Search

We conducted a state-wide survey of 251 clinicians serving people with severe mental illness (SMI) in community support programs, to identify barriers to the diagnosis and treatment of PTSD and other trauma-related problems. Most clinicians did not feel competent to effectively treat these problems. Competence/confidence and belief in utility of intervention were positively related to the percentage of clients with whom trauma and PTSD had been discussed, documented in charts, and addressed directly in treatment. Clinicians need training that develops skills and knowledge as well as conveys the value of addressing PTSD and other trauma-related problems in people with SMI. [ABSTRACT FROM AUTHOR]

Objective: Fidelity scales, which are instruments for measuring implementation of a program practice, are sorely needed as the mental health field increasingly moves toward adoption of evidence-based practices. We examined the psychometric properties of a new fidelity scale developed for assessing supported employment for people with severe mental illness.Study design: Telephone surveys were conducted in 5 states using the 33-item Quality of Supported Employment Implementation Scale (QSEIS) and the 15-item Individual Placement and Support (IPS) Fidelity Scale. We interviewed program directors for 144 vocational programs, including 106 supported employment programs and 38 programs offering vocational services other than supported employment.Results: Internal consistency for the total QSEIS was 0.72. For 27 (82%) of the QSEIS items, at least one-third of the supported employment sites were rated as fully implemented, suggesting concordance between the operating principles of supported employment as practiced in the field and the content of the QSEIS. Factor analysis yielded 5 interpretable factors: Job Placement, Integration with Mental Health Treatment, Long-Term Support, Teamwork, and Engagement. Supported employment differed from other vocational services, especially with respect to job placement in competitive employment and long-term support in these jobs. Concurrent validity was suggested by a 0.85 correlation between the QSEIS and the IPS Fidelity Scale.Conclusions: Fidelity scales are an essential component of an evidence-based practice. Surveys based on psychometrically adequate fidelity scales, such as the QSEIS, can foster greater understanding to the extent of implementation of such practices. For local, state, and national surveys of supported employment, it is incumbent that researchers and program planners use the QSEIS or instruments like it to describe vocational services. [ABSTRACT FROM AUTHOR]

Background: Advances in instrumented mouthguards (iMGs) allow for accurate quantification of single high-acceleration head impacts and cumulative head acceleration exposure in collision sports. However, relationships between these measures and risk of brain cell injury remain unclear., Aim: The purpose of this study was to quantify measures of non-concussive head impact exposure and assess their association with blood glial fibrillary acidic protein (GFAP), neurofilament light (NfL) and phosphorylated-tau-181 (p-tau-181) levels in male Australian football players., Methods: A total of 31 athletes underwent in-season (24 h post-match) and post-season (> 5 weeks) blood collections and/or wore HITIQ Nexus A9 iMGs measuring peak linear (PLA) and rotational (PRA) acceleration. Match footage was used to verify and code impacts. Blood GFAP, NfL, and p-tau-181 were quantified using Simoa and natural log transformed for analysis. Associations between post-match biomarkers and within match maximum single impact and cumulative PLA/PRA were assessed with linear mixed models., Results: In-season versus post-season elevations were found for GFAP (mean difference 0.14, 95% CI 0.01-0.26, p = 0.033), NfL (mean difference = 0.21, 95% CI 0.09-0.32, p = 0.001) and p-tau-181 (mean difference = 0.49, 95% CI 0.33-0.65, p < 0.001). Post-match GFAP was associated with maximum single impact PLA (B = 0.003, 95% CI 0.0002-0.005, p = 0.036), cumulative PLA (B = 0.001, 95% CI 0.0002-0.002, p = 0.017), cumulative PRA (B = 0.01, 95% CI 0.002-0.02, p = 0.014), and impact number (B = 0.03, 95% CI 0.003-0.05, p = 0.029) within a single match. Change in NfL levels between two-matches correlated with cumulative PLA (r = 0.80, 95% CI 0.38-0.95, p = 0.005), PRA (r = 0.71, 95% CI 0.19-0.92, p = 0.019) and impact number (r = 0.63, 95% CI 0.05-0.89, p = 0.038)., Conclusion: Maximum and cumulative head accelerations in Australian football, measured by iMGs, were associated with elevated blood biomarkers of brain injury, highlighting the potential of both technologies for head impact management in collision sports., Competing Interests: Declarations Conflict of interest T.J.O. has had research support from Australian and US Government research agencies (MRFF, DoD, NINDS), and research and consultancy support to his institution from Eisai, UCB Pharma, ES Therapeutics, Biogen, Liva Nova, and Kinoxis Therapeutics. L.J.E., W.T.O., G.S., S.M., B.X., L.P.G., B.P.M., J.W.H., S.S.H.R., B.M., S.R.S. and S.J.M. have no conflicts of interest to disclose. Ethics Approval and Consent to Participate The Monash University Human Research Ethics Committee approved study procedures (MUHREC project: 36556) and all participants provided written informed consent., (© 2024. The Author(s).)

Purpose: Poor bioavailability may contribute to iron deficiency among children in high-resource countries, but iron bioavailability of Australian pre-schooler diets is unknown. This study aimed to estimate the bioavailability of Australian pre-schooler iron intakes across the day and by eating occasions to identify optimal timing for intervention, by using five previously developed algorithms, and to estimate the proportion of children with intakes of absorbable iron below the requirements., Methods: Dietary data of children aged 2 to < 6 y (n = 812) from the 2011-12 National Nutrition and Physical Activity Survey were collected via two 24-h recalls. Usual food and nutrient intakes were estimated via Multiple Source Method. Phytate, polyphenol, and heme iron values were sourced from international databases or the literature. Five previously published algorithms were applied to observed dietary data to estimate iron bioavailability and calculate the prevalence of children with intakes of absorbable iron below requirements., Results: Pre-schooler daily iron bioavailability was low (2.7-10.5%) and corresponded to intakes of 0.18-0.75 mg/d of absorbable iron. The proportion of children with inadequate intakes of absorbable iron ranged between 32 and 98%. For all eating occasions, dinner offered iron of the greatest bioavailability (4.2-16.4%), while iron consumed at breakfast was of the lowest bioavailability (1.2-5.6%)., Conclusion: Future strategies are required to improve intakes of bioavailable iron for pre-schoolers to prevent the risk of deficiency. These strategies could include the encouragement of concomitant consumption of enhancers of iron absorption with iron-rich sources, particularly at breakfast., (© 2024. The Author(s).)

