Search

Background Previous studies have found high rates of intellectual disabilities (ID) in prison. However, little is understood about prisoners with ID. This study aimed to identify prisoners with ID and compare their characteristics with prisoners without neurodevelopmental disorders with regard to demographic profile, mental health, suicide risk and offences. Method This was a descriptive, cross-sectional study carried out using face-to-face interviews with 240 participants in a London Category C prison. Standardised tools were used to assess prisoners for ID and mental disorder. Results The study identified 18 prisoners as having ID. Participants with ID were less likely to be from a black or minority ethnic background, be over 35 years of age or have any qualifications. They were more likely to have been single, homeless or unemployed before coming into prison. Prisoners with ID were significantly more likely to have mental health problems and 25% had thought about suicide in the last month and 63% had attempted suicide in the past. Prisoners with ID were also more likely to be housed in the vulnerable prisoners' wing and significantly more likely to have committed robbery than other prisoners. Conclusions The findings confirm the presence of significant numbers of people with ID with high levels of mental illness in a male prison. Services across the CJS are required for this group, specifically, there is a need for raised awareness among those working in prison about ID and improved skills to recognise offenders with ID and address major gaps in current healthcare provision in prison. [ABSTRACT FROM AUTHOR]

The passive separation of a binary mixture of spherical particles is accomplished using a laboratory scale quasi-two-dimensional inclined board such that gravity alone drives the flow of the mixture through a static array of obstacles. Experimental results compare well with simulations both qualitatively and quantitatively. An increase in separation is observed for increasing board length, whereas a decrease in separation is observed as the solid fraction (area coverage) of particles increases. The possibility of designing green technology for solid-solid separations by taking advantage of particle properties that aid naturally occurring segregation is demonstrated. A probability-based model is suggested as a way to predict the viability of separation between particle types as a function of particle size and coefficient of restitution. It should be noted that size separation is achieved despite peg spacings that are larger than both particles in a mixture. © 2017 American Institute of Chemical Engineers AIChE J, 63: 3717-3727, 2017 [ABSTRACT FROM AUTHOR]

The Ashkenazi Jewish (AJ) population has an increased risk for a variety of recessive diseases due to historical founder effects and genetic drift. For some, the disease-causing founder mutations have been identified and well-characterized, but for others, further study is necessary. The purpose of this study is to assess the carrier frequencies of 85 pathogenic variants causative of 29 recessive conditions in the AJ population. Up to 3000 AJ individuals were genotyped by Luminex MagPlex®-TAG™ bead array or Agena Bioscience™ MassARRAY assays. We identified seven conditions with carrier frequencies higher than 1 in 100, nine between 1 in 100 and 1 in 200, and four between 1 in 200 and 1 in 500. Variants in nine conditions had a detected carrier rate of less than 1 in 500 or were not identified in approximately 2000 AJ individuals. We assessed the combined AJ carrier frequency for 18 relatively prevalent diseases to be 1 in 6, and the risk of AJ individuals to be a carrier couple for one of these 18 diseases as 1 in 441. We note additional recessive genetic conditions should be considered for AJ carrier screening panels. [ABSTRACT FROM AUTHOR]

Background Previous studies have found high rates of attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD) and intellectual disability (ID) within the criminal justice system (CJS). However, little is understood about prisoners with neurodevelopmental disorders and difficulties (NDD) or their needs. This study aimed to identify prisoners with NDD and compare their characteristics with prisoners without NDD on a range of socio-demographic and social functioning measures. Method This was a descriptive, cross-sectional study carried out using face-to-face interviews with 240 participants in a London Category C prison. Standardised tools were used to assess prisoners for ADHD, ASD and ID. Results The study identified 87 prisoners who screened positive for one or more type of NDD. Participants with NDD were significantly younger and more likely to be single [(odds ratio) OR = 2.1], homeless (OR = 3.4) or unemployed (OR = 2.6) before they came into prison. They also had poorer educational achievements that those without NDD. Over 80% of those with NDD had a previous conviction or imprisonment. Conclusions The findings confirm the presence of significant numbers of people with NDD in a male prison. Services across the CJS are required for this group; specifically, there is a need for raised awareness among those working in the CJS to improve the recognition of offenders with NDD. Services in the community need to work with individuals with NDD who are at risk of offending, targeting those who are homeless, unemployed and have poor employment opportunities. [ABSTRACT FROM AUTHOR]

