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Contains fulltext : 237261.pdf (Publisher’s version ) (Closed access) Adherence to national and international clinical practice guidelines is suboptimal throughout Europe. The European Association of Urology Guidelines Office project "IMAGINE" (IMpact Assessment of Guidelines Implementation and Education) has been developed to measure baseline adherence to urological guideline recommendations across Europe and to identify issues that drive nonadherence.

Pediatric cholesteatoma occurs in one of two forms: congenital cholesteatoma, developing from embryonic epidermal cell rests or acquired cholesteatoma, associated with a focal defect in the tympanic membrane. This disease has been traditionally managed with the operating microscope, often requiring mastoidectomy for adequate visualization of and access to the middle ear and mastoid cavities. Recently, advances in endoscopic equipment have enabled otologists to manage most cases of pediatric cholesteatoma via a minimally-invasive, transcanal endoscopic approach. This review discusses the current literature relating to the etiopathogenesis, assessment and endoscopic management of pediatric cholesteatoma. Early outcomes of endoscopic treatment, emerging trends and technologies are also reviewed. Keywords: Cholesteatoma, Pediatric, Endoscopic, Minimally-invasive, Middle ear, Mastoid

Long-term hemodialysis (HD) imposes a significant burden on the quality of life of end-stage kidney disease patients. Optimizing dialysis dose is an important consideration in this population; however, evidence exists that suggests that attainment of population dialysis targets is associated with increased intradialytic complications. In this prospective, before-after study, the blood flow rate (BFR) of 63 maintenance HD patients was increased by 100 mL/min to a maximum BFR of 400 mL/min to determine the impact on patient tolerability and urea reduction ratio (URR) of an increased BFR. Tolerability was assessed by time to recovery (TTR) after dialysis, a validated measure of patient tolerability, and intradialytic complications. Median pre-increase BFR was 252 mL/min compared to 349 mL/min post-increase. Mean TTR decreased from 4.67 h to 4.03 h (P = 0.688). No association was observed between percentage change in BFR (R2 = 0.0) or post-increase BFR (R2 = 0.0) and absolute change in TTR. A significant, positive association was observed between both the absolute and relative changes to BFR and the achieved URR. We found no evidence that increasing BFR by 100 mL/min diminishes patient tolerability.

The lack of pan-European guidelines for empowering children of parents with mental illness led to the EU project CAMILLE - Empowerment of Children and Adolescents of Mentally Ill Parents through Training of Professionals working with children and adolescents. The aim of this initial task in the project was to analyse needs, expectations and consequences for children with respect to living with a parent with mental illness from the perspective of professionals and family members. This qualitative research was conducted in England, Finland, Germany, Italy, Norway, Poland and Scotland with 96 professionals, parents with mental illness, adult children and partners of parents with mental illness. A framework analysis method was used. Results of the study highlighted that the main consequences described for children of parental mental illness were role reversal; emotional and behavioural problems; lack of parent's attention and stigma. The main needs of these children were described as emotional support, security and multidisciplinary help. Implications for practice are that professionals working with parents with mental illness should be aware of the specific consequences for the children and encourage parents in their parental role; multi-agency collaboration is necessary; schools should provide counselling and prevent stigma.

A training package (pre-tested in a pilot phase) about supporting children who have parents with a mental illness and/or with substance misuse (COPMI) was developed and delivered to 131 different professionals from six different European Countries. A questionnaire about importance, awareness and competence on the issue (8 items on knowledge and 15 items on skills) was developed and completed by participants before and after the training. The training was evaluated by participants as generally very successful in terms of improving the importance, awareness and competence of their knowledge and skills, with a statistically significant difference in the pre-/post-analyses (no decreases occurred). Different professional groups performed differently in the pre-training self-rating scores. The participants in some countries were mainly drawn from one professional group (i.e. teachers in Finland, social workers in Germany and psychologists in Poland). It was found that stigma was considered an extremely important concern even before the training, whilst country-specific legal issues were not taken into proper account in the training. Some possibilities for further refinement of the training programme are suggested.

Purpose – This paper is about a single case study of a three-year BSc Mental Health Nursing degree programme based at a London University. The purpose of the paper is to evaluate the extent to which the programme sufficiently addresses the ten quality criteria developed by the “PROMISE” (2009) Mental Health Promotion Project. PROMISE (2009) is a European public health project funded by the European Commission and was conducted from 2009 to 2012. Its aim was the European-wide development of criteria and training guidelines in mental health promotion and recommended these should be integrated into the professional training curricula of nurses, psychiatrists, psychologists and social workers. Design/methodology/approach – A content analysis method (Bryman, 2012) was used for this case study. This method allowed for a line-by-line scrutiny of the contents of the curriculum for evidence of the ten PROMISE quality criteria for mental health promotion (PROMISE project; http://promise-mental-health.com/training-guidelines.html). Findings – The findings revealed that the PROMISE (2009) project was not one of the four key documents stated as forming the basis for the design of the curriculum content. However, the study found evidence of the curriculum addressing the first PROMISE criterion of embracing the principles of mental health promotion in seven of the 14 modules (50 per cent) in the programme. In the first year of the programme five of the ten PROMISE quality criteria were embedded in two of the four modules. In year 2, quality criteria 1, 4 and 7 were addressed in the course content of four of the five modules (see Table I). In the final year of the programme PROMISE quality criteria 1, 2, 4 and 8 were embedded in the syllabus and assessment strategy in two out of the five final year modules. It was also found that quality criteria 2 and 9 were not included in any of the modules in the programme. Research limitations/implications – This is a case study based on the content analysis of a single curriculum document in a London University. It is therefore not possible to make wide generalisation of its findings across the countries involved in the EU Promise project. However, it could be argued that it is possible to find a number of the key findings present in other UK University programmes that may be similar in structure to that selected for this study. The other limitation to this content analysis is that the evaluation process did not include accounts of the students’ experience on the programme. This could have contributed significantly to the outcome of the evaluation exercise. Although the methodology used is simple, practical and relatively sound, it is not necessarily rigorous in terms of quantitative research methodology but arguably an acceptable contribution to the spectrum within qualitative research paradigm. Practical implications – The emergence of the “PROMISE” criteria especially on a European-wide basis puts emphasis on the importance of mental health promotion in the training of health care professionals. This is expected to be achieved by the training institutions in the European Union. In the UK, this notion is well embraced in various health policy documents (e.g. “No Health Without Mental Health” DH 2011). In the case of the programme examined at one London University, work is required to ensure that a pervasive incorporation of mental health promotion strategies in the curriculum in order to help the students to become better equipped to understand and effectively apply the mental health promotion criteria in their work upon qualification. Originality/value – This is one of the first papers to address the “PROMISE” project and the issue of incorporating mental health promotion criteria in a pre-registration mental health pathway training programme in a university in the UK.