Importance: Sport-related concussion (SRC), a form of mild traumatic brain injury, is a prevalent occurrence in collision sports. There are no well-established approaches for tracking neurobiologic recovery after SRC., Objective: To examine the levels of serum glial fibrillary acidic protein (GFAP) and neurofilament light (NfL) in Australian football athletes who experience SRC., Design, Setting, and Participants: A cohort study recruiting from April 10, 2021, to September 17, 2022, was conducted through the Victorian Amateur Football Association, Melbourne, Australia. Participants included adult Australian football players with or without SRC. Data analysis was performed from May 26, 2023, to March 27, 2024., Exposure: Sport-related concussion, defined as at least 1 observable sign and/or 2 or more symptoms., Main Outcomes and Measures: Primary outcomes were serum GFAP and NfL levels at 24 hours, and 1, 2, 4, 6, 8, 12, and 26 weeks. Secondary outcomes were symptoms, cognitive performance, and return to training times., Results: Eighty-one individuals with SRC (median age, 22.8 [IQR, 21.3-26.0] years; 89% male) and 56 control individuals (median age, 24.6 [IQR, 22.4-27.3] years; 96% male) completed a total of 945 of 1057 eligible testing sessions. Compared with control participants, those with SRC exhibited higher GFAP levels at 24 hours (mean difference [MD] in natural log, pg/mL, 0.66 [95% CI, 0.50-0.82]) and 4 weeks (MD, 0.17 [95% CI, 0.02-0.32]), and NfL from 1 to 12 weeks (1-week MD, 0.31 [95% CI, 0.12-0.51]; 2-week MD, 0.38 [95% CI, 0.19-0.58]; 4-week MD, 0.31 [95% CI, 0.12-0.51]; 6-week MD, 0.27 [95% CI, 0.07-0.47]; 8-week MD, 0.36 [95% CI, 0.15-0.56]; and 12-week MD, 0.25 [95% CI, 0.04-0.46]). Growth mixture modeling identified 2 GFAP subgroups: extreme prolonged (16%) and moderate transient (84%). For NfL, 3 subgroups were identified: extreme prolonged (7%), moderate prolonged (15%), and minimal or no change (78%). Individuals with SRC who reported loss of consciousness (LOC) (33% of SRC cases) had higher GFAP at 24 hours (MD, 1.01 [95% CI, 0.77-1.24]), 1 week (MD, 0.27 [95% CI, 0.06-0.49]), 2 weeks (MD, 0.21 [95% CI, 0.004-0.42]) and 4 weeks (MD, 0.34 [95% CI, 0.13-0.55]), and higher NfL from 1 week to 12 weeks (1-week MD, 0.73 [95% CI, 0.42-1.03]; 2-week MD, 0.91 [95% CI, 0.61-1.21]; 4-week MD, 0.90 [95% CI, 0.59-1.20]; 6-week MD, 0.81 [95% CI, 0.50-1.13]; 8-week MD, 0.73 [95% CI, 0.42-1.04]; and 12-week MD, 0.54 [95% CI, 0.22-0.85]) compared with SRC participants without LOC. Return to training times were longer in the GFAP extreme compared with moderate subgroup (incident rate ratio [IRR], 1.99 [95% CI, 1.69-2.34]; NfL extreme (IRR, 3.24 [95% CI, 2.63-3.97]) and moderate (IRR, 1.43 [95% CI, 1.18-1.72]) subgroups compared with the minimal subgroup, and for individuals with LOC compared with those without LOC (IRR, 1.65 [95% CI, 1.41-1.93])., Conclusions and Relevance: In this cohort study, a subset of SRC cases, particularly those with LOC, showed heightened and prolonged increases in GFAP and NfL levels, that persisted for at least 4 weeks. These findings suggest that serial biomarker measurement could identify such cases, guiding return to play decisions based on neurobiologic recovery. While further investigation is warranted, the association between prolonged biomarker elevations and LOC may support the use of more conservative return to play timelines for athletes with this clinical feature.

Four medications with neuroprotective disease-modifying effects are now in use for motor neuron disease (MND). With FDA approvals for tofersen, relyvrio and edaravone in just the past year, 2022 ended a quarter of a century when riluzole was the sole such drug to offer to patients. The acceleration of approvals may mean we are witnessing the beginning of a step-change in how MND can be treated. Improvements in understanding underlying disease biology has led to more therapies being developed to target specific and multiple disease mechanisms. Consideration for how the pipeline of new therapeutic agents coming through in clinical and preclinical development can be more effectively evaluated with biomarkers, advances in patient stratification and clinical trial design pave the way for more successful translation for this archetypal complex neurodegenerative disease. While it must be cautioned that only slowed rates of progression have so far been demonstrated, pre-empting rapid neurodegeneration by using neurofilament biomarkers to signal when to treat, as is currently being trialled with tofersen, may be more effective for patients with known genetic predisposition to MND. Early intervention with personalized medicines could mean that for some patients at least, in future we may be able to substantially treat what is considered by many to be one of the most distressing diseases in medicine., (Copyright © 2024. Published by Elsevier Inc.)

Grass leaves develop from a ring of primordial initial cells within the periphery of the shoot apical meristem, a pool of organogenic stem cells that generates all of the organs of the plant shoot. At maturity, the grass leaf is a flattened, strap-like organ comprising a proximal supportive sheath surrounding the stem and a distal photosynthetic blade. The sheath and blade are partitioned by a hinge-like auricle and the ligule, a fringe of epidermally derived tissue that grows from the adaxial (top) leaf surface. Together, the ligule and auricle comprise morphological novelties that are specific to grass leaves. Understanding how the planar outgrowth of grass leaves and their adjoining ligules is genetically controlled can yield insight into their evolutionary origins. Here we use single-cell RNA-sequencing analyses to identify a 'rim' cell type present at the margins of maize leaf primordia. Cells in the leaf rim have a distinctive identity and share transcriptional signatures with proliferating ligule cells, suggesting that a shared developmental genetic programme patterns both leaves and ligules. Moreover, we show that rim function is regulated by genetically redundant Wuschel-like homeobox3 (WOX3) transcription factors. Higher-order mutations in maize Wox3 genes greatly reduce leaf width and disrupt ligule outgrowth and patterning. Together, these findings illustrate the generalizable use of a rim domain during planar growth of maize leaves and ligules, and suggest a parsimonious model for the homology of the grass ligule as a distal extension of the leaf sheath margin., (© 2023. The Author(s).)