Background People with intellectual disability ( ID) account for a large proportion of aggressive incidents in secure and forensic psychiatric services. Although the Historical, Clinical, Risk Management 20 ( HCR-20) has good predictive validity in inpatient settings, it does not perform equally in all groups and there is little evidence for its efficacy in those with ID. Method A pseudo-prospective cohort study of the predictive efficacy of the HCR-20 for those with ID ( n = 109) was conducted in a UK secure mental health setting using routinely collected risk data. Performance of the HCR-20 in the ID group was compared with a comparison group of adult inpatients without an ID ( n = 504). Analysis controlled for potential covariates including security level, length of stay, gender and diagnosis. Results The HCR-20 total score was a significant predictor of any aggression and of physical aggression for both groups, although the area under the curve values did not reach the threshold for a large effect size. The clinical subscale performed significantly better in those without an ID compared with those with. The ID group had a greater number of relevant historical and risk management items. The clinicians' summary judgment significantly predicted both types of aggressive outcomes in the ID group, but did not predict either in those without an ID. Conclusions This study demonstrates that, after controlling for a range of potential covariates, the HCR-20 is a significant predictor of inpatient aggression in people with an ID and performs as well as for a comparison group of mentally disordered individuals without ID. The potency of HCR-20 subscales and items varied between the ID and comparison groups suggesting important target areas for improved prediction and risk management interventions in those with ID. [ABSTRACT FROM AUTHOR]

Objective Cytoblocks ( CBs), or cell blocks, provide additional morphological detail and a platform for immunocytochemistry ( ICC) in cytopathology. The Cellient™ system produces CBs in 45 minutes using methanol fixation, compared with traditional CBs, which require overnight formalin fixation. This study compares Cellient and traditional CB methods in terms of cellularity, morphology and immunoreactivity, evaluates the potential to add formalin fixation to the Cellient method for ICC studies and determines the optimal sectioning depth for maximal cellularity in Cellient CBs. Methods One hundred and sixty CBs were prepared from 40 cytology samples (32 malignant, eight benign) using four processing methods: (A) traditional; (B) Cellient (methanol fixation); (C) Cellient using additional formalin fixation for 30 minutes; (D) Cellient using additional formalin fixation for 60 minutes. Haematoxylin and eosin-stained sections were assessed for cellularity and morphology. ICC was assessed on 14 cases with a panel of antibodies. Three additional Cellient samples were serially sectioned to determine the optimal sectioning depth. Scoring was performed by two independent, blinded reviewers. Results For malignant cases, morphology was superior with Cellient relative to traditional CBs ( P < 0.001). Cellularity was comparable across all methods. ICC was excellent in all groups and the addition of formalin at any stage during the Cellient process did not influence the staining quality. Serial sectioning through Cellient CBs showed optimum cellularity at 30-40 μm with at least 27 sections obtainable. Conclusions Cellient CBs provide superior morphology to traditional CBs and, if required, formalin fixation may be added to the Cellient process for ICC. Optimal Cellient CB cellularity is achieved at 30-40 μm, which will impact on the handling of cases in daily practice. [ABSTRACT FROM AUTHOR]

Scabies is an ectoparasitic infestation by the mite Sarcoptes scabiei. Although commonly self-limiting, a fraction of patients develop severely debilitating crusted scabies. The immune mechanisms underlying the development of crusted scabies are unclear, and undertaking longitudinal infection studies in humans is difficult. We utilized a porcine model to compare cellular immune responses in peripheral blood and skin of pigs with different clinical manifestations of scabies ( n = 12), and in uninfected controls ( n = 6). Although clinical symptoms were not evident until at least 4 weeks post-infestation, the numbers of peripheral IFNγ-secreting CD4+ T cells and γδ T cells increased in infected pigs from week 1 post-infestation. γδ T cells remained increased in the blood at week 15 post-infestation. At week 15, skin cell infiltrates from pigs with crusted scabies had significantly higher CD8+ T cell, γδ T cell and IL-17+ cell numbers than those with ordinary scabies. Peripheral IL-17 levels were not increased, suggesting that localized skin IL-17-secreting T cells may play a critical role in the pathogenesis of crusted scabies development. Given the potential of anti- IL-17 immunotherapy demonstrated for other inflammatory skin diseases, this study may provide a novel therapeutic avenue for patients with recurrent crusted scabies. [ABSTRACT FROM AUTHOR]