This paper draws on findings from a European project ‘Rights through alliances: Innovating and networking both within homes and schools’ (RAINBOW-HAS) conducted 2013-2015. It built collaboration between six European Union countries to analyse and improve the rights of children and youth regarding sexual orientation and gender identity in educational settings. The main focus of discussion derives from a secondary discourse analysis following thematic analyses of the qualitative interviews undertaken with a range of different families, schools and community associations across these European countries, which provide a snapshot of contemporary practice. We discuss the relative silence of social work in challenging homophobic and transphobic bullying, given their potential in promoting family and young people’s engagement.

BACKGROUND Separate studies indicate that endothelial perturbation, as demonstrated by abnormal endothelial progenitor cells (EPCs), circulating endothelial cells (CECs), and plasma markers such as von Willebrand factor (vWf) and soluble E selectin (sEsel) are present in cancer. However, there are no reports where these indices are compared. Accordingly, we hypothesized altered EPCs and CECs in prostate cancer that would correlate with vWf, sEsel, and prostate specific antigen (PSA). METHODS We recruited 29 men with biopsy proven prostate cancer, with 25 with benign prostate disease and 27 free of prostate disease. CECs were defined on flow cytometry as being CD34+, CD146+, CD45−, and CD309−, EPCs were similarly defined as being CD34+, CD309+, CD45−, and CD146−. vWf, sEsel, and PSA were measured by immunoassay. RESULTS Despite higher PSA, sE-sel, and vWf in prostate cancer (all P 0.48, P

The article will outline the logic, parameters, and methodology of an attempt at mainstreaming ethnicity within EMILIA, an EU 6th FP multi-sites project focused on mental health and social inclusion over two years. Led by two social work researchers within a large multi-disciplinary group consisting of eight sites spread across Southern, Central and Northern Europe, alongside mainstreaming gender, we will look at the findings of the baseline audit, the ensuing action plans and the changes which followed. Examining the process and its outcomes for mainstreaming across the different sites and the services they provide for people experiencing mental health problems highlights the impact of country-specific policies on disclosure of information pertaining to ethnicity as well as country and site policies and practices pertaining to recognising the existence of ethnic inequality and tackling it. Issues underlying formal mainstreaming staff and users' training will be explored. The role of social work within a ...

In 2005 the alcohol in-patient ward at South London and Maudsley NHS Foundation Trust participated in a 2-day training programme designed to reduce levels of burn-out amongst staff. The training intervention was derived from a large-scale project that focused on in-patient and community mental health staff in five European countries. A research component was built into the work, with levels of staff burn-out being measured prior to the training intervention and 1 month afterwards, using the Maslach Burn-out Inventory (MBI). The team were able to identify four sources of stress at work. A 1-month follow-up using the MBI showed that levels of emotional exhaustion and depersonalization had been reduced and feelings of personal accomplishment at work risen. Staff identified four main sources of stress at work. These were: (i) group-work; (ii) dealing with complex clients; (iii) effectively evaluating the shift; and (iv) client aggression. The implications of whole team training is discussed in the context of ...

Abnormalities in coagulation/platelet activation and angiogenesis are present in all common human cancers. We hypothesized that surgical treatment of prostate cancer would modulate these abnormalities.Forty-two men with biopsy-proven prostate cancer were recruited of whom 24 had radical prostatectomy (RP), 12 other treatments and 6 had no treatment. RP patients were followed up from baseline, and samples were collected at 3- and 12-month intervals to assess the effects of the surgery. Plasma was obtained for the measurement of markers of vascular/coagulation/platelet activation (von Willebrand factor (vWf), soluble P selectin (sPsel) (all ELISA), fibrinogen and D-dimer (both nephelometry)) and angiogenesis (vascular endothelial growth factor (VEGF), angiopoietin-1 (Ang-1), angiopoietin-2 (Ang-2) and their receptors s-Flt-1 and s-Tie-2). We also measured the angiogenesis markers VEGF and angiopoietin-1 within platelets (all ELISA).In those undergoing RP, there were changes in plasma VEGF (to 48% of pre-surgery levels at 1 year follow up), Ang-1 (to 82%), Ang-2 (to 27%), sPsel (78%), and fibrinogen (to 91%) at 3 months and/or 12 months (p0.03). The relative falls in Ang-2, Ang-1 and VEGF were not significant (p=0.448).RP is associated with a lowering of markers of angiogenesis and platelet activation. This suggests that these pathological processes are driven to a large extent by the tumour and/or tumour-secreted factors, and that removal of the primary growth results in a gradual normalisation of measured indices.