Crisis stabilization units (CSUs), which offer a range of short-term psychiatric and psychological services, are one of several treatment programs that may create "alternative to arrest" options for law enforcement. Here, we examined the characteristics of the population who was referred to a newly established CSU in its first year of operation and examined the impact of the CSU on regional jail bookings. Administrative medical records and regional jail booking data were merged to form our study sample. Adults who had at least one jail booking and/or one CSU admission during our study period were included. We found that from September 1, 2018 to August 30, 2019, 458 people were admitted into the CSU. Approximately one-third (33.8%) had a jail booking during the study period. In the 3 months following CSU admission, 4.1% had an increase in jail bookings, 11.1% had a decrease, and 66.2% had no change. CSU patients self-reported high depressive and posttraumatic stress disorder symptoms, while also reporting low quality of life scores overall. We conclude that CSUs may be promising components of jail diversion efforts, providing critical services to populations experiencing significant mental health symptoms and who are at risk for incarceration. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Many crop plants rely on insect pollination, particularly insect-pollinated crops which are functionally dioecious. These crops require insects to move pollen between separate plants which are functionally male or female. While honey bees are typically considered the most important crop pollinator species, many other insects are known to visit crops but the pollination contribution of the full diversity of these flower visitors is poorly understood. In this study, we examine the role of diverse insect pollinators for two kiwifruit cultivars as model systems for dioecious crops: Actinidia chinensis var. deliciosa 'Hayward' (a green-fleshed variety) and A. chinensis var. chinensis 'Zesy002' (a gold-fleshed variety). In our round-the-clock insect surveys, we identified that psychodid flies and mosquitoes were the second and third most frequent floral visitors after honey bees ( Apis mellifera L), but further work is required to investigate their pollination efficiency. Measures of single-visit pollen deposition identified that several insects, including the bees Leioproctus spp. and Bombus spp. and the flies Helophilus hochstetteri and Eristalis tenax , deposited a similar amount of pollen on flowers as honey bees ( Apis mellifera ). Due to their long foraging period and high pollen deposition, we recommend the development of strategies to boost populations of Bombus spp., Eristalis tenax and other hover flies, and unmanaged bees for use as synergistic pollinators alongside honey bees., Competing Interests: The authors declare there are no competing interests. Melissa A. Broussard, Brad G. Howlett, Samantha F Read and David E. Pattemore are employed by The New Zealand Institute for Plant & and Food Research Limited and Lisa J. Evans and Brian T. Cutting are employed by Plant and Food Research Australia Ltd., (©2022 Broussard et al.)

Hybrid crop production is more reliant on pollinators compared to open-pollinated crops because they require cross-pollination between a male-fertile and a male-sterile line. Little is known about how stigma receipt of pollen from male-sterile genotypes affects reproduction in hybrids. Non-viable and non-compatible pollen cannot fertilise plant ovules, but may still interfere with pollination success. Here we used seedless watermelon (Citrullus lanatus (Thunb.) Matsum. & Nakai) as a model hybrid plant, to evaluate the morphology, physiology, and movement of pollen from inter-planted genotypes (diploids and triploids). We found that pollen from triploids ('Exclamation' and 'Royal Armada') and diploids ('SP-6', 'Summer Flavor 800', and 'Tiger') was visually distinguishable. Pollen in triploids had more deformities (42.4-46%), tetrads (43-44%), and abnormal growth of callose plugs in pollen tubes. The amount of pollen in triploids to germinate on stigmas was low (8 ± 3%), and few pollen grains produced pollen tubes (6.5 ± 2%). Still, contrary to previous reports our results suggest that some viable pollen grains are produced by triploid watermelons. However, whilst honey bees can collect and deposit pollen from triploids onto stigmas, its effect on hybrid watermelon reproduction is likely to be minimal due to its low germination rate., (© 2022. The Author(s).)

Conservation planning tends to focus on protecting species' ranges or landscape connectivity but seldom both-particularly in the case of diverse taxonomic assemblages and multiple planning goals. Therefore, information on potential trade-offs between maintaining landscape connectivity and achieving other conservation objectives is lacking. We developed an optimization approach to prioritize the maximal protection of species' ranges, ecosystem types, and forest carbon stocks, while also including habitat connectivity for range-shifting species and dispersal corridors to link protected area. We applied our approach to Sabah, Malaysia, where the state government mandated an increase in protected-area coverage of approximately 305,000 ha but did not specify where new protected areas should be. Compared with a conservation planning approach that did not incorporate the 2 connectivity features, our approach increased the protection of dispersal corridors and elevational connectivity by 13% and 21%, respectively. Coverage of vertebrate and plant species' ranges and forest types were the same whether connectivity was included or excluded. Our approach protected 2% less forest carbon and 3% less butterfly range than when connectivity features were not included. Hence, the inclusion of connectivity into conservation planning can generate large increases in the protection of landscape connectivity with minimal loss of representation of other conservation targets., (© 2019 Society for Conservation Biology.)

The widespread use of protective covers in horticulture represents a novel landscape-level change, presenting the challenges for crop pollination. Honeybees ( Apis mellifera L) are pollinators of many crops, but their behavior can be affected by conditions under covers. To determine how netting crop covers can affect honeybee foraging dynamics, colony health, and pollination services, we assessed the performance of 52 nucleus honeybee colonies in five covered and six uncovered kiwifruit orchards. Colony strength was estimated pre- and postintroduction, and the foraging of individual bees (including pollen, nectar, and naïve foragers) was monitored in a subset of the hives fitted with RFID readers. Simultaneously, we evaluated pollination effectiveness by measuring flower visitation rates and the number of seeds produced after single honeybee visits. Honeybee colonies under cover exhibited both an acute loss of foragers and changes in the behavior of successful foragers. Under cover, bees were roughly three times less likely to return after their first trip outside the hive. Consequently, the number of adult bees in hives declined at a faster rate in these orchards, with colonies losing on average 1,057 ± 274 of their bees in under two weeks. Bees that did forage under cover completed fewer trips provisioning their colony, failing to reenter after a few short-duration trips. These effects are likely to have implications for colony health and productivity. We also found that bee density (bees/thousand flowers) and visitation rates to flowers were lower under cover; however, we did not detect a resultant change in pollination. Our findings highlight the need for environment-specific management techniques for pollinators. Improving honeybee orientation under covers and increasing our understanding of the effects of covers on bee nutrition and brood rearing should be primary objectives for maintaining colonies and potentially improving pollination in these systems., Competing Interests: None declared.