Background Patient experience of those accessing mental health services has been found to be different between ethnic groups. Although the needs of people with intellectual disabilities (ID) from different ethnic communities are being increasingly recognised, little has been published about their experiences of mental health services. The aim of this study was to establish whether there are any differences in the experiences of people with ID and mental health problems from two ethnic communities in South London. Method A two-round Delphi process was utilised. White British and Black or Black British service users from a specialist community-based mental health service for adults with ID completed a specially compiled questionnaire. Statements on participants' experiences, including satisfaction with care, staff members' attitudes, cultural awareness and level of support, were rated using a Likert scale. Results Twenty-four out of 32 participants (75%) completed both rounds of the Delphi consultation. Consensus (≥80% agreement with the group median) was reached for 20 items in the White group and five items in the Black group. All responses that reached consensus were positive about the services that were being received. The Black group were less positive about a range of their experiences, including the use of medication. Conclusions People with ID from two ethnic groups were able to successfully complete a Delphi consultation regarding their experiences of mental health services. Broad consensus on positive experiences of services was reached in the White group but not for the Black participants. [ABSTRACT FROM AUTHOR]

Aims: Supraphysiologic glucocorticoid activity is well established to cause impaired glucose tolerance and insulin resistance, yet no study has evaluated dose-dependent effects of low-dose prednisone during short-term oral administration. Methods: The objective of this study was to quantify the effects of daily 10 or 25 mg prednisone administration for one week on insulin sensitivity by employing a two-step hyperinsulinemic euglycemic glucose clamp (Step 1: insulin infusion = 20 mU/m2/min; Step 2: insulin infusion = 80 mU/m2/min) in healthy, lean males. The amount of glucose infused at steady-state to maintain stable blood glucose [90 mg/dl (4.95 mmol/l)] was used to calculate several indices of insulin sensitivity. Results: During Step 1 of the clamp, whole body glucose disposal ( M) was reduced by 35% (p = 0.003) and M/ I was reduced by 29% (p = 0.025) for 25 mg prednisone compared to placebo. No appreciable effect of 10 mg prednisone was observed. During Step 2, M was reduced by 33% (p = 0.001) and 15% (p = 0.006) for 25 and 10 mg prednisone compared to placebo; and M/ I ratio was reduced by 31% (p < 0.001) and 13% (p = 0.026), respectively. The insulin sensitivity index, S i, calculated as the quotient of augmentation of M/I between Step 1 and 2, was reduced by 35.3% (p < 0.01) and 23.5% (p < 0.05) for 25 and 10 mg prednisone, respectively. Conclusion: Administration of relatively low pharmacological doses of prednisone for one week impaired insulin sensitivity in a dose-dependent manner in healthy males. These observed changes in insulin sensitivity are likely to be clinically relevant, especially in individuals predisposed to develop glucose intolerance. [ABSTRACT FROM AUTHOR]

Summary. Low levels of serum lipids were reported in subjects chronically infected with the hepatitis C virus (HCV) and correlated with poorer clinical outcomes. Whether HCV 'hypo-lipidemia' is constant across age, sex and race has not been systematically explored. We therefore investigated the association between HCV infection and serum lipid levels in two independent National Health and Nutrition Examination Survey (NHANES) cohorts. HCV antibody status and serum lipid levels were obtained from 14 369 adults from NHANES 1999-2006 and 12 261 from NHANES III (enrolled in 1988-1994). In multivariable models, the prevalence of HCV-associated hypo-low density lipoprotein-cholesterol was highest among women >50 years of age in both NHANES 1999-2006 (OR: 10.51, 95% CI: 2.86, 38.62) and III (OR: 24.21, 95% CI: 6.17, 94.92), but among women <50 years of age, the odds ratios were 3.01 (95% CI: 1.00, 9.04) for NHANES 1999-2006 and 0.52 (95% CI: 0.14, 1.88) for III, respectively. HCV by age interaction among women was significant in both cohorts ( P < 0.001 and P = 0.004, respectively). Among men, the odds ratios of HCV-associated hypo-LDL-cholesterol were 2.74 (95% CI: 1.55, 4.85) in NHANES 1999-2006 and 3.84 (95% CI: 1.66, 8.88) in III, respectively, with no significant age effects. Similar patterns were observed for total-cholesterol, but no significantly discernable patterns for high density lipoprotein-cholesterol and triglycerides. Results show that HCV infection is associated with lower total- and LDL-cholesterol in two US population-based cohorts, and this relationship varies significantly by age and sex, suggesting a possible influence of sex hormones on host lipid response to HCV infection. [ABSTRACT FROM AUTHOR]

The article discusses the findings of a study which determined the effects of dietary variations on placental growth and function in mice. It proposes that fetal growth can be supported through placental adaptations such as increased glucose transport and transporter gene expression resulting from reduced protein during late pregnancy. The experiment confirmed that placentas in mice with lower protein diets were better adapted and had slightly larger endocrine compartment.

