from its evaluation. The evaluation highlighted the issues about the incorporation of genetic risk assessment in primary care. The results of the evaluation along with findings from other studies, juxtaposed with the implications of developments in genetics suggest that changes are required to accommodate the integration of genetic risk assessment into primary care clinical practice. We discuss what these changes are, the benefits and drawbacks, and whether primary care can and is ready to make the changes required, further shifting the focus from disease treatment to disease prevention.

There has been an upsurge in interest in treatments for sleep disorders recently, as new discoveries in the physiology of sleep-related brain neurotransmitter systems have been made. New targets for therapies have been identified in the field of insomnia, and these will be described in this article.

Sleep has restorative qualities and can negatively affect quality of life if disordered. Sue Wilson discusses the importance of maximizing the chances of a good sleep for the resident in care and those providing the care.

Links between sleep and depression are strong. About three quarters of depressed patients have insomnia symptoms, and hypersomnia is present in about 40% of young depressed adults and 10% of older patients, with a preponderance in females. The symptoms cause huge distress, have a major impact on quality of life, and are a strong risk factor for suicide. As well as the subjective experience of sleep symptoms, there are well-documented changes in objective sleep architecture in depression. Mechanisms of sleep regulation and how they might be disturbed in depression are discussed. The sleep symptoms are often unresolved by treatment, and confer a greater risk of relapse and recurrence. Epidemiological studies have pointed out that insomnia in nondepressed subjects is a risk factor for later development of depression. There is therefore a need for more successful management of sleep disturbance in depression, in order to improve quality of life in these patients and reduce an important factor in depressive relapse and recurrence.

Six patients seeking treatment for chronic insomnia participated in two focus groups as a first stage of questionnaire design. Despite the low attendance at the groups, the results are presented because they offer an illuminating insight into the experience of insomnia.The participants reported major disruption to their daytime activities, especially in terms of safety and reliability, which could affect their life choices and, they believed, could affect their health. They did not feel understood by others, especially doctors, and wanted better information about insomnia and its management. The study also highlighted practical problems involved in running focus groups as well as ethical considerations that arise when conducting research with current patients. These issues are discussed along with the implications of the research, which raise questions about the role of sleep in maintaining lifestyle balance.Further research with a larger and more varied group is recommended in order to consolidate the findings and it is suggested that further reflection is necessary to determine the extent to which sleep is a legitimate concern for occupational therapists.

The tiredness and poor performance associated with insomnia have a considerable impact on quality of life. Our Drug Review considers when drug treatments are justified and which are preferred, followed by sources of further information and a review of prescription data. Copyright © 2008 Wiley Interface Ltd

OBJECTIVE: To determine the cost effectiveness of Helicobacter pylori "test and treat" compared with empirical acid suppression in the initial management of patients with dyspepsia in primary care. Design Randomised controlled trial. Setting 80 general practices in the United Kingdom. Participants 699 patients aged 18-65 who presented to their general practitioner with epigastric pain, heartburn, or both without "alarm symptoms" for malignancy. Intervention H pylori 13C urea breath test plus one week of eradication treatment if positive or proton pump inhibitor alone; subsequent management at general practitioner’s discretion. MAIN OUTCOME MEASURES: Cost effectiveness in cost per quality adjusted life year (QALY) (EQ-5D) and effect on dyspeptic symptoms at one year measured with short form Leeds dyspepsia questionnaire. RESULTS: 343 patients were randomised to testing for H pylori, and 100 were positive. The successful eradication rate was 78%. 356 patients received proton pump inhibitor for 28 days. At 12 months no significant differences existed between the two groups in QALYs, costs, or dyspeptic symptoms. Minor reductions in costly resource use over the year in the test and treat group "paid back" the initial cost of the intervention. CONCLUSIONS: Test and treat and acid suppression are equally cost effective in the initial management of dyspepsia. Empirical acid suppression is an appropriate initial strategy. As costs are similar overall, general practitioners should discuss with patients at which point to consider H pylori testing. Trial registration Current Controlled Trials ISRCTN87644265.

An interest in the nonpharmacological management of chronic insomnia led to the establishment of a treatment group in which occupational therapists have been involved. The outcome data from seven groups are presented. Sleep diaries indicate a modest improvement in total sleep time, with further improvement at 3-month follow-up. Participant feedback shows that people with insomnia value expert advice and support as well as meeting others with similar problems. Additional research and evaluation are planned, but these findings suggest that the programme should be developed further. It is argued that the management of insomnia is an appropriate area of concern for occupational therapists.