Objective: To explore the differences in access to, and outcomes of, psychological therapy for different ethnic groups across a South London Mental Health Trust., Method: This study used Trust data to explore the proportions of ethnic groups accessing psychological therapy as a proportion of all patients supported by the Trust, as well as their outcomes within broad diagnostic clusters., Results: Compared to proportions in the local population, there were significantly more White/White British patients and significantly fewer patients from 'other ethnic groups' in the Trust (p < .05). There was also significantly greater proportion of Black/Black British patients with schizophrenia diagnoses compared to the proportion of Black/Black British people in the local population (p < .001). Of those accessing psychological therapy, there were significantly more White/White British and 'other ethnic group' patients and significantly fewer Black/Black British patients (p < .05). For schizophrenia diagnoses, significantly fewer Black/Black British and 'other ethnic group' patients were accessing psychological therapy (p < .05); however for behavioural and emotional disorders, there were significantly higher proportions of 'other ethnic group' and White/White British patients. Outcomes varied by diagnosis; Black/Black British patients experienced significantly higher distress scores at the beginning of therapy for depression and neurotic diagnoses (p < .05), with the latter persisting at the end of treatment., Conclusions: Across the Trust, there were significant differences in the proportion of ethnic groups in accessing psychological therapy, as well as in outcomes. More research is needed to understand the factors that may underlie these disparities.

Metal partitioning in soils is a key process controlling metal bioavailability and mobility and is greatly influenced by the solid/liquid ratio. However, metal partitioning is difficult to describe either by a simple partition coefficient or by isotherm adsorption equations. This study investigated the solubility of Ni(II) and Cd(II) in 19 soils as a function of three extraction reagents (water, 0.01 M NaNO 3 , and 0.01 M CaCl 2 ), five solid/liquid ratios (5-400 g/L) and field condition extracted by Rhizon samplers. Thermodynamically based multi-surface models (MSMs) that included generic parameters were used to describe metal partitioning under the studied conditions. The results showed that Ni/Cd solubility depended on the soil type, extraction reagent, and solid/liquid ratio. Soil major background cations (especially Ca 2+ , Mg 2+ , Fe 3+ and Al 3+ ) had a significant effect on the model's prediction ability. The MSM was able to predict the extractable metal in 0.01 M CaCl 2 in various soils at different solid/liquid ratios when soil background cations were included in the calculation; without the background cations, the model was able to predict metal partitioning only at solid/liquid ratios of <100 g/L. In addition, the model failed to predict water-extracted and 0.01 M-NaNO 3 -extracted Ni/Cd if background cations were not included, but could reasonably do so if they were included. More importantly, after the background cations were included, MSMs relatively well predicted the Ni/Cd content in soil pore water under 80% field capacity conditions with water as the solution matrix., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Continual efforts have been made to determine a simple and universal method of estimating heavy metal phytoavailability in terrestrial systems. In the present study, a mechanism-based multi-surface model (MSM) was developed to predict the partition of Ni(II) in soil-solution phases and its bioaccumulation in wheat (Triticum aestivum L.) in 19 Chinese soils with a wide range of soil properties. MSM successfully predicted the Ni(II) dissolution in 0.01 M CaCl 2 extracting solution (R 2  = 0.875). The two-site model for clay fraction improved the prediction, particularly for alkaline soils, because of the additional consideration of edge sites. More crucially, the calculated dissolved Ni(II) was highly correlated with the metal accumulation in wheat (R 2  = 0.820 for roots and 0.817 for shoots). The correlation coefficients for the MSM and various chemical extraction methods have the following order: soil pore water > MSM ≈ diffuse gradient technique (DGT) > soil total Ni > 0.43 M HNO 3  > 0.01 M CaCl 2 . The results suggested that the dissolved Ni(II) calculated using MSM can serve as an effective indicator of the bioavailability of Ni(II) in various soils; hence, MSM can be used as an supplement for metal risk prediction and assessment besides chemical extraction techniques., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Background: Following the 2014 Ebola virus disease (EVD) outbreak in West Africa, the UK Department for International Development funded South London and Maudsley National Health Service (NHS) to develop a psychological intervention that ex-Ebola Treatment Centre (ETC) staff could be trained to deliver to their peers to improve mental health in Sierra Leone., Aim: The two key aims were to assess the feasibility of training a national team to deliver a cognitive behavioural therapy (CBT)-based group intervention, and to evaluate the effectiveness of the overall intervention within this population., Methods: UK clinicians travelled to Sierra Leone to train a small team of ex-ETC staff in a three-phased CBT-based intervention. Standardised clinical measures, as well as bespoke measures, were applied with participants through the intervention to assess changes in mental health symptomology, and the effectiveness of the intervention., Results: The results found improvements across all factors of mental health in the bespoke measure from phase 1 to phase 3. Additionally, the majority of standardised clinical measures showed improvements between phase 2 and the start of phase 3, and pre- and post-phase 3., Conclusion: Overall, the findings suggest that it is possible to train staff from ETCs to deliver effective CBT interventions to peers. The implications of these results are discussed, including suggestions for future research and clinical intervention implementation within this population. The limitations of this research are also addressed.

The purpose of this research was to identify factors associated with lengthy stays in psychiatric hospital in a UK mental health trust. A multiple regression using a multiple imputation method to deal with missing data was performed on inpatient admissions data over a four-year period for 7653 individuals. Factors associated with a longer length of stay included gender (being male), ethnicity (being Asian/Asian British, Black/Black British, or having a mixed background compared to being White/White British), accommodation status (being homeless, or in accommodation with support), primary diagnostic group of psychosis (F20-29), and number of care coordinators. Marital status was not found to be associated with length of stay in this sample. Length of stay is likely to be multifactorially determined, and more similar studies examining factors associated with length of hospital stay are needed to understand the operation of psychiatric services.