This article briefly outlines some of the key problems with the way in which the moral realm has traditionally been understood and analysed. I propose two alternative views of what is morally interesting and applicable to nursing practice and I indicate that instability has its upsides. I begin with a moral tale - a 'Good Samaritan' story - which raises fairly usual questions about the nature of morality but also the more philosophically fundamental question about the relationship between subjectivity and moral agency. I then consider this relationship from the perspectives of two twentieth century philosophers: Emmanuel Levinas and Michel Foucault. Levinas' basic point is that the experience of ethical subjectivity is made possible through others: the demand to respond to the existence of others is the basic social structure that precedes individual freedom. If Levinas posits intersubjectivity as a fundamental or primitive feature of the moral realm, Foucault poses an even more basic question: how have moral subjects and relations of obligation been constituted? The aim of ethical inquiry, for Foucault, is to describe the network of discourses, institutions, relations, and practices through which certain kinds of subjects are constituted and constitute themselves, e.g. as a kind of person who can act morally. Finally, I consider some recent research in philosophy of nursing which illustrates how Levinasian and/or Foucauldian perspectives can deepen understanding of nurses' moral practices, specifically, the work of Norwegian public health nurses, Canadian pediatric nurses, and Irish midwives. I suggest that in spite of the instability of morality in general and the particular ethical challenges that face nurses, there are grounds for hope and possible strategies for living in unstable times. [ABSTRACT FROM AUTHOR]

Accessible summary • This research was about people with learning disabilities who went into hospital when they had mental health problems. • We looked at when they went into ordinary mental health units and also into a special unit for people who also have learning disabilities. • We looked at what their mental health problems were and how long they stayed for. We looked at what types of places they were living in before they went to hospital and where they went to live afterwards. We found some differences in what happened to the people depending on where they stayed. • This research will help to find out where people with learning disabilities who also have mental health problems should be treated if they need to go to hospital. This study aimed to compare the characteristics of service users with intellectual disabilities and mental health problems admitted to either a specialist or a generic inpatient unit in an area of South London. Socio-demographic and clinical characteristics of consecutive admissions over a 5.5-year period were recorded using a questionnaire. Key differences in psychiatric diagnosis, residence type and discharge destination were found between individuals using generic and specialist provision. Length of stay was significantly longer for specialist unit admissions. Admissions to the specialist unit were significantly more likely to reside with family prior to admission and admissions to generic units were significantly more likely to come from ‘other’ forms of residence such as hostels, prison and ‘no fixed abode’. At discharge the proportion of those admitted to the specialist unit who resided with their families reduced. At the same time the proportion of those living in supported accommodation increased although compared with those admitted to generic units they were still significantly more likely to return to the family home. Significantly, more adults admitted to generic units were diagnosed with an affective disorder. Specialist inpatient provision may be crucial in helping mainstream services meet the needs of individuals with intellectual disabilities and mental health problems. [ABSTRACT FROM AUTHOR]

The article presents a study investigating a method for controlling the segregation of granular mixtures in rotating tumblers using time-modulation via selective baffle placement. The usage of simulations and experiments to study bidisperse, cohesionless granular materials in quasi-two-dimensional rotating containers is noted. Results are presented in two configurations, which involve placement of the baffles in an axial orientation and attached to the tumbler's periphery. The axially located baffles are found to be effective in reducing segregation, whereas the baffles attached at the periphery are not.

