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Aim: Early intervention for people diagnosed with bipolar disorder is a priority, but little is known about how recovery from first episode psychotic mania is experienced by this group. This study aimed to explore the experience of recovery from first episode psychotic mania for people diagnosed with bipolar disorder. Methods: Semi‐structured interviews were conducted with 11 young adults during recovery from first episode psychotic mania and were analysed using Interpretative Phenomenological Analysis. Results: Three themes were identified: (i) 'Possession of purpose and staying well', (ii) 'Coping with compromise' and (iii) 'Manic relapse: pressure and proving self'. On becoming well, the participants experienced a sense of purpose through engaging with activities and goals that also drove their efforts to engage in strategies to stay well. However, these strategies created feelings of compromise that not all were prepared to accept. Though having purpose and goals created a positive sense of direction, for a minority of the participants they also created additional pressure, contributing to manic relapse. Conclusions: The purpose created by engaging with aspirations and career‐related activities during early intervention was found to be important for a meaningful recovery from first episode bipolar disorder. This instilled positivity and purpose, motivating efforts to maintain wellness. The feelings of compromise that some participants experienced point to the need for individually tailored interventions. Findings suggest a delicate relationship between the positivity of engaging in goals and the risk of manic relapse during recovery from first episode psychotic mania. [ABSTRACT FROM AUTHOR]

Objectives This article presents a detailed idiographic analysis of patients' experience of first-episode depression. Design This is a qualitative interview study using interpretative phenomenological analysis ( IPA). Methods Semi-structured interviews were carried out with a purposive sample of seven patients presenting to a mental health service in London, UK with symptoms of first-episode major depression. There were four males and three females; mean age was 44 years. Interviews were audio-recorded and subjected to IPA. Results Participants described a significant loss event prior to onset of depression. The depression involved a major diminishing of the life-world with relational, corporeal, and temporal depletion. This depletion was accompanied in each case by occasional extreme emotions, frenzied thoughts, confused sense of self. Conclusions Depression can represent a major existential threat to the sufferer. We discuss how our findings can illuminate the extant literature. The study suggests the value of exploring these existential features in early therapy. Practitioner points Offers a detailed phenomenological analysis of core experiential features of first episode depression: being alone, being empty, life is over., Also reveals an unstable dynamic of major psychological depletion interrupted by emotional and cognitive agitation involving confusion, lack of confidence, and/or trust., Provides rationale and material for intensive exploration of these features in therapy. [ABSTRACT FROM AUTHOR]

Background Patients with free pulmonary regurgitation or mixed pulmonary stenosis and regurgitation and severely dilated right ventricles (RV) show little improvement in ventricular function after pulmonary valve replacement when assessed by traditional echocardiographic markers. We evaluated changes in right and left ventricular (LV) function using speckle tracking echocardiography in patients after SAPIEN transcatheter pulmonary valve (TPV) placement. Methods Echocardiograms were evaluated at baseline, discharge, 1 and 6 months after TPV placement in 24 patients from 4 centers. Speckle tracking measures of function included peak longitudinal strain, strain rate, and early diastolic strain rate. RV fractional area change, tricuspid annular plane systolic excursion, and left ventricular LV ejection fraction were assessed. Routine Doppler and tissue Doppler velocities were measured. Results At baseline, all patients demonstrated moderate to severe pulmonary regurgitation; this improved following TPV placement. No significant changes were detected in conventional measures of RV or LV function at 6 months. RV longitudinal strain (−16.9% vs. −19.6%, P < 0.01), strain rate (−0.87 s−1 vs. −1.16 s−1, P = 0.01), and LV longitudinal strain (−16.2% vs. −18.2%, P = 0.01) improved between baseline and 6 month follow-up. RV early diastolic strain rate, LV longitudinal strain rate and early diastolic strain rate showed no change. Conclusion Improvements in RV longitudinal strain, strain rate, and LV longitudinal strain are seen at 6 months post-TPV. Diastolic function does not appear to change at 6 months. Speckle tracking echocardiography may be more sensitive than traditional measures in detecting changes in systolic function after TPV implantation. [ABSTRACT FROM AUTHOR]

The author discusses the biomedical research or bioscientific research in the U.S. Topics discussed include advancements in biomedical knowledge, factors that contribute to the perpetual growth in biomedical research such as the doubling of the National Institutes of Health (NIH) budget from 1998-2003, and the consequences of continuous growth beliefs on biomedical research such as increase in doctor of philosophy (PhD) awardee.