This study aimed to use nuanced statistical methods in a large UK sample to identify and explore the factors associated with different types of frequent user of Emergency Departments (EDs) who are referred to Mental Health Liaison Services (MHLS). A retrospective 5-year longitudinal study was conducted of all attenders (n = 23,718) of four London EDs who were referred to their MHLS. Longitudinal group-based trajectory analysis of monthly MHLS referrals enabled identification of factors which may contribute to membership of the resulting groups. Analysis revealed six clusters representing distinct attendance patterns; three clusters of these were identified as frequent attender groups (occasional, intermediate, heavy) containing 1119 people (4.7%). This 4.7% of the sample accounted for 24.2% of all admissions. Factors significantly related to membership of each of these groups were: having been involuntarily detained under the Mental Health Act, a higher number of care coordinators, and a diagnosis of substance abuse. The study revealed three clusters of frequent ED users with a MHLS referral who were more likely to have certain clinical and social care needs. A small proportion of clients identified as frequent users (4.7%) were responsible for nearly a quarter of all admissions (24.2%) during this timeframe., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Objective: To investigate the effectiveness of psychological therapy in reducing psychological distress for adults with autism spectrum conditions (ASC) and co-morbid mental health conditions in routine clinical practice. To explore the effect of individual characteristics and service factors on change in general distress., Method: In a specialist psychological therapies service for adults with ASC, the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) self-report questionnaire of psychological distress is completed by clients at start and end of therapy. Change over time and reliable and clinical change was assessed for 81 of a total of 122 clients (66.4%). Factors which may influence change over time were explored using available clinical information., Results: Overall, there was a significant reduction in CORE-OM score during therapy with a small effect size. Most clients showed an improvement in psychological distress over therapy (75.4% improved, with 36.9% of these showing reliable changes). Significant and comparable reductions from pre-therapy to post-therapy were seen across the sample, showing that individual differences did not mediate therapy effectiveness. CORE-OM scores mediate the association between age of ASD diagnosis and hours of therapeutic input required, with greater age at diagnosis and higher distress associated with longer therapy duration., Conclusions: Our preliminary findings suggest that psychological therapy may be effective in reducing general distress for clients with ASC and co-morbid mental health conditions and should be routinely offered. Individuals who are diagnosed with ASD in adulthood are likely to require a longer course of therapy when their general distress scores are high., (Copyright © 2017 John Wiley & Sons, Ltd.)

Objective: This article aims to examine the impact of clinical and demographic factors on both rapid readmission (being readmitted within 30 d) and frequent readmission (experiencing three or more admissions) in a London mental health trust., Methods: A four-year study period with a sample of 7648 inpatients were examined with chi-square or Mann-Whitney U tests, and binary logistic regressions to assess the associations and possible predictors of rapid (readmitted within 30 d) and frequent (admitted at least three times) readmission., Results: Frequent admitters were more likely to be unemployed, have more care-coordinators, be living in accommodation with support, be Black or Black British, and to have certain diagnoses. Binary logistic regression revealed that our variables of interest explained between 36.1 and 60.9% of the variation in number of readmissions (±3 admissions), and between 3.7 and 4.2% of the variation in time to readmission (±30 d)., Conclusions: Identifying factors that are associated with rehospitalisation and understanding their importance is necessary to reduce the risk of readmission. This study suggests that particular demographic, clinical and treatment factors require consideration to tackle the seemingly wide range of factors that could be affecting readmission to inpatient services.

Riparian ecosystems are amongst the most biodiverse tropical habitats. They are important, and essential, ecological corridors, linking remnant forest fragments. In this study, we hypothesised that crocodile's actively select nocturnal resting locations based on increased macaque predation potential. We examined the importance of riparian vegetation structure in the maintenance of crocodile hunting behaviours. Using airborne Light Detection and Ranging (LiDAR) and GPS telemetry on animal movement, we identified the repeated use of nocturnal resting sites by adult estuarine crocodiles (Crocodylus porosus) throughout the fragmented Lower Kinabatangan Wildlife Sanctuary in Sabah, Malaysia. Crocodile resting locations were found to resemble, in terms of habitat characteristics, the sleeping sites of long-tailed macaque; positioned in an attempt to avoid predation by terrestrial predators. We found individual crocodiles were actively selecting overhanging vegetation and that the protrusion of trees from the tree line was key to site selection by crocodiles, as well as influencing both the presence and group size of sleeping macaques. Although these findings are correlational, they have broad management implications, with the suggestion that riparian corridor maintenance and quality can have implications beyond that of terrestrial fauna. We further place our findings in the context of the wider ecosystem and the maintenance of trophic interactions, and discuss how future habitat management has the potential to mitigate human-wildlife conflict.

Facial emotion perception plays a key role in interpersonal communication and is a precursor for a variety of socio-cognitive abilities. One brain region thought to support emotion perception is the inferior frontal cortex (IFC). The current study aimed to examine whether modulating neural activity in the IFC using high frequency transcranial random noise stimulation (tRNS) could enhance emotion perception abilities. In Experiment 1, participants received either tRNS to IFC or sham stimulation prior to completing facial emotion and identity perception tasks. Those receiving tRNS significantly outperformed those receiving sham stimulation on facial emotion, but not identity, perception tasks. In Experiment 2, we examined whether baseline performance interacted with the effects of stimulation. Participants completed a facial emotion and identity discrimination task prior to and following tRNS to either IFC or an active control region (area V5/MT). Baseline performance was a significant predictor of emotion discrimination performance change following tRNS to IFC. This effect was not observed for tRNS targeted at V5/MT or for identity discrimination. Overall, the findings implicate the IFC in emotion processing and demonstrate that tRNS may be a useful tool to modulate emotion perception when accounting for individual differences in factors such as baseline task performance.

Objectives: This study explores whether improvements, as measured by the CORE-OM/10, as a result of psychological therapy were related to length of treatment in weeks, number of treatment sessions, or treatment intensity, as well as any effect of diagnostic group., Methods and Design: Pre- and post-therapy CORE-OM/10 scores were extracted from the clinical records of all secondary care adult psychological therapy team patients who undertook psychological therapy between 2010 and 2013 in one mental health trust. Of the 4,877 patients identified, 925 had complete records. Length of therapy was divided by the number of sessions to create 'treatment intensity' (sessions per week). Nonparametric analyses were used, initial score was controlled for, and diagnostic group was explored., Results: No relationship was found between change in score and the number of sessions, therapy length, or treatment intensity; however, change in score was positively correlated with first-session score. Patients with higher initial scores had longer therapies; however, treatment intensity was similar for patients with lower pre-therapy distress. There were differences in treatment length (weeks) between diagnostic groups. Demographic differences were found between patients with and without complete records, prompting caution in terms of generalizability., Conclusions: These findings are consistent with the responsive regulation model (Barkham et al., 1996) which proposes that patients vary in their response to treatment, resulting in no associations between session numbers or treatment intensity and therapeutic gain with aggregated scores. Patients with higher CORE scores at the outset of psychological therapy had longer not more intensive therapy. There was variation in treatment intensity between diagnostic clusters., Practitioner Points: Number of sessions, length of therapy (in weeks), and treatment intensity (the number of sessions per week between the first and last therapy sessions) were not related to therapeutic gains. These results fit with a responsive regulation model of therapy duration, suggesting an individualized approach to therapy cessation as opposed to therapy session limits as the number of sessions a patient experienced was not generally associated with outcome. We found that clients with a diagnosis of a behavioural syndrome (F50-59) had less 'intensive' therapy; they experienced the same number of sessions over a longer time frame. Despite this, there were no associations between diagnosis category and change in score., (© 2017 The British Psychological Society.)