Background Studies of people with intellectual disability suggest that several individual characteristics and environmental factors are associated with behaviour disorder. To date there are few studies looking at risk factors within specific syndromes and the relationship between early risk markers and later behaviour disorder. The key aim of the study was to determine if childhood risk factors were predictors of severe behaviour disorder in young adults with Down syndrome. Materials and methods A longitudinal cohort study of 50 people with Down syndrome was assessed with the same behavioural measure used in both childhood and adult life. The early risk factors which were assessed included childhood functioning, childhood psychopathology and early family environment as determined by measures of parental mental health, quality of parental marriage and social background. Results Childhood psychopathology and functioning were associated with severe behaviour disorder in adult life whereas childhood family environment was not. Conclusions Children with Down syndrome at risk for severe behaviour disorder in adult life may be identified in childhood and appropriate interventions offered to reduce their risk. [ABSTRACT FROM AUTHOR]

Indices of the monthly post-smolt growth of three maturity groups of Atlantic salmon Salmo salar from the Drammen River in Norway were examined. Scale samples were collected from 1983 to 2003, providing a retrospective growth history for 2854 individuals. Overall post-smolt growth of all three maturity groups decreased throughout the study period. When the post-smolt year was segmented into 8 monthly indices, there was a significant decline in growth during the fourth and fifth month, typically months of maximum growth. The pre-fishery abundance of one and two sea-winter fish from Norway also showed a decline throughout the study period and was positively correlated to the post-smolt growth of fish returning to the Drammen River. Freshwater growth was negatively correlated to the pre-fishery abundance, thus indicating that factors affecting post-smolt growth during the fourth and fifth months at sea may be responsible for declining return numbers in Norway. [ABSTRACT FROM AUTHOR]

Permethrin as a topical acaricide cream is widely used to treat scabies. The neuronal voltage-sensitive sodium channel (Vssc), necessary for the generation of action potentials in excitable cells, is the target of pyrethroid acaricides such as permethrin. Pyrethroid resistance has been linked to specific mutations in the Vssc gene. Following the partial sequencing of the Vssc gene in the scabies mite Sarcoptes scabiei (L.) (Astigmata: Sarcoptidae), we compared Vssc gene sequences from permethrin-sensitive and -tolerant S. scabiei var. canis Gerlach mites, and identified a G to A single nucleotide polymorphism (SNP) in permethrin-tolerant mites resulting in an amino acid change from glycine to aspartic acid in domain III S6. The mutation is in a region of the gene where mutations have been identified in a range of pyrethroid-resistant arthropods. Results of in vitro permethrin exposure assays showed that survival rates for mites bearing the mutation were similar to those previously reported for mites from human subjects where clinical tolerance to permethrin had been observed. A real-time polymerase chain reaction−high-resolution melt (PCR-HRM) assay was developed to detect this SNP. This assay provides a useful methodology for screening for this and other mutations associated with permethrin resistance in scabies mite populations and thus facilitates surveillance for acaricide resistance. [ABSTRACT FROM AUTHOR]

Interaction of water and organic matter (OM) in pores affects the capacity for long-term C sequestration and water retention in soils. This study investigated the effects of the amount and distribution of OM in microstructures on water retention in soil microaggregates. The focus of the study was on the hysteretic soil water characteristic (i.e., the difference between the main drying and wetting curves), which has been largely ignored in previous studies on water-OM relations. The main drying and wetting branches of the water retention curve were measured using a water activity meter on water-stable microaggregates (53-250 μm), which were collected from surface soils (0-15 cm) subject to different management practices: tallgrass prairie restoration on a Mollisol, and tillage with and without N fertilization on an Alfisol. The results show that the presence of OM in <5-μm-diameter pores increases water retention in microaggregates, while management practices that either increased or decreased the abundance of OM-filled pore volume in the microaggregates promoted hysteresis of water retention characteristics due to changes in soil pore structure. Comparison of the drying and wetting curves between intact and combusted (OM removed) microaggregates indicated a strong retention of water by pore-filling OM. This retention suggests that the high water saturation in microaggregates from soils under management practices that increased OM-filled porosity, which also offered physical protection of the OM, may be a positive feedback mechanism that retards OM decomposition in micropores. The water retention data measured on intact and combusted microaggregates were consistent with results from ultra-small-angle x-ray scattering, and indicated that management practices have a great potential for facilitating the synergistic retention of water and organic C in soils. [ABSTRACT FROM AUTHOR]

In this article, we use the exemplar of domestic violence to examine the construction of self online. To do this, a positional approach to language is combined with a Bakhtinian inspired, phenomenological approach to language. Such an approach is designed to capture both the rhetorical and the intoned quality of language. This approach also draws attention to the role of the assumed community in dialogically interrupting and reflexively structuring the construction of self online. From this conceptual perspective, we examine a variety of posted messages to the public bulletin boards of a number of different online support groups for domestic violence. Three interpenetrating analytic themes emerged from this analysis: (1) The construction of self in relation to online support group members; (2) The construction of self in relation to abuser and (3) The construction of self in relation to past self. These themes are explicated over four key extracts. These extracts are also analysed in terms of the insights they offer into the phenomenological, positional and dialogical dimensions of an utterance directed at a community. [ABSTRACT FROM AUTHOR]