Objectives Psychotic clients may be difficult to engage in psychological therapy, and many potential participants decline to participate in controlled trials of cognitive behavioural therapy. The aim of this study was to investigate psychotic patients' perspectives regarding therapy. Design The design was qualitative and used thematic analysis to investigate emerging themes. Methods A total of 46 inpatients with psychosis were interviewed about their views on therapy. Interview summaries were submitted to thematic analysis. Results A total of 41% of participants were rated as interested, 36% were rated as not interested and 23% appeared ambivalent, or their interest in therapy was unable to be assessed. Themes related to interest in therapy included the desire to build skills, to address (usually non-psychotic) symptoms and for a therapeutic relationship. Themes related to not wanting therapy included a denial of psychological problems, distrust in the healthcare system and psychologists and low perceived efficacy in therapy. Conclusions A large minority of psychotic patients may be interested in therapy, although mostly not to address psychotic symptoms. Future research on pre-treatment approaches to disconfirm negative perceptions and increase interest in therapy is warranted. Copyright © 2013 John Wiley & Sons, Ltd. Key Practitioner Message The reasons why some patients with psychosis are not interested in receiving psychological therapy may relate to past negative experiences with psychologists, negative perceptions of psychologists as a group and low perceived efficacy of therapy. These barriers may be addressed through interactions with psychotic patients during an admission to a hospital that disconfirms these perceptions and provides a positive alternative experience with a psychologist., Patients who are hospitalized with psychosis may be interested in receiving psychological therapy; however, the reason for this likely will not be to address psychotic symptoms. Rather, the therapist should be willing to work with the patient on a range of other presenting problems., If a patient has a lack of insight into their psychotic symptoms, this does not always negate them from perceiving other psychological problems for which they may desire support in addressing. Thus, therapists should be encouraged to approach all psychotic patients on a ward, even when there is an apparent lack of awareness of their psychotic symptoms., The themes related to patients' perspectives were generated from psychologists' summaries of interviews with patients and not directly from verbatim transcripts. Although this meant that the reasons given for participants being interested or not interested in therapy were interpreted by the psychologist, efforts were made to relate the exact reasons provided by the participants., Eighteen (29%) of the potential participants were not interviewed, usually as a result of their being discharged or transferred prior to arrangement of an interview. This meant we were unable to capture the views of these patients. Discharge prior to being seen by a psychologist is a barrier to engaging a patient in therapy and preventing them falling through the gaps of service provision. [ABSTRACT FROM AUTHOR]

Objectives To evaluate echocardiographic changes after SAPIEN valve implantation in the pulmonary position. Background The feasibility of the SAPIEN transcatheter pulmonary valve ( TPV) has recently been demonstrated. We evaluated changes in pulmonary valve function and the right ventricle after SAPIEN TPV placement. Methods We evaluated echocardiograms at baseline, discharge, 1 and 6 months after TPV placement in 33 patients from 4 centers. Pulmonary insufficiency severity was graded 0-4. TPV peak and mean gradients were measured. Right ventricular ( RV) size and function were quantified using routine measures derived from color, spectral, and tissue Doppler indices and two-dimensional echocardiography. Results At baseline, 94% patients demonstrated pulmonary insufficiency grade 2-4. This decreased to 12% patients at 6 months (P < 0.01). TPV peak (P < 0.01) and mean gradient (P < 0.01) decreased. RV end-diastolic area indexed to body surface area (BSA) (P < 0.01), Tricuspid regurgitation ( TR) gradient (P < 0.01), and the ratio of TR jet area to BSA (P < 0.01) decreased. Tricuspid inflow peak E:A, tissue Doppler imaging ( TDI): septal E' and A', TDI: tricuspid A' improved between baseline and discharge, but trended back to baseline by 6-month follow-up. Tricuspid valve annulus z-score, RV area change, tricuspid annular plane systolic excursion ( TAPSE), RV dP/dt, tricuspid E:E', and TDI: tricuspid annulus E' showed no change. Conclusion Improvements in pulmonary insufficiency and stenosis, RV size, and TR gradient and severity are seen after SAPIEN TPV placement. Selected indices of RV diastolic function improve immediately after TPV implantation, but return to baseline by 6 months. RV systolic function is unchanged. [ABSTRACT FROM AUTHOR]