Working in mental health services has always been recognised as a stressful occupation and many studies have attested to the high levels of stress and burnout. This study examined comparative levels of stress among inpatient and community mental health staff across five European countries.Using a quasi experimental pre‐test post‐test design, data was collected from staff at baseline, six months and 12 months. This paper examines data from the baseline period. Staff working in acute inpatient wards and community mental health teams in Denmark (Aarhus, Storstrøm), Finland (Tampere), Norway (Bodo), Poland (Warsaw) and the UK (Cambridge), were asked to complete the Maslach Burnout Inventory (MBI) (Maslach, & Jackson, 1986), the Mental Health Professional Stress Scale (Cushway, Tyler & Nolan, 1996) and a demographic questionnaire designed for this study. Results on the MBI are reported in this article. Both community and inpatient teams reported high levels of burnout. There was evidence to suggest that burnout differed by site but not by team type. The English teams scored highest in emotional exhaustion and depersonalisation. Relatively high levels of work‐related personal accomplishment were reported across all of the sites.

A technique for performing nanomechanical testing of free-standing structures using contact scanning mode atomic force microscopy (AFM) has been developed and implemented. The technique consists of performing a contact mode scan of an area of a cantilever test structure as well as of an area that does not deform. The use of two different values of the force during the scan allows the effect of the topography of the test structure to be eliminated. Also note that in this constant force scan, the bending moment in the test cantilever changes continuously with the position of the applied force, allowing both the stress and strain to change even though the force remains constant. With the dimensions of the structure known, material properties (i.e. the elastic modulus) can be determined from the relationship between the applied force and the structural deflection. This method is not susceptible to nonlinearities in the AFM photodetector and allows for piezo drift during testing to be quantified and corrected. 50 nm thick chromium cantilever structures were fabricated for testing using electron-beam lithography. The determination of the elastic modulus gave consistent results as the AFM tip was scanned along the cantilever. As is the case with AFM fixed position force–displacement measurements, the accuracy of the results is affected by uncertainties in the measured AFM cantilever stiffness and by uncertainties in the test structure dimensions. This testing method can be performed by any AFM capable of scanning in the contact mode without requiring specialized software. Fabrication of the cantilevers requires only a single-mask process.

This paper analyses the basic issues in the strategic market planning process as an important part of the strategic marketing and tries to see whether Irish Banking system formally applies this concept. A mail questionnaire was used to carry out a survey covering all the banks in the Greater Dublin Area, which hosts 90% of the banks operating in Ireland. Although the main findings of the survey show similarities with earlier studies, Irish banks have shown some distinct characteristics in their approach to the strategic planning.

This article summarizes the main results and policy implications of a Department of Health funded mental health case management research and development project. The project imple mented case management services in four different sites, and worked with clients who were severely disabled with long-term mental illness. Higher levels of engagement (95 per cent) were achieved by case-managed as compared to control clients. They were also linked to a wider range of community services. However, costs of the experimental services were higher, and client outcome variable. In two sites, case-managed clients achieved significant improvements in psycho-social adjustment, whereas on the third site, there were no differ ences in outcome between the control andexperimental clients. The article concludes that case management continues to be a mode of service delivery which can achieve real benefits for clients in terms of preventing them from falling through the net, and in linking them in responsive ways to community services. However, the increased costs can make it an unattractive option for purchasers, and ways need to be found to retain the established benefits, whilst reducing the costs to service purchasers.

The cost-effectiveness of intensive case management (ICM), compared with standard psychiatric services, was evaluated. Referrals to ICM were randomly allocated to either ICM (n=39), or existing services (n=38). Use of all publicly financed services was collected, from study entry for 18 months. Services used were costed and the two groups compared. In comparison with standard psychiatric services, ICM clients received more psychiatric out-patient, primary health, residential and social services care, in addition to high levels of input from case managers. The ICM group therefore cost nearly three times as much as the control group. ICM teams may be necessary to keep contact with some clients, but achieve very limited clinical or social outcome, at high cost. The cost could be reduced by either adjusting team skill mix, varying intensity of contact with clients or by a corresponding reduction in the use of in-patient care.

Background A distinctive feature of patients suffering from Crohn's disease is a predisposition to develop a variety of anal complications. The aetiology of such conditions is unclear, and the reported incidence of anal involvement in Crohn's disease varies party due to the various criteria used for classification. This study aims to review the management of patients with symptomatic anal pathology associated with Crohn's disease at St Vincent's Hospital, Melbourne. Methods A database of 306 patients with Crohn's disease referred to the department between January 1978 and October 1994 was reviewed to identify those patients with symptomatic anal disease. The anal pathology was recorded and classified. Demographic data and the clinical and surgery history of the patient were recorded. Results Of the 306 patients with Crohn's disease, 129 (42.4%) were identified as having symptomatic anal pathology. Patients were likely to present with anal symptoms after they had been diagnosed as having intestinal Crohn's disease (46.1%). The commonest presentations were perianal abscess (29.5%), anal fissure (27.6%), and low anal fistula (26.7%). A minority of patients presented with high/complex anal fistulae (3.8%), or recto-vaginal fistulae (5.2%). Five per cent of patients had Crohn's disease localized to the anal area. The pattern of intestinal disease in the remaining patients was small bowel 21.1%. small bowel and colon 31.9%, and colon 43.0%. A total of 244 local anal and surgical procedures were performed on these patients; the commonest of these were drainage of an abscess (38.5%), examination under anaesthetic (29.1%), and laying open of a low anal fistula (22.5%). Following surgical treatment, the recurrence rate for perianal abscesses was 13%, and for low anal fistulae 6%. Conclusions The majority of patients with Crohn's disease who develop anal pathology have an excellent prognosis. A minority of patients develop complex anal complex anal fistulae and these remain a therapeutic challenge.