Cat's claw creeper, Macfadyena unguis-cati, a major environmental weed in coastal and sub-coastal areas of Queensland and New South Wales, Australia is a target for classical biological control. Host specificity of Hypocosmia pyrochroma Jones (Lep., Pyralidae), as a potential biological control agent was evaluated on the basis of no-choice and choice larval feeding and survival, and adult oviposition preference tests, involving 38 plant species in 10 families. In no-choice tests, larval feeding and development occurred only on cat's claw creeper. In choice tests, oviposition and larval development was evident only on cat's claw creeper. The results support the host-specificity tests conducted in South Africa, and suggest that H. pyrochroma is a highly specific biological control agent that does not pose any risk to non-target plants tested in Australia. This agent has been approved for field release by relevant regulatory authorities in Australia. [ABSTRACT FROM AUTHOR]

An automatic data-collection system has been implemented and installed on seven insertion-device beamlines and a bending-magnet beamline at the ESRF (European Synchrotron Radiation Facility) as part of the SPINE (Structural Proteomics In Europe) development of an automated structure-determination pipeline. The system allows remote interaction with beamline-control systems and automatic sample mounting, alignment, characterization, data collection and processing. Reports of all actions taken are available for inspection via database modules and web services. [ABSTRACT FROM AUTHOR]

A standard sample holder and vial for cryocooled macromolecular crystals has been defined for use with robotic sample changers. This SPINE standard sample holder is a modified version, with added features and specifications, of sample holders in common use. In particular, the SPINE standard meets the precision required for automatic sample exchange and includes a cap that is identified by a two-dimensional datamatrix code as well as an optional vial. At the ESRF, the sample holder standard is in use with the EMBL/ESRF/BM14 robotic sample changer (SC3) which is installed on eight beamlines. The SC3 can hold up to 50 crystals stored in five baskets. A datamatrix reader in the SC3 ensures safe management of the sample flow and facilitates fully automatic screening and characterization of samples. Tools for handling and transporting 50 samples in a dry shipping dewar have been developed. In addition to the SC3, the SPINE sample holder is currently compatible with a number of other robotic sample changers. [ABSTRACT FROM AUTHOR]

In this article, we explore what we perceive to be a gap between agency as articulated in practice theories and agency as personally experienced. The gap is not created by a turn to practice in theorizing, but by the tendency to produce theoretical representations that silence the particularity of experience and the diversity of voices in experience. In exploring the gap, we identify aspects of practice theories that explicitly commit to theoretical representation over personal experience and describe Bakhtin's commitment to action and personal experience as an alternative. In order to exemplify Bakhtin's approach in practice, we then present an analysis of one artist-teacher's experience of her own agency in making art and in teaching. Finally, we comment on what a commitment to representational theorizing does to accounts of an artist's activities and personal experience. [ABSTRACT FROM AUTHOR]

Undulator radiation is the X-ray source of choice for modern macromolecular crystallography beamlines. Here, the basic properties of undulator sources are described and it is indicated why they make such good X-ray sources for macromolecular crystallography. Collection of excellent data from these beamlines is not always straightforward; therefore, a number of rules are postulated for undulator data collection and guidelines are offered which will help to ensure a satisfactory experiment. [ABSTRACT FROM AUTHOR]

: While wintertime vitamin D deficiency has been well-documented in Crohn's disease patients, less is known about vitamin D status during summertime and whether a seasonal variation exists in bone turnover.: To compare vitamin D status and bone turnover markers in Crohn's disease patients with age- and sex-matched controls during late-summer and late-winter.: Crohn's disease patients (n = 44; mean age 36.9 years, currently in remission) and matched controls (n = 44) were recruited from Cork University Hospital and Cork City area, respectively.: Bloods were analysed for 25-hydroxyvitamin D, parathyroid hormone, bone-specific alkaline phosphatase, osteocalcin and urine analysed for N-telopeptides of type 1 collagen.: Serum 25-hydroxyvitamin D concentrations were significantly (P < 0.003) lower in Crohn's disease patients than in control subjects during both seasons. In Crohn's disease patients, serum 25-hydroxyvitamin D concentrations were lower (P < 0.0001) whereas serum parathyroid hormone, osteocalcin and bone-specific alkaline phosphatase and urinary N-telopeptides of type 1 collagen levels were higher (P < 0.001) during late-winter than late-summer.: There were notable seasonal variations in vitamin D status and bone turnover markers in Crohn's disease patients. The impact of winter decline in vitamin D status and increase in bone turnover on long-term risk of osteopenia/osteoporosis in Crohn's disease patients is unclear. [ABSTRACT FROM AUTHOR]