Despite widespread interest in the potential adaptive value of individual differences in cognition, few studies have attempted to address the question of how variation in learning and memory impacts their performance in natural environments. Using a novel split-colony experimental design we evaluated visual learning performance of foraging naïve bumble bees (Bombus terrestris) in an ecologically relevant associative learning task under controlled laboratory conditions, before monitoring the lifetime foraging performance of the same individual bees in the field. We found appreciable variation among the 85 workers tested in both their learning and foraging performance, which was not predicted by colony membership. However, rather than finding that foragers benefited from enhanced learning performance, we found that fast and slow learners collected food at comparable rates and completed a similar number of foraging bouts per day in the field. Furthermore, bees with better learning abilities foraged for fewer days; suggesting a cost of enhanced learning performance in the wild. As a result, slower learning individuals collected more resources for their colony over the course of their foraging career. These results demonstrate that enhanced cognitive traits are not necessarily beneficial to the foraging performance of individuals or colonies in all environments.

Due to its mobility and toxicity, chromate [Cr(VI)] partitioning in soils, especially in the vadose zone, is an important environmental concern. The aim of this study was to develop a mechanism-based multi-surface complexation model using published parameters to predict the soil/water partitioning of Cr(VI) in 12 soils (previously depleted of organic matter) from China. The retention of Cr(VI) in soils was attributed to two reactive oxide surfaces: goethite and hydrous ferric oxide (HFO); however, modeling results showed that the best prediction was obtained with goethite alone, whereas the addition of HFO resulted in an overestimation of adsorption in some soils. Cr(VI) adsorption onto goethite could be described using our previously proposed CD-MUSIC model. In the absence of a specific value for the soil-reactive surface area of goethite, a general value of 45.8m 2 /g was used. The available phosphate in soils was identified as a strong competitor for Cr(VI) adsorption; thus, for soils with a low Fe/P ratio (<1) the effect of phosphate on Cr(VI) retention should not be neglected. The simple method presented herein can be applied to soils with a wide range of properties, pH values, and Cr(VI) loading concentrations., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Objective: This paper identifies the characteristics of emergency department (ED) attendees with a referral to their Mental Health Liaison Service (MHLS) who are at increased risk for rapidly reattending, attending frequently, or attending intensely at this service (which is defined here as rapid and frequent reattendance)., Methods: A retrospective 5-year longitudinal study was conducted of all visitors (n=24 010) attending four busy EDs with a referral to their MHLS from the beginning of 2009 until the end of 2013. A Cox proportional hazards regression was used to identify factors associated with intense use, and a negative binomial regression was used to identify factors associated with frequent attendance., Results: People with certain characteristics were more likely to make 'intense' use of mental health emergency services, which we define as shorter time to reattendance and a higher number of visits over 5 years. The people more likely to make intense use are more likely to have certain clinical diagnoses such as substance misuse, stress disorder, personality disorder and learning disability, to have certain social characteristics such as not being in a relationship, or living alone, and to have healthcare issues such as having been detained under the Mental Health Act and having a greater number of care coordinators over 5 years., Conclusion: Individuals with certain clinical and social characteristics were significantly more likely to reattend EDs and have referral to MHLS rapidly and frequently (i.e. intensely).

Background: A lack of consensus exists concerning how to identify "heavy users" of inpatient mental health services., Aim: To identify a statistical approach that captures, in a clinically meaningful way, "heavy" users of inpatient services using number of admissions and total time spent in hospital., Methods: "Simple" statistical methods (e.g. top 2%) and data driven methods (e.g. the Poisson mixture distribution) were applied to admissions made to adult acute services of a London mental health trust., Results: The Poisson mixture distribution distinguished "frequent users" of inpatient services, defined as having 4 + admissions in the study period. It also distinguished "high users" of inpatient services, defined as having 52 + occupied bed days. Together "frequent" and "high" users were classified as "heavy users"., Conclusions: Data driven criteria such as the Poisson mixture distribution can identify "heavy" users of inpatient services. The needs of this group require particular attention.

The role that oil palm plays in the Lower Kinabatangan region of Eastern Sabah is of considerable scientific and conservation interest, providing a model habitat for many tropical regions as they become increasingly fragmented. Crocodilians, as apex predators, widely distributed throughout the tropics, are ideal indicator species for ecosystem health. Drones (or unmanned aerial vehicles (UAVs)) were used to identify crocodile nests in a fragmented landscape. Flights were targeted through the use of fuzzy overlay models and nests located primarily in areas indicated as suitable habitat. Nests displayed a number of similarities in terms of habitat characteristics allowing for refined modelling of survey locations. As well as being more cost-effective compared to traditional methods of nesting survey, the use of drones also enabled a larger survey area to be completed albeit with a limited number of flights. The study provides a methodology for targeted nest surveying, as well as a low-cost repeatable flight methodology. This approach has potential for widespread applicability across a range of species and for a variety of study designs., Competing Interests: The authors declare no conflicts of interest.

A sequential fractionation method proposed by Jiang and Gu (1989) distinguished three types of calcium phosphates (Ca-P) according to their different plant availabilities. Three extractants, NaHCO3, NH4Ac, and H2SO4 were used to extract Ca2-P, Ca8-P, and Ca10-P types, respectively, from soil. This sequential fractionation method was tested and modified for analyzing the P chemistry of a calcareous soil. The solubility test and the model diagrams of the stability of the major Ca-P minerals showed that NaHCO3 was able to extract brushite (Ca2-P type), and NH4Ac extracted brushite and β-tricalcium P (Ca8-P type) as well as hydroxyapatite (Ca10-P type). Therefore the P forms targeted by extraction with NH4Ac should include both Ca8-and Ca10-P types. The sum of the P extracted by all extractants in the sequential fractionation method in the calcareous soil was in agreement with the total P measured by the perchloric acid digestion method. A proportion of organic P measured by the sequential fractionation method was in agreement with the result from solution (31)P NMR spectroscopy. This study showed that the modified sequential fractionation method and its target P forms would be useful for quantifying and characterizing inorganic and organic P in a calcareous soil, even though it should be used in combination with other techniques, such as solution (31)P NMR spectroscopy., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Although Neglected Tropical Diseases (NTDs) are largely endemic in the developing nations of Africa, Asia, and South and Central America, they are reemerging with increasing frequency in developed countries. Their diagnosis, treatment, and control are an increasing public health concern that requires a different awareness by health care providers. Neglected tropical diseases (NTDs) are chronic infectious diseases which disproportionately burden poor, rural, and marginalized populations with significant mortality and high morbidity (disability, disfigurement, impaired childhood growth and cognitive development, increased vulnerability to coinfection) that reinforces their poverty. What can we learn from the nurses in developing countries already battling NTD's that could be useful in the developed world? This article provides an overview of distribution, pathophysiology, symptoms, and management of 13 NTDs, with particular attention to the role of nurses in delivering cost-effective integrated interventions. Case studies of schistosomiasis, Chagas disease, and leishmaniasis address recognition and treatment of infected individuals in developed nations where NTD infection is limited primarily to immigrants and travelers., (© 2014 Wiley Periodicals, Inc.)