Intensive case management for people with the most serious mental illness can co-ordinate care and keep 'at risk' people in contact with services. However, can case management also bring about improved outcomes? Over an 18-month period the outcomes for 47 clients receiving case management, in addition to standard mental health services, were compared to those for a matched control group in a neighbouring area, who only received standard services. Compared to the matched controls the case managed group had superior improvements in social functioning, perceived social support, less risk behaviour and increased involvement with activities and social organisations. Improvements in mental state and subjective quality of life occurred but were non-significant when compared to the control group. Intensive case management, it is argued, was able to bring about these benefits by making best use of the available treatment and rehabilitation services.

The effect of boron and phosphorous doping and co-doping on the optical properties of silicon nanocrystals formed in fused-silica by ion implantation is being studied. Boron-phosphorus pairs in silicon nanocrystals are of interest for possible applications in optical quantum computing.

Background Unqualified/non-registered caregivers (N-R Cs) will continue to play important roles in the mental health services. This study compares levels of burnout and sources of stress among qualified and N-R Cs working in acute mental health care. Methods A total of 196 nursing staff - 124 qualified staff (mainly nurses) and 72 N-R Cs with a variety of different educational backgrounds - working in acute wards or community mental teams from 5 European countries filled out the Maslach Burnout Inventory (MBI), the Mental Health Professional Scale (MHPSS) and the Psychosocial Work Environment and Stress Questionnaire (PWSQ). Results (a) The univariate differences were generally small and restricted to a few variables. Only Social relations (N-R Cs being less satisfied) at Work demands (nurses reporting higher demands) were different at the .05 level. (b) The absolute scores both groups was highest on variables that measured feelings of not being able to influence a work situation characterised by great demands and insufficient resources. Routines and educational programs for dealing with stress should be available on a routine basis. (c) Multivariate analyses identified three extreme groups: (i) a small group dominated by unqualified staff with high depersonalization, (ii) a large group that was low on depersonalisation and high on work demands with a majority of qualified staff, and (iii) a small N-R C-dominated group (low depersonalization, low work demands) with high scores on professional self-doubt. In contrast to (ii) the small and N-R C-dominated groups in (i) and (iii) reflected mainly centre-dependent problems. Conclusion The differences in burnout and sources of stress between the two groups were generally small. With the exception of high work demands the main differences between the two groups appeared to be centre-dependent. High work demands characterized primarily qualified staff. The main implication of the study is that no special measures addressed towards N-R Cs in general with regard to stress and burnout seem necessary. The results also suggest that centre-specific problems may cause more stress among N-R Cs compared to the qualified staff (e.g. professional self-doubt).

Completely sutureless end-to-end large bowel anastomoses were successfully created in New Zealand white rabbits (n = 26) by using a low-energy (0.4-W wave of power) Nd:YAG laser to produce welded anastomoses. In this study, the short-term integrity, degree of narrowing, macroscopic appearance, and microscopic findings were compared with those of the conventional interrupted one-layer anastomosis (n = 24) at zero, one, four, and seven days after surgery. Two rabbits in the laser group died from leakage. All remaining animals had an uneventful postoperative course. The bursting pressures in the laser group at zero, one, and four days were lower than those in the control group. The narrowing index of the laser anastomosis was higher than that of the suture anastomosis at four and seven days. However, the laser anastomoses showed fewer adhesions, no instances of bowel obstruction, and histologic healing with less fibrosis. The technique of laser anastomosis presents a promising alternative to suturing in reconstitution of the large bowel.

In cases of severe colon bleeding, it is more important to know the site than the cause, in case surgery is required. Technetium-labeled red-cell scan (TLRCS) is known to identify the site of bleeding at the rate of 0.1 ml per minute or more. The aim of this retrospective study was to see whether TLRCS was a reliable indicator of the site of severe colon bleeding. A retrospective study was made of patients investigated in this way for acute, severe colon bleeding at St. Vincent's Hospital, Melbourne, from 1984 to 1988 (five years). TLRCS identified the site of bleeding in less than half of the cases but correctly identified the site in all nine patients in whom bleeding was so severe as to require emergency surgery, avoiding total colectomy in eight cases.

MapReduce is a distributed processing algorithm which breaks up large problem sets into small pieces, such that a large cluster of computers can work on those small pieces in an efficient, timely manner. MapReduce was created and popularized by Google, and is widely used as a means of processing large amounts of textual data for the purpose of indexing it for search later on. This paper examines the feasibility of using smart mobile devices in a MapReduce system by exploring several areas, including quantifying the contribution they make to computation throughput, end-user participation, power consumption, and security. The proposed MapReduce System over Heterogeneous Mobile Devices consists of three key components: a server component that coordinates and aggregates results, a mobile device client for iPhone, and a traditional client for reference and to obtain baseline data. A prototypical research implementation demonstrates that it is indeed feasible to leverage smart mobile devices in heterogeneous MapReduce systems, provided certain conditions are understood and accepted. MapReduce systems could see sizable gains of processing throughput by incorporating as many mobile devices as possible in such a heterogeneous environment. Considering the massive number of such devices available and in active use today, this is a reasonably attainable goal and represents an exciting area of study. This paper introduces relevant background material, discusses related work, describes the proposed system, explains obtained results, and finally, discusses topics for further research in this area.