Summary Background : Patients report that the prophylactic consumption of a proton pump inhibitor minimizes gastrointestinal symptoms expected to be provoked by late-night food and alcohol consumption. The efficacy of this practice has not been studied formally. Aim : To perform a randomized, double-blind, placebo-controlled trial of a single dose of lansoprazole (30 mg) taken prior to a large meal and alcohol consumption. Methods : Study subjects were recruited randomly from local primary care and hospital physicians. Each participant (n = 56; 37 male, 19 female; mean age, 38 years) completed questionnaires before and after the meal. Approximately 90 min prior to the provocative meal, participants were witnessed taking either placebo or 30 mg lansoprazole. Bar tokens were dispensed to permit the accurate quantification of alcohol consumption (mean, 15 units). Results : Forty per cent of subjects reported significant reflux symptoms. For the entire group, there was no significant difference between lansoprazole and placebo. Post-prandial reflux was more frequent in those consuming > 15 units of alcohol (13/26, 50%) compared with those consuming < 15 units (7/30, 24%; P < 0.05). In the group who consumed > 15 units of alcohol, lansoprazole was associated with a lower rate of heartburn (5/15, 33%) compared with placebo (8/11, 73%; P < 0.05). Conclusion : A single dose of a proton pump inhibitor prior to indulgence was only associated with reduced heartburn in those consuming > 15 units of alcohol. [ABSTRACT FROM AUTHOR]

Abstract Background There is evidence that the mental health needs of children with disabilities are inadequate. The aim of the present study was to determine the extent of specialist health service use during adolescence by a group of individuals with intellectual disability (ID) and mental health problems. Method The study population consisted of 80 young people with ID, who were examined in childhood and adolescence for psychiatric and behaviour disorder. These young people were interviewed again in early adult life for the presence of psychiatric and behaviour disorder. Evaluation questionnaires were used during the follow-up study to assess service use from adolescence. Results The key finding was that the great majority (64%) of subjects with persistent challenging behaviour from childhood into adult life and those with an established childhood psychiatric disorder received no specialist mental health care. Conclusions The development of mental health services for this vulnerable group with complex psychiatric and behaviour disorders has been poor for a number of reasons, including lack of recognition at the primary care level and insufficient numbers of trained professionals within specialist services. [ABSTRACT FROM AUTHOR]

There is a scarcity of follow-up studies into adult life of psychiatric disorder in young people with intellectual disability. The key aims of the present study were: (1) to determine the outcome of psychopathology present in childhood in individuals with Down's syndrome (DS); and (2) to look at childhood predictors of adult psychiatric disorder. Fifty-two young people with DS were identified from a sample of 193 subjects examined in childhood and adolescence for psychiatric and behaviour disorder. These young adults were interviewed for the presence of psychiatric disorder. No significant relationship was found between childhood mental disorder and psychiatric disorder in adult life for those individuals with DS. Early childhood factors of psychiatric disorder, challenging behaviour and family environment, except social background, did not predict adult psychopathology in young people with DS. Childhood disorder in individuals with DS has a good early prognosis with little evidence of continuity of the disorder into adult life. [ABSTRACT FROM AUTHOR]

Explores the contributions of some contemporary approaches to conceptualizing people's participation in social settings. Development of practice and discursive theories of participation in schooling; Perspective on contemporary social theorizing; Participation in communities of practice; Moments of participation and nonparticipation in practices; Momentary gaps between normative practice and difference; Discussion on positioning theory.