There are many descriptions in the research literature of the onset of delusions in psychosis: it is still not clear however whether there is one specific pathway to delusions or in fact several, and the role of social difficulties remains controversial. In this research we wished to explore the first person perspective of participants who had developed delusions. Interpretative phenomenological analysis was used to interview and analyse themes from 28 participants. An additional matrix analysis of themes was used to examine the importance of social difficulties in relation to types of onset and diagnoses. Our results suggest 3 types of onset: an eruptive sudden transformation of self or world; a slow progressive onset characterised by interconnected changes in meaning and experience; and onset beginning in childhood experience. Social difficulties were mentioned spontaneously by 17 participants in describing onset and a further 9 discussed social difficulties when explicitly asked. One feature that appears to be present both in the progressive and childhood onset is negative emotion about, and preoccupation with, a difficult interpersonal topic over long periods of time. The descriptions given suggest that certain ideas or images could take hold of a person and become interwoven in his or her thinking and perhaps even begin to influence the way the person experienced the world or self. We suggest that it may be important for therapeutic work with delusions to articulate a narrative of onset. Copyright © 2010 John Wiley & Sons, Ltd. Key Practitioner Message: • Exploring the onset of delusions can lead to useful information about social and emotional difficulties. • Most patients are able to give detailed accounts of onset, though some might only describe social and emotional difficulties if prompted. • Reported changes in experience and/or social difficulties may have occurred for some patients over many years and may even begin in childhood. • There may be a process of mutual influence between extreme negative ideas and experience over years for some patients. [ABSTRACT FROM AUTHOR]

The article focuses on the removal of existing restorations, crowns, and core material to gain access to root canals for non-surgical treatment. It states that the condition and amount of the remaining tooth substance can be evaluated by removing a full coverage restoration. It mentions various methods in removing full coverage restorations which include levering, ultrasonics, and forceps.

The extracellular matrix plays a number of important roles, among them providing structural support and information to cellular structures such as blood vessels imbedded within it. As more complex organisms have evolved, the matrix ability to direct signalling towards the vasculature and remodel in response to signalling from the vasculature has assumed progressively greater importance. This review will focus on the molecules of the extracellular matrix, specifically relating to vessel formation and their ability to signal to the surrounding cells to initiate or terminate processes involved in blood vessel formation. [ABSTRACT FROM AUTHOR]

During an assessment for therapy, one patient on an acute psychiatric ward proved to be extremely difficult to interview. He believed that demons were about to visit him, and this made conversation on the topic near impossible at first. Investigation of his beliefs resulted in him getting angry. At a later date, however, he requested meeting the first author. It was then decided to try out solution-focused therapy. Given this new start, it was then possible to begin systematic assessment of beliefs and emotional state. Over 6 months a fluctuating pattern of change emerged. Follow-up over 2 years suggested maintenance and considerable re-engagement with everyday activities. Beliefs were modified yet he retained notions of possible judgement by demonic forces. Copyright © 2002 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

SummaryIn addition to macromolecular interactions that provide co-stimulation during antigen-presenting cell (APC) and CD4+ T-cell conjugation, covalent chemical events between specialized ligands have been implicated in T-cell co-stimulation. These take the form of transient Schiff base formation between carbonyls and amines expressed on APC and T-cell surfaces. Small Schiff base-forming molecules, such as tucaresol, can substitute for the physiological donor of carbonyl groups and provide co-stimulation to T cells, thereby functioning as orally active immunopotentiatory drugs. The Schiff base co-stimulatory pathway in T cells has been partially characterized in terms of changes in Na+ and K+ transport, and activation of the mitogen activated protein kinase (MAPK) ERK2. In the present study, the effects of Schiff base co-stimulation by tucaresol on the T-cell receptor (TCR)-dependent pathway leading to Ca2+ release were investigated. Schiff base co-stimulation by tucaresol was found to prime for enhanced TCR-dependent phospholipase C-γ phosphorylation, inositol 1,4,5-triphosphate production, and Ca2+ mobilization that correlated with functional enhancement of interleukin-2 production in primary T cells. The effects on Ca2+ occurred comparably in Jurkat and primary CD4+ T cells responding to anti-CD3 monoclonal antibody. Enhancement of the Ca2+ response required a 10-min priming period and was prevented by prior covalent ligation of cell-surface free amino groups by sulpho-N-hydroxy succinimido-biotin; clofilium-mediated inhibition of tucaresol-induced changes in intracellular K+; and selective inhibition of the MAPK pathway. The data are consistent with a priming mechanism in which late co-stimulation-triggered events exert a positive influence on early TCR-triggered events. In additional studies of murine T cells expressing trans-gene TCRs, tucaresol was... [ABSTRACT FROM AUTHOR]