Fifty-two surgically removed large bowel specimens and 3 colonoscopically removed polyps with mucosal carcinomas were studied. Among 36 frank colorectal carcinomas, six (17%) had a focus of adenomatous remnant. The average size of carcinomas without adenomatous remnant was 56.0 mm and of those with adenomatous remnant was 44.3 mm. Four (67%) of 6 submucosal carcinomas and all of 4 mucosal carcinomas showed an adenomatous remnant. The average size of submucosal carcinomas was 17.7 mm and that of mucosal carcinomas was 16.3 mm. The smaller and less advanced the carcinoma, the more likely it was to show an adenomatous remnant, suggesting that carcinomas arise in adenomas and destroy surviving benign tumour as they grow. Coexisting adenomas were seen in 19 of 46 neoplasm-bearing patients (41%) and 1 of 9 patients (11%) without neoplasms. Average sizes of adenomas with moderate and mild atypia were 13.0 mm and 8.2 mm respectively, which were smaller than the sizes of submucosal and mucosal carcinomas. Although the numbers were small, these findings support the concept of adenoma-carcinoma sequence. Twenty-one flat elevations were collected during the study. Ten were neoplasm (9 adenomas and an early carcinoma), ten were metaplastic polyps and one was a histologically normal mucosal protrusion. The atypism of 10 flat adenomas increased with increasing size, as with ordinary adenomas. As 10 of 55 adenomas (18.2%) were flat adenomas, which are difficult to detect during routine colonoscopic examination, colonoscopists should make every effort to discover flat adenomas, which seem to play an important role in the adenoma-carcinoma sequence.

The potential use of carbon nanotubes (CNT) as interconnects requires also new characterization approaches as the existing ones are optimized for three-dimensional materials and do not work for inherently one-dimensional structures like CNTs. Therefore, we have developed a so-called pick-and-place process which allows to remove an individual CNT from a specific site and to place it at another location for further analysis. The approach is based on nanomanipulation combined with scanning electron microscopy (SEM). This paper presents the pick-and-place concept and explains the different steps required for its successful application. We further demonstrate its power by characterizing individual CNTs using transmission electron microscopy (TEM) and atomic force microscopy (AFM). The developed pick-and-place approach overcomes the challenge of site-specific analysis of CNT interconnects and strongly facilitates the routine analysis of CNTs.

Professionals who work alone or in small teams often provide services for people with serious mental health problems in community settings. Stress is common in community teams and this may cause burnout and threaten the quality and stability of the services. This study compares levels of burnout and sources of stress among community and acute ward staff in six European centres.A total of 6 acute ward (N = 204) and community staff (N = 209) in 5 different European countries filled out the Maslach Burnout Inventory (MBI), the Mental Health Professional Scale (MHPSS) the Agervold Questionnaire for psychosocial work environment (QPWES) in addition to a comprehensive demographic questionnaire.In the univariate analyses, except for Emotional Exhaustion (MBI), there were no differences in burnout between the two groups of staff. Community teams reported more organisational problems, higher work demands, less contact with colleagues, but also better social relations and more control over their work. The ward staff was more satisfied with the organisational structure and access to colleagues, but complained about lack of control over operating conditions at work. The multivariate analyses identified four groups of staff: (1) a Control-dissatisfied and Contact satisfied group (N = 184) with 2/3 coming from the wards. (2) A Contact-satisfied and Work-demand dissatisfied group (N = 147) with (3/4) from the community staff. (3) A Control- and Contact dissatisfied group (N = 47) with a majority from community teams, and (4) a Contact- and Work demand satisfied group (N = 37) with a majority from the wards.Burnout as measured was not a serious problem among community and ward staff members, and did not differentiate between the two groups. Acute ward working implied lack of control but much contact with colleagues, whereas community work entailed more control but demanding work in terms of difficult task and hard-to-find-solutions.

SummaryIn health, haemostasis and angiogenesis are tightly regulated processes, but may become deregulated in cancer. Recent evidence suggests that platelet activation may link these processes as platelets can release angiogenic factors such as vascular endothelial growth factor (VEGF). Furthermore, inflammation has also been implicated in regulating both coagulation and angiogenesis, possibly by activating platelets directly and increasing, for example, plasma fibrinogen. We hypothesized relationships between plasma markers of the processes in two common forms of cancer. Plasma levels of VEGF (reflecting angiogenesis), soluble P-selectin, (marking platelet activation), tissue factor [TF], fibrinogen and fibrin D-dimer (coagulation markers), and serum levels of IL-6 (inflammation) were measured by ELISA in 30 patients with biopsy-proven breast cancer, 30 patients with biopsy-proven prostate cancer, and 30 ageand sex-matched controls for each group. Prostate specific antigen was also measured in the men. Release of VEGF from IL-6 stimulated platelets was assessed by ELISA. Plasma levels of IL-6 (P

Distributed interactive simulation (DIS) is a widely-used networking protocol standard that provides a method of communicating entity information among simulators and simulations to create a synthetic environment. The IEEE DIS standard is being revised with balloting expected to be completed in 2012. The proposed new standard includes an extensive revision, clearing up ambiguities present in the existing 1998 version, and adding additional capabilities that reflect changes in military equipment and doctrine, and also advances in technology such as the internet, mobile telephony, and the widespread use of the global positioning system for positional and time data. Five new protocol data units have been added to include information operations capability, enhanced warfare support, and the ability to communicate information about individual attributes for a particular entity, object, or event. In this paper we review these new capabilities in detail, and explore what this will mean for the Australian simulation ecosystem.