Objectives: Delineation of clinical characteristics affecting the airway in a cohort of craniofacially deformed children. What factors differ between patients requiring and those not requiring surgical airway intervention? What factors predispose to the need for tracheotomy? When can decannulation be expected if tracheotomy is required? What interventions aid decannulation?Study Design: Five-year retrospective chart review at tertiary center.Methods: Two hundred fifty-one patients met the following entry criteria: enrollment in the New York University Institute of Reconstructive and Plastic Surgery's Craniofacial Clinic and admission to Tisch Hospital in Manhattan for surgery from 1990 to 1994. Hospital, clinic, and departmental office records were reviewed. All patients had major craniofacial bony anomalies and underwent administration of general anesthesia at least once.Results: Nearly 20% of all children required tracheotomy (47/251). Craniofacial synostosis patients (Crouzon, Pfeiffer, or Apert syndrome) had the highest rate of tracheotomy (48% [28/59]). Mandibulofacial dysostoses patients (Treacher Collins or Nager syndrome) had the next highest rate (41% [28/59]). Patients with oculo-auriculo-vertebral sequence were less likely to undergo tracheotomy (22% [9/41]). Children with craniosynostosis rarely required a surgical airway, unless there was marked associated facial dysmorphism (1% [1/72]). The duration of cannulation was related to the age at tracheotomy in a bimodal distribution. Generally, tracheotomies required before age 4 years remained for several years, whereas those placed after age 4 were removed after several weeks. The presence of a cleft palate correlated with reduced risk for tracheotomy, but the presence of a ventriculoperitoneal shunt correlated with an increased risk for tracheotomy. Procedures selectively used to improve the airway included midface advancement, mandibular expansion, tonsillectomy and adenoidectomy, uvulopalatopharyngoplasty, anterior tongue reduction, and endoscopic tracheal granuloma excision.Conclusions: The likelihood for surgical airway management is related to specific craniofacial diagnosis. The length of tracheal cannulation is greatest for infants and young children who manifest severe airway compromise, often because of nasal obstruction in combination with other anatomic factors. Early tracheotomy is advocated for these patients to promote optimal growth and development. Choanal atresia is often misdiagnosed in these infants; nasal obstruction is actually secondary to midface retrusion. Staged surgical interventions can allow eventual successful decannulation in nearly all cases of craniofacial syndromes. [ABSTRACT FROM AUTHOR]

Permanent deformation, strain in compression, flow, dimensional stability, reproduction of detail and gypsum compatibility of three commercial tissue conditioners (Coe-Comfort, FITT and Hydro-cast) and one polysulphide base Type I impression material (Coe-flex) were measured according to ADA Specification No. 19. Although the tissue conditioners generally exhibited higher deformations and lower gypsum compatibility than specified by ADA Specification No. 19, the materials can, in all probability, be considered adequate for the present. It would appear that the development of international standards for tissue conditioners and functional impression materials is badly needed. [ABSTRACT FROM AUTHOR]

Impressions of a laboratory model of an edentulous ridge were made with three commercial tissue conditioners (FITT, Hydro-Cast and Coe-Comfort). Combinations of undercut dimensions and tray relief were tested by using three different sized trays with each tissue conditioner. Greater tray relief increased the accuracy of all materials tested; increasing ageing time from 7 to 24 h resulted in little change of accuracy of the stone models poured from the impressions taken. [ABSTRACT FROM AUTHOR]

Four commercially available, battery operated, unipolar electric pulp testers were tested and compared under identical laboratory conditions. The form and duration of the electrical impulses varied considerably between the instruments as did the maximum output voltage. None of the models tested passed constant current values when connected to a range of resistances. [ABSTRACT FROM AUTHOR]

Stimulation of cloned cytotoxic T lymphocytes (CTL) with anti-T-cell receptor (TCR) monoclonal antibody (mAb) in solution resulted in rapid and sustained activation of adhesion to immobilized fibronectin (FN) but did not initiate degranulation. Addition of a second antibody (Ab) to further cross-link the TCR substantially increased the level of adhesion and also activated degranulation, as measured by release of serine esterase, in the presence of immobilized FN but not in its absence. Thus, binding to FN can provide a costimulatory signal to activate degranulation. TCR cross-linking also activated CD8-dependent adhesion to class I, and CD8 provided a costimulatory signal upon binding to class I. However, the requirements for activating adhesion and generating the costimulatory signal differed significantly for FN versus class I ligand, suggesting that these two receptor-ligand systems do not share a common mechanism of action. Co-immobilizing FN and alloantigen resulted in increased serine esterase release in comparison with that stimulated by antigen alone, and required the FN and class I be on the same surface. Peptide and antibody blocking demonstrated that CTL binding to EN, and to vitronectin (VN), was mediated by the αVβ3 vitronectin receptor (VNR). Thus, VNR is activated by a signal from the TCR to mediate adhesion to FN or VN, and delivers a costimulatory signal for degranulation via a different mechanism than costimulation by CD8 binding to class I. [ABSTRACT FROM AUTHOR]