Dual atrioventricular nodal (DAVN) physiology has been reported in up to 63% of pediatric patients with anatomically normal hearts, yet atrioventricular nodal reentrant tachycardia (AVNRT) accounts for only 13%-16% of supraventicular tachycardia (SVT) in childhood. The incidence of AVNRT increases with age and becomes the most common form of SVT by adolescence. We investigated the age related electrophysiological responses to programmed atrial and ventricular stimulation in 14 pediatric patients who underwent intracardiac electrophysiological study prior to radiofrequency catheter ablation for AVNRT and who exhibited DAVN physiology. Single atrial and ventricular extrastimuli were placed following drive trains with cycle lengths of 400-700 ms and 350-500 ms, respectively. Six children (mean age 8.2 years, range 5.2-11.5 years) were compared to eight adolescents (mean age 16.6 years, range 13.3-20.7 years). Adolescents were found to have a significantly longer fast pathway effective refractory period (ERP) (median 375 vs 270 ms, P = 0.03), slow pathway ERP (median 270 vs 218 ms, P = 0.04), atrio-Hisian (AH) during AVNRT (median 300 vs 225 ms, P = 0.007), and AVNRT cycle length (median 350 vs 290ms, P = 0.03). There was a strong trend for the AH measured at the fast pathway ERP to be longer in adolescents than in children (median 258 vs 198 ms, P = 0.055). The AH at the fast pathway ERP was more strongly correlated with baseline cycle length than with age (r = 0.7, P = 0.01 vs r = 0.5, P = 0.7). There was no significant difference in the retrograde VA conduction between adolescents and children. These results demonstrate an age related difference in AV nodal response to programmed atrial stimuli in pediatric patients with DAVN physiology and AVNRT. These differences are consistent with mechanisms that may explain the increased incidence of AVNRT in adolescents compared to children. [ABSTRACT FROM AUTHOR]

This paper presents new evidence and analysis on the effectiveness of regional policy in the United Kingdom in the postwar period. The evidence relates to the movement of manufacturing firms into "development areas" from other regions of the United Kingdom and abroad---and thus provides information on one of the major mechanisms at work in creating employment in these regions of high unemployment. The analysis is designed to estimate the impact of different instruments of regional policy on the number of firms moving into development areas, although a short section examines the employment implications of these moves.
A "move" is defined as the opening in a new location of a new manufacturing establishment, the origin of which is in some other location. This concept of movement is appropriate for purposes of finding out how policy works and for evaluating its effects because a number of instruments of regional policy are specifically aimed at encouraging mobility in the sense in which it is here defined. An example of this is the system of industrial development controls whereby firms considering a factory expansion are required to obtain an Industrial Development Certificate (IDC) if that expansion exceeds a certain minimum limit (in terms of floor space required). The Department of Industry may refuse the IDC authorizing the firm to proceed with plans for expansion, thereby hoping to divert the proposed expansion to a development area. In these circumstances the firm may consider going ahead with the expansion by establishing a new plant in a new location in a development area. In this example the IDC policy would have had a direct effect in inducing a "move" as defined here. [ABSTRACT FROM AUTHOR]

The article discusses methods of controlling stocks and variety within the manufacturing industry, demonstrating how the costs of excessive variety might be identified and calculated within individual firms. While Great Britain's manufacturing industry is in disagreement over both the degree of variety which exists and the degree of variety which should exist, the author notes that the real goal of marketing is to combine the economics of long production runs with a variety in the final product to satisfy the customer. The larger the average production batch size of an individual line the greater the cost of investing in holding stocks will be. Large production batches also mean that each "stock line' needs to be produced more infrequently per year than would be the case with small batch sizes.

The article presents abstracts of papers presented to the Tenth Annual Meeting of the Association for the Psychophysiological Study of Sleep (APSS). APSS for founded in 1961 for the purpose of promoting both formal and informal exchange of information among workers from various disciplines with a common interest in the psychophysiology of sleep.

Background. In recent years several diseases have been shown to have a relationship with smoking. Psoriasis is largely a disease of smokers, whereas acne appears to be associated with not smoking. Methods. One hundred and fifty patients with atopic dermatitis were sent a postal questionnaire on smoking habits and the results were compared with those from matched controls in the local community. Results One hundred and twenty-seven patients (85%) completed the questionnaire. There was no apparent difference in the prevalence of current smokers amongst atopic dermatitis patients compared with controls (odds ratio = 1.1, 95% confidence limits 0.65-1.86, P = 0.8). Conclusions. There was no significant difference between the smoking prevalence of patients with atopic dermatitis and matched controls. [ABSTRACT FROM AUTHOR]

Presents comments from a group of congressmen and national leaders in the United States on whether or not business interests are using their contributions to gain overwhelming influence in Congress. Adequacy of election laws to provide the regulation needed; Consequences of the development of political action committees; Moral issue in political contributions by businessmen. INSETS: Moonlight and Moonshine;Government for the Governing.