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The safe administration of oil-based depot, and other long-acting intramuscular antipsychotic injections, is an integral and distinct aspect of the role of registered nurse practitioners within mental health nursing. This article provides an evaluation of education and training workshops for inpatient and community nurses at West London Mental Health NHS Trust. There was a significant (p > 0.05) difference in pre- and post-training self-ratings for knowledge, confidence and attitude observed.

Evaporative pads are frequently used for the cooling of greenhouses. However, a drawback of this method is the consumption of freshwater. In this paper it is shown, both theoretically and through a practical example, that effective evaporative cooling can be achieved using seawater in place of fresh water. The advantages and drawbacks of using seawater are discussed more generally. In climates that are both hot and humid, evaporative systems cannot always provide sufficient cooling, with the result that cultivation often has to be halted during the hottest months of the year. To overcome this, we propose a concept in which a desiccant pad is used to dehumidify the air before it enters the evaporative pad. The desiccant pad is supplied with a hygroscopic liquid that is regenerated by the energy of the sun. The performance of this concept has been modelled and the properties of various liquids have been compared. An attractive option is to obtain the liquid from seawater itself, given that seawater contains hygroscopic salts such as magnesium chloride. Preliminary experiments are reported in which magnesium chloride solution has been regenerated beneath a solar simulator.

Filter-based microbiological wastewater treatment systems (such as subsurface flow constructed wetlands, trickling filters and recirculating sand filters) require a thorough understanding of system hydraulics for their correct design and efficient operation. As part of the treatment process, the filter media will gradually become clogged through a combination of solids filtration and retention, biomass production and chemical precipitation. Eventually the media may become so clogged that hydraulic malfunctions ensue, such as untreated wastewater bypassing the system. To achieve good asset lifetime a balance must be struck between these essential treatment mechanisms and the hydraulic deterioration that they cause. For many wastewater filtration systems the exact mechanism of clogging is not obvious, and few specialised techniques have been developed which allow the cause and extent of clogging to be measured in typical systems. The resultant lack of understanding regarding clogging hinders the ability of operators to maintain good hydraulic performance. In this chapter, for the first time, we compare three different families of standard hydraulic measurement techniques and discuss the information that they can provide: hydraulic conductivity measurements; clog matter characterisation and hydrodynamic visualisation. Each method is assessed on its applicability to typical wastewater filtration systems using horizontal subsurface flow constructed wetlands as a case study. Furthermore, several new techniques will be considered which have been specifically developed to allow in situ determination of hydraulic health for subsurface flow constructed wetland wastewater filtration systems. These include in situ constant and falling head permeameter techniques and embeddable magnetic resonance probes. Discussion is given to the ways in which different methods can be combined to gather detailed information about the hydraulics of wastewater filtration systems before exploring methods for condensing heterogeneous hydraulic conductivity survey results (that vary by several orders of magnitude) into a single representative value to describe the overall hydraulic health of the system.

Clogging is a major operational and maintenance issue associated with the use of subsurface flow wetlands for wastewater treatment, and can ultimately limit the lifetime of the system. This review considers over two decades of accumulated knowledge regarding clogging in both vertical and horizontal subsurface flow treatment wetlands. The various physical, chemical and biological factors responsible for clogging are identified and discussed. The occurrence of clogging is placed into the context of various design and operational parameters such as wastewater characteristics, upstream treatment processes, intermittent or continuous operation, influent distribution, and media type. This information is then used to describe how clogging develops within, and subsequently impacts, common variants of subsurface flow treatment wetland typically used in the U.S., U.K., France and Germany. Comparison of these systems emphasized that both hydraulic loading rate and solids loading rate need to be considered when designing systems to operate robustly, i.e. hydraulic overloading makes horizontal-flow tertiary treatment systems in the U.K. more susceptible to clogging problems than vertical-flow primary treatment systems in France. Future research should focus on elucidating the underlying mechanisms of clogging as they relate to the design, operation, and maintenance of subsurface flow treatment wetlands.

A Finite Element Analysis (FEA) model is used to explore the relationship between clogging and hydraulics that occurs in Horizontal Subsurface Flow Treatment Wetlands (HSSF TWs) in the United Kingdom (UK). Clogging is assumed to be caused by particle transport and an existing single collector efficiency model is implemented to describe this behaviour. The flow model was validated against HSSF TW survey results obtained from the literature. The model successfully simulated the influence of overland flow on hydrodynamics, and the interaction between vertical flow through the low permeability surface layer and the horizontal flow of the saturated water table. The clogging model described the development of clogging within the system but under-predicted the extent of clogging which occurred over 15 years. This is because important clogging mechanisms were not considered by the model, such as biomass growth and vegetation establishment. The model showed the usefulness of FEA for linking hydraulic and clogging phenomenon in HSSF TWs and could be extended to include treatment processes.

We report the clinical and MRI findings of symmetric hyperintensity involving the deep and subcortical white matter of the frontal lobes in a neurologically normal child with macrocephaly. In this patient, a serum test for mutations in glial fibrillary acidic protein, used to diagnose Alexander's disease (AD), was positive. This case indicates an extraordinarily mild or early form of juvenile-onset AD.

WISH TO CONSIDER A PARTICULAR TEXTUAL and structural problem in King Lear, concerning an event that happens offstage, out of the audience's sight or hearing, and yet upon which the whole outcome of the play depends. As everyone knows, in Act 1 King Lear's favorite daughter Cordelia is suddenly disowned by her father, scorned and dismissed by her sisters, and deprived of any claim to British land or power. Then, just as suddenly, her fortunes are reversed: she is taken to wife by a noble and loving man, is thereby made queen of the great country of France, and is forthwith moved safely away from her father's wrath and her sisters' malice. Why then should she return so soon, almost instantly, to her native country, now alien and hostile to her, only to lose everything, including her life? The tragic genre requires it, of course; she must return in order to die and in order for her death to overwhelm Lear. History also required it: in all of Shakespeare's apparent sources she returns-though more happily, restoring Lear to his throne for several years and then succeeding him. In Shakespeare's play, however, her personal motive for this most crucial of decisions is anything but clear. Like much else in the play, it happens offstage and can be understood, if at all, only from occasional passing hints. Even to attempt to comprehend it, as many critics have done, raises basic critical questions: Should we be able to understand her action? If so, does Shakespeare give us the means to do so? If he does not, why does his play differ so radically from all of his sources, where the motive for the French invasion is always made perfectly explicit? If audiences watching a performance do not much worry about such questions, should anyone else? Is our critical attention to such offstage events mere perversity, an attempt to play omniscient author and convert a dramatic action into a novelistic fiction? Or can it tell us anything of Shakespeare's dramatic art, about his intentions and his degree of success in realizing them? There is in the sources no mystery about the motive or circumstances of the French invasion. In Geoffrey of Monmouth's twelfth-century History of the Kings of Britain, which is the origin of the Lear story and source of all later versions, after Lear has been forcibly bereft by Albania and Cornwall of the half of his kingdom he had retained, he goes to Gaul and asks Cordeilla and the king of the Franks to help him recover his dominions. They do so out of sympathy. This is essentially the series of events in Holinshed's Historie of England, John Higgins's Mirourfor Magistrates, Spenser's Faerie Queene, and William Warner's Albion's England. In the anonymous play The History of King Leir, Leir's complaint is graver-after he has dispossessed himself, two daughters order him murdered-but here, as in all of the other sources, righteous moral outrage on the part of Cordelia and France motivates an armed invasion to restore Lear to his throne.1