If the cognitive performance of animals reflects their particular ecological requirements, how can we explain appreciable variation in learning ability amongst closely related individuals (e.g. foraging workers within a bumble bee colony)? One possibility is that apparent 'errors' in a learning task actually represent an alternative foraging strategy. In this study we investigate the potential relationship between foraging 'errors' and foraging success among bumble bee (Bombus terrestris) workers. Individual foragers were trained to choose yellow, rewarded flowers and ignore blue, unrewarded flowers. We recorded the number of errors (visits to unrewarded flowers) each bee made during training, then tested them to determine how quickly they discovered a more profitable food source (either familiar blue flowers, or novel green flowers). We found that error prone bees discovered the novel food source significantly faster than accurate bees. Furthermore, we demonstrate that the time taken to discover the novel, more profitable, food source is positively correlated with foraging success. These results suggest that foraging errors are part of an 'exploration' foraging strategy, which could be advantageous in changeable foraging environments. This could explain the observed variation in learning performance amongst foragers within social insect colonies.

Crassignathadanaugirangensis sp. n. (Araneae: Symphytognathidae) was discovered during a tropical ecology field course held at the Danau Girang Field Centre in Sabah, Malaysia. A taxonomic description and accompanying ecological study were completed as course activities. To assess the ecology of this species, which belongs to the ground-web-building spider community, three habitat types were surveyed: riparian forest, recently inundated riverine forest, and oil palm plantation. Crassignathadanaugirangensis sp. n. is the most abundant ground-web-building spider species in riparian forest; it is rare or absent from the recently inundated forest and was not found in a nearby oil palm plantation. The availability of this taxonomic description may help facilitate the accumulation of data about this species and the role of inundated riverine forest in shaping invertebrate communities.

Organisation in eusocial insect colonies emerges from the decisions and actions of its individual members. In turn, these decisions and actions are influenced by the individual's behaviour (or temperament). Although there is variation in the behaviour of individuals within a colony, we know surprisingly little about how (or indeed if) the types of behaviour present in a colony change over time. Here, for the first time, we assessed potential changes in the behavioural type of foragers during colony development. Using an ecologically relevant foraging task, we measured the decision speed and learning ability of bumble bees (Bombus terrestris) at different stages of colony development. We determined whether individuals that forage early in the colony life cycle (the queen and early emerging workers) behaved differently from workers that emerge and forage at the end of colony development. Whilst we found no overall change in the foraging behaviour of workers with colony development, there were strong differences in foraging behaviour between queens and their workers. Queens appeared to forage more cautiously than their workers and were also quicker to learn. These behaviours could allow queens to maximise their nectar collecting efficiency whilst avoiding predation. Because the foundress queen is crucial to the survival and success of a bumble bee colony, more efficient foraging behaviour in queens may have strong adaptive value.

Background: The neurotrophin Nerve Growth factor (NGF) is known to influence the phenotype of mature nociceptors, for example by altering synthesis of neuropeptides, and changes in NGF levels have been implicated in the pathophysiology of chronic pain conditions such as neuropathic pain. We have tested the hypothesis that after partial nerve injury, NGF accumulates within the skin and causes 'pro-nociceptive' phenotypic changes in the remaining population of sensory nerve fibres, which could underpin the development of neuropathic pain., Results: Eleven days after chronic constriction injury of the rat mental nerve the intra-epidermal nerve fibre density of the chin skin from had reduced from 11.6 ± 4.9 fibres/mm to 1.0 ± 0.4 fibres/mm; this slowly recovered to 2.4 ± 2.0 fibres/mm on day 14 and 4.0 ± 0.8 fibres/mm on day 21. Cold hyperalgesia in the ipsilateral lower lip was detectable 11 days after chronic constriction injury, although at this time skin [NGF] did not differ between sides. At 14 days post-injury, there was a significantly greater [NGF] ipsilaterally compared to contralaterally (ipsilateral = 111 ± 23 pg/mg, contralateral = 69 ± 13 pg/mg), but there was no behavioural evidence of neuropathic pain at this time-point. By 21 days post-injury, skin [NGF] was elevated bilaterally and there was a significant increase in the proportion of TrkA-positive (the high-affinity NGF receptor) intra-epidermal nerve fibres that were immunolabelled for the neuropeptide Calcitonin Gene-related peptide., Conclusions: The temporal mismatch in behaviour, skin [NGF] and phenotypic changes in sensory nerve fibres indicate that increased [NGF] does not cause hyperalgesia after partial mental nerve injury, although it may contribute to the altered neurochemistry of cutaneous nerve fibres.

We report for the first time a novel room temperature methane (CH(4)) sensor fabricated using porous tin oxide (SnO(2)) nanorods as the sensing material. The porous SnO(2) nanorods were synthesized by using multiwall carbon nanotubes (MWCNTs) as templates. Current versus time curves were obtained demonstrating the room temperature sensing capabilities of the sensor system when exposed to 0.25% CH(4) in air. The sensor also exhibited a wide temperature range for different concentrations of CH(4) (25-500 °C), making it useful in harsh environments as well.

Microbial productivity at hydrothermal vents is among the highest found anywhere in the deep ocean, but constraints on microbial growth and metabolism at vents are lacking. We used a combination of cultivation, molecular, and geochemical tools to verify pure culture H(2) threshold measurements for hyperthermophilic methanogenesis in low-temperature hydrothermal fluids from Axial Volcano and Endeavour Segment in the northeastern Pacific Ocean. Two Methanocaldococcus strains from Axial and Methanocaldococcus jannaschii showed similar Monod growth kinetics when grown in a bioreactor at varying H(2) concentrations. Their H(2) half-saturation value was 66 μM, and growth ceased below 17-23 μM H(2), 10-fold lower than previously predicted. By comparison, measured H(2) and CH(4) concentrations in fluids suggest that there was generally sufficient H(2) for Methanocaldococcus growth at Axial but not at Endeavour. Fluids from one vent at Axial (Marker 113) had anomalously high CH(4) concentrations and contained various thermal classes of methanogens based on cultivation and mcrA/mrtA analyses. At Endeavour, methanogens were largely undetectable in fluid samples based on cultivation and molecular screens, although abundances of hyperthermophilic heterotrophs were relatively high. Where present, Methanocaldococcus genes were the predominant mcrA/mrtA sequences recovered and comprised ∼0.2-6% of the total archaeal community. Field and coculture data suggest that H(2) limitation may be partly ameliorated by H(2) syntrophy with hyperthermophilic heterotrophs. These data support our estimated H(2) threshold for hyperthermophilic methanogenesis at vents and highlight the need for coupled laboratory and field measurements to constrain microbial distribution and biogeochemical impacts in the deep sea.