Large bowel anastomoses were successfully performed without sutures on New Zealand white rabbits using 1,064 nm, 0.4-W power pulsating Nd:YAG laser to create tissue welding. PURPOSE: The aim of this study was to assess long-term results of our experimental data and summarize our experimental work on laser colon anastomosis. METHODS: This experimental study investigated long-term integrity, degree of narrowing, animal body weight change, visual findings, microscopic appearance, and collagen concentration of laser colon anastomoses, compared with those of conventional sutured anastomoses at thirty and ninety postoperative days. RESULTS: Two animals in the laser group died without leakage. Postsurgical course in all remaining rabbits studied was uneventful. Bursting pressures in the two groups were equivalent, but the laser group exhibited a consistent narrowing tendency. However, laser anastomoses demonstrated fewer and milder adhesions, and animals showed a better recovery of body weight. Histologically, laser anastomoses showed better layer-to-layer reconstitution without foreign body response and with less fibrosis. Difference in collagen (hydroxyproline) concentration did not reach statistical significance. CONCLUSION: The nature of tissue welding via laser remains undefined, but there is definitely a future for laser bowel anastomosis.

Background Although mental health promotion is a priority mental health action area for all European countries, high level training resources and high quality skills acquisition in mental health promotion are still relatively rare. The aim of the current paper is to present the results of the DG SANCO-funded PROMISE project concerning the development of European guidelines for training social and health care professionals in mental health promotion. Methods The PROMISE project brought together a multidisciplinary scientific committee from eight European sites representing a variety of institutions including universities, mental health service providers and public health organisations. The committee used thematic content analysis to filter and analyse European and international policy documents, scientific literature reviews on mental health promotion and existing mental health promotion programmes with regard to identifying quality criteria for training care professionals on this subject. The resulting PROMISE Guidelines quality criteria were then subjected to an iterative feedback procedure with local steering groups and training professionals at all sites with the aim of developing resource kits and evaluation tools for using the PROMISE Guidelines. Scientific committees also collected information from European, national and local stakeholder groups and professional organisations on existing training programmes, policies and projects. Results The process identified ten quality criteria for training care professionals in mental health promotion: embracing the principle of positive mental health; empowering community stakeholders; adopting an interdisciplinary and intersectoral approach; including people with mental health problems; advocating; consulting the knowledge base; adapting interventions to local contexts; identifying and evaluating risks; using the media; evaluating training, implementation processes and outcomes. The iterative feedback process produced resource kits and evaluation checklists linked with each of these quality criteria in all PROMISE languages. Conclusions The development of generic guidelines based on key quality criteria for training health and social care professionals in mental health promotion should contribute in a significant way to implementing policy in this important area.

This study reviewed a series of patients with Crohn's disease managed by surgeons of the Department of Colon and Rectal Surgery, St Vincent's Hospital, Melbourne, since 1978. There were 306 patients: 171 males and 135 females. The mean age at diagnosis was 33.4 years (ranger 11-93). The distribution of the disease was small bowel 32.3%, small bowel and colon 26.5%, colon 39.9%, and anal disease alone 1.6%. A total of 416 abdominal operations were performed on 204 patients. The commonest indications for surgery were failed medical therapy (21.9%), small bowel obstruction (15.9%), enteric fistula (10.1%), and intra-abdominal abscess (10.1%). The most frequently performed procedures were ileocolic resection with anastomosis (28.8%), small bowel resection (9.4%), and total colectomy and ileostomy (7.0%). Postoperative complications included anastomotic leaks in 4.0%, intra-abdominal abscess formation in 3.6%, and enterocutaneous fistulae developed in 6%. Three patients died during the review period. During follow up (mean 84.4), 30% of patients developed recurrence requiring further surgery at a mean of 72.7 months postoperatively. The most frequent site for a recurrence was the pre-anastomotic terminal ileum (61.7%). In conclusion, the majority of patients with Crohn's disease will require resectional surgery at some stage. This can be performed with a low mortality and morbidity, and a recurrence rate of around 5% per year.

PURPOSE: Our previous experimental work showed the feasibility of colon anastomosis using laser; however, it also revealed a narrowing tendency after laser anastomosis. Long-term observation of the postoperative course of laser anastomosis was planned to assess this point. METHODS: Clinical observation and histologic examination of transverse colotomies (average, 21.2 mm) in New Zealand white rabbits (n=12) closed with a 1,064-nm neodymiumyttrium aluminum garnet (Nd:YAG) laser were carried out up to the third postoperative month, compared with closure of colotomies using a single layer of interrupted sutures of 5-0 Maxon® (Davis & Geck, Pearl River, NY) in a control group (n=12). RESULTS: Whereas the narrowing tendency was observed up to one month after the operation in the laser group (P

PURPOSE: The optimal time for reversal of Hartmann's procedure is controversial. Significant operative difficulty and morbidity have been reported for Hartmann's reversal. The purpose of this study was to examine 11 years' experience with Hartmann's reversal, with particular attention to rate of reversibility, operative difficulty, and timing of reversal. METHODS: Case records of all patients undergoing either Hartmann's procedure or Hartmann's reversal at St. Vincent's Hospital between 1981 and 1991 were examined. Patients having Hartmann's reversal were divided into an early group (before 15 weeks) and a late group (after 15 weeks). These groups were compared in terms of morbidity and mortality, bed stay, and operative difficulty. RESULTS: Hartmann's procedure was performed on 111 patients, mostly for advanced cancer and complicated diverticular disease. Of 96 patients who survived, 50 (52 percent) underwent reversal. Of those with diverticular disease, 40 of 48 (83 percent) underwent reversal. Mortality for Hartmann reversal was 2 percent; anastomotic leak rate 4 percent; and overall complication rate 26 percent. Early reversal was performed in 13 patients and late reversal in 37 patients. There was no difference between these groups in mortality, morbidity, or anastomotic leakage. However, bed stay was longer in the early group and graded operative difficulty greater. In particular, cases in which adhesion density was most severe and in which accidental enterotomy occurred were more common in the early group (P = 0.02, Miettinen's modification of Fisher's exact test). CONCLUSIONS: Hartmann's reversal can be performed with an acceptable morbidity and mortality in most survivors of complicated diverticular disease. Operative difficulty appears to be less after a delay of 15 weeks.

With the implementation of the European Green Paper on Mental Health, and the development of the Mental Health Pact, the strategic importance of Mental Health promotion and illness reduction as keystones of a European mental health policy and practice has never been greater.The PROMISE project is a EU project and is financed by the European Commission, Directorate General for Health and Consumers, DG Sanco. It aims to develop and disseminate guidelines for generic training and education with respect to Mental Health Promotion and Illness Reduction. The best practice guidelines will specifically focus on the prevention of suicide, depression, and alcohol and drug abuse, and the promotion of healthy living.A specific innovation is the involvement of mental health service users as non-traditional actors by developing multi-disciplinary training guidelines and training programs with a special emphasis on positive mental health, healthy living, diet and exercise project.Project partners are all ‘multiplier’ organizations from 8 different European countries and have extensive previous expertise in their designated roles.The role of Parc de Salut Mar, Barcelona PROMISE is: Identify best practice media guidelines for engaging press and media with the mental health promotion agenda through the use of positive role models. Monitor the implementation of the best practice guidelines through the design and development of local case studies in 7 sites across Europe.Outcomes are an integrated and comprehensive set of training guidelines and model training programs accessed through an interactive website, endorsed by European level professional body and university networks.

1 Introduction.- 1.1 What Are Formal Methods?.- 1.2 Formal Methods and Mathematics.- 1.3 What Good Are Formal Methods?.- 1.4 The Myth of Control.- 1.5 Hyperprogramming.- 1.6 Recommendations.- 2 Formal Methods of Software Development: Painted into the Corner of High-Integrity Computing?.- 2.1 The Dominant Rationale for Formal Methods.- 2.2 Some Pragmatic Objections to Formal Methods.- 2.3 Dissolving Resistance to Formal Methods?.- 2.4 A Brief Sketch of Formal Methods in High-Integrity Computing.- 2.5 The Projects.- 2.6 The Formal Methods Community in High-Integrity Computing.- 2.6.1 The Clients.- 2.6.2 The Developers.- 2.7 The Information Networks.- 2.8 Does the Use of Formal Methods Within High-Integrity Computing Perpetuate its "Myths"?.- 3 The Social Negotiation of Proof: An Analysis and a Further Prediction.- 3.1 Background.- 3.2 VIPER.- 3.3 Disputing "Proof".- 3.4 Formal Proof and Rigorous Argument.- 3.5 A Further Prediction.- 3.6 Conclusion.- 4 On Constructing Large Software Systems.- 4.1 Introduction.- 4.2 People.- 4.3 Frames.- 4.4 Sets.- 4.5 Programs.- 4.6 Proof.- 4.7 Tools.- 4.8 Conclusion.- 4.9 Acknowledgments.- 5 Composition of Descriptions: A Progress Report.- 5.1 Introduction.- 5.2 Why Compose Descriptions ?.- 5.3 What is Described?.- 5.4 What is a Description?.- 5.5 What is Composition?.- 5.6 Description Reuse.- 5.7 Conclusion.- 6 Integrating Methods in Practice.- 6.1 Introduction.- 6.2 Development and Development Methods.- 6.3 Aspects of Specification.- 6.4 Aspects of Design.- 6.4.1 Detail and Structure.- 6.4.2 Reification and Algorithm Design.- 6.4.3 Summary.- 6.5 Implications for Research and Development.- 7 Formal Methods and Product Documentation.- 7.1 Introduction.- 7.2 The Fully Formalised Software Product.- 7.3 The Elements of Product Documentation.- 7.4 Product Documentation and the Product Range.- 7.5 Product Documentation and Product Development.- 7.6 Product Documentation and Customers.- 7.7 Developing from a Fully Formalised Base.- 7.8 New Requirements.- 7.9 Errors Detected Before Release.- 7.10 Errors Detected After Release.- 7.11 How to Get There.- 7.12 Summary.- 7.13 Acknowledgments.- 8 Software Quality: A Modelling and Measurement View.- 8.1 Software Quality Needs.- 8.2 Modelling Software Experiences.- 8.3 Model Evolution.- 8.4 An Organization for Packaging Experience Models for Reuse.- 8.5 Conclusions.- 9 Modelling Working Group Summary.- 9.1 Description.- 9.2 Discussion Topics.- 9.3 Discussion.- 9.3.1 Why and to What End Formal Methods?.- 9.3.2 What is a Formal Method?.- 9.4 How Does Mathematical Modelling Help to Increase our Understanding of Digital Systems?.- 9.4.1 What Are the Limits of Mathematical Modelling?.- 9.5 What is Required to Validate that a Mathematical Model Describes a Digital System Accurately?.- 9.5.1 What Insights do Other Fields of Engineering Provide?.- 9.5.2 What Can we Do by 1995 with the Mathematical Modelling Capabilities we Have Now?.- 9.5.3 What Is our Target for the Year 2000?.- 9.5.4 Formal Methods and Safety Standards.- 9.6 Conclusions.- 10 Quality Assurance Working Group.- 10.1 Group Description.- 10.2 Quality Assurance vs. Quality Control.- 10.3 What Is a Formal Method?.- 10.4 Integration of Formal Methods and Quality Control.- 10.5 A Plan to Integrate Formal Methods into QC/QA.- 10.5.1 Phase 1.- 10.5.2 Phase 2.- 10.5.3 Phase 3.- 10.5.4 Phase 4.- 11 Design Methods Working Group.- 11.1 Description.- 11.2 The Context of Formal Methods.- 11.3 The Role of Proof in Assurance.- 11.4 Analytical Capabilities of Formal Methods.- 11.5 Foundational Capabilities of Formal Methods.- 11.6 The Role of Formal Methods with Respect to the Software Development Process.- 11.7 Formal Methods During Development and Implementation.- 11.8 Education.- 11.9 Tools.- 12 Conclusions.- A Survey of Formal Methods Tools.- B Survey of Formal Methods Applications.- C Acronyms and Trademarks.- List of Contributors.