An outbreak of tuberculosis (TB) caused by Mycobacterium bovis in a llama herd is described. Over a 25-month period, a total of 70 llamas were selected for postmortem examination using four distinct criteria: clinical suspicion of disease (15 animals), positive tuberculin skin test result (three animals), antibody positive using a novel serological test (Rapid Test, 54 animals) and elective cull (five animals). Some animals qualified on more than one criterion. Gross lesions of TB were detected in 15 animals, with lung and lymph node lesions consistently observed. Samples were collected from 14 of 15 animals with visible lesions as well as those with no visible lesions, for histopathology and mycobacterial culture. All 14 llamas with visible lesions had caseonecrotic granulomatous lesions associated with acid-fast bacteria and variable mineralisation, and M bovis was isolated from 13. There were no histopathological lesions of TB in llamas with no grossly visible lesions, and M bovis was not isolated from any of these. The predictive value of suspicious gross lesions at postmortem examination was therefore high in the herd. Molecular typing results indicated that the outbreak was caused by a single strain likely to have originated from a local reservoir, probably cattle or wildlife. Antemortem indicators of infection assisted control of the outbreak, but no single test accurately identified all TB cases. Visible lesions were detected in nine of 15 llamas with clinical suspicion of disease, in two of three that had positive tuberculin skin test results and in 10 of 54 that were antibody positive; there was none (zero out of five) in llamas that were electively culled.

Background: Supported employment is identified as an evidence-based practice for people with severe mental illness, with Individual Placement and Support (IPS) emerging as the clearest articulation of this practice. Yet throughout the U.S., programs labeled as supported employment operate in a wide variety of ways, with different staffing patterns, organizational features, and services. Consensus on critical ingredients is crucial for establishing standards for evidence-based services, guiding implementation of new programs, and fostering communication in the literature. The current study examined the degree of agreement on the critical ingredients of supported employment among experts and practitioners., Methods: The expert sample (n=19) consisted primarily of university-based researchers, while the practitioner sample (n=55) was a convenience sample generated from lists provided by state leaders in 2 Western, 2 Central, and 2 Eastern states. Using multiple sources, including published guidelines and 3 supported employment fidelity scales, we developed a 59-item survey checklist. Respondents rated items on a 7-point importance scale and indicated ideal specifications in 11 areas., Findings: We found strong agreement on the critical ingredients of supported employment within the expert and practitioner groups. On most items, the two groups had similar mean ratings of importance. Experts rated 4 items reflecting evidence-based principles and 2 items related to outcome monitoring as more important than did practitioners, while practitioners rated as more important 10 items reflecting pragmatic concerns (e.g., funding, accreditation). Comparing survey responses on the 15 items from the IPS Fidelity Scale suggested general endorsement of IPS principles, except in the area of staffing. Ideal model specifications included caseload size of 16 and twice weekly supervision. Respondents also suggested critical ingredients not measured by the IPS Fidelity Scale, such as benefits counseling, supported education, a cultivation of employers., Conclusions: This survey shows a growing consensus within the psychiatric rehabilitation field on IPS principles while suggesting additional strategies endorsed by experts and practitioners.

Illite samples from Fithian, IL were purified and saturated with Na(+) ions. The acid-base surface chemistry of the Na-saturated illite was studied by potentiometric titration experiments with 0.1, 0.01, and 0.001 M NaNO(3) solutions as the background electrolyte. Results showed that the titration curves obtained at different ionic strengths did not intersect in the studied pH range. The adsorption of Cd(II), Cu(II), Ni(II), Pb(II), and Zn(II) onto illite was investigated as a function of pH and ionic strength by batch adsorption experiments. Two distinct mechanisms of metal adsorption were found from the experimental results: nonspecific ion-exchange reactions at lower pH values on the basal surfaces and 'frayed edges' and specific adsorption at higher pH values on the mineral edges. Ionic strength had a greater effect on the ion-exchange reactions. The binding constants for the five heavy metals onto illite were determined using the least-square fitting computer program FITEQL. Linear free energy relationships were found between the surface binding constants and the first hydrolysis constants of the metals.

Background: Cervical screening is a procedure that is mainly carried out in primary care, predominantly by general practitioners (GPs) and practice nurses (PNs). Much has been published about the effects on women of receiving an abnormal smear result but little has been done to investigate the preparation of women by primary care professionals for this., Objective: To explore the self-reported behaviours of GPs and PNs in preparing a woman for a cervical smear test and possible abnormal result., Methods: Letters inviting respondents to participate were sent to selected GPs and PNs at medical student teaching practices in Manchester, England. Twelve GPs and 15 PNs were interviewed. Interviews were audiotaped and covered aspects of the cervical screening programme, practice protocols and explored views about consenting a woman for a smear test and the information giving about the possibility of an abnormal test result. Interviews were analysed by constant comparison and the interview schedule modified. Recruitment for interviews ceased when category saturation was achieved., Conclusion: PNs and GPs differed widely in their descriptions of how they prepare a women for a smear. PNs reported following routines which they felt incorporated women's questions and anxieties; GPs reported that the discussion with the woman depended on the reason for doing the smear but also the amount of time available within the consultation. Few respondents reported raising issues of reliability or sensitivity of the test with women, neither did they report discussing with women the possibility of an abnormal smear result or what further investigation and treatment may be required. The degree of persuasion reported by practitioners used to encourage women to attend for smears varied and was related to their attitudes to the national cervical screening programme., Practice Implications: The current system for recall being separate from practice activity, whilst ensuring accuracy of the data-base, may limit the opportunity for information-giving which is sensitive to the needs to the local population. There is a need to include consent issues in the training of PNs, rather than just practical aspects of smear-taking, and to formalise training updates for GPs. In addition, the taking of opportunistic smears and the constraints placed upon time and information-giving need addressing. The role of other primary care staff in encouraging women to attend for smears raises training needs for these staff which practices or primary care trusts must address.