A case is reported of a para-aortic lymph node metastasis from a testicular teratoma that eroded into the overlying duodenum resulting in severe gastrointestinal haemorrhage.

Platinum group metals have become indispensable in modern industrial society and the demand for PGMs has greatly increased. An in-depth quantitative analysis of PGM applications, lifecycle structure, deficits and optimisation potential in Germany has been carried out by Umicore Precious Metals Refining and Oko-Institute. Besides detailed insights into one of the more opaque metal markets, the study elaborates fundamental differences between lifecycles of industrial applications and those in the consumer sector, which are relevant beyond PGMs also for other materials. While 'closed loop' systems in the industrial sector inherently lead to high lifecycle recycling rates, the 'open loop' consumer systems usually imply significant metal losses. Main deficits lay in insufficient collection rates of end-of-life products, global export streams of 'consumer scrap' and inefficiencies in the early, 'sub-industrial' steps of the recycling chain. The study also develops the aspect of 'static' and 'dynamic' recycling ratios, which has to be considered when lifecycle efficiencies in growing (or decreasing) application areas are evaluated.

To assess the possibility of laser anastomosis of the colon, experimental laser closure of colotomies was performed. Transverse colotomies (average 20.7 mm) in New Zealand white rabbits (n = 20) were closed with a 1,064-nm Nd:YAG laser at a pulsating 0.5-W wave of power, using guy sutures to approximate the tissue edges. The laser energy was applied through a specially designed hand piece and hand-held 600-μ m gas-cooled noncontact quartz fiber to produce a satisfactory tissue welding. Similar colotomies were closed using a single layer of interrupted sutures of 5−0 Maxon ® (Davis & Geck, Pearl River, NY) in a control group (n=20). Bursting pressure and index of narrowing were recorded immediately after anastomosis and at 1, 4, and 7 days following surgery. Bursting pressure of the laser-welded closure at 1 day was significantly lower than that of the sutured controls (P

Changes in the administrative structure of the National Health Service and in policy concerning the role of the psychiatric hospitals in the delivery of mental health care mean that local authorities have a growing responsibility for providing a range of supportive services for people who formerly would have lived for long periods in mental hospitals. Sheltered living environments will be an essential part of these services but there is little systematic information regarding the kind of care required in terms of the needs of the adult mentally ill. A pilot study is reported of the non-hospital residential care experienced by mentally ill adults who were financially assisted by three South London boroughs. The findings are related to a wider study of new long-stay patients in mental hospitals, some of whom could be discharged if alternative services were available. The appropriateness of short-term rehabilitation hostels as opposed to long-term maintenance environments of various kinds is discussed. The study is now being extended to include other forms of care including group homes, sheltered housing schemes and a wider range of local authority hostels than was encountered at the pilot stage.

Microsurgical revascularization in the neck has improved the survival rate of free small-bowel grafts used to replace the cervical oesophagus. Colon vessels are larger than those in the jejunum, and even with naked-eye technique good results have been reported following free colon grafting of the oesophagus. The authors thought it might be possible to achieve even better results using microvascular anastomoses in the neck, and in this way replaced the cervical oesophagus in each of 15 dogs with a free transverse colon autotransplant. Four dogs died during operation and four within three days, two of the latter with graft necrosis. The next seven dogs survived eight days or more, and all their colon grafts were viable. Where patent arteries were demonstrated (three cases) the mucosa and myenteric plexuses of the graft survived. In all four dogs where the arteries were thrombosed or not demonstrated, the mucosa was absent, myenteric plexuses were absent in three, and one graft was grossly stenosed. Among these seven dogs there were three fistulae, one where graft arteries were patent and two where they were not; immediate anastomotic healing was not guaranteed by graft survival or arterial patency.

Conventionally, acquired diverticular disease of the colon has been regarded as a single entity, so far as complications go. Experience at St. Vincent's Hospital, Melbourne, suggests that there are two kinds of diverticular disease, one with the classic muscle abnormality, chiefly confined to the left colon and characterized by inflammatory and perforative complications and the other without muscle abnormality, but with diverticula throughout the colon, in which bleeding is common, perhaps due to a connective-tissue abnormality which, on the one hand, allows development of diverticula in the absence of abnormal intraluminal pressure and, on the other, provides inadequate support for vessels in the diverticular wall or for vascular malformations, which are therefore likely to bleed. Clinical evidence from admissions to St. Vincent's Hospital suggests that both acute and chronic pain may be either inflammatory or associated with muscle spasm and hypertrophy. Finally, there is some evidence to suggest that perforation may be due often, or usually, to abnormal intraluminal pressures rather than to diverticular inflammation.

During experiments designed to test the effect of bacterial contamination and infection upon the healing of colon wounds, fecal specimens removed directly from the dog's colon at colotomy have been examined microbiologically in one (“treated”) group after, and in another (“control”) group without, framycetin medication. The bacterial flora of the dog's colon were found to resemble those in the human colon, and as previously shown in human cases, framycetin completely eliminated coliform organisms from the feces. After closure of such a colotomy wound, an abscess almost always developed in the subcutaneous pouch in which it had been fixed, whether or not the dog had been “prepared” with framycetin, but fewer colonies of organisms grew from the abscesses found in the “prepared” cases, and pus from none of these latter abscesses grew Escherichia coli on culture.