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Trends in detention under the Mental Health Act 1983 in two major London secondary mental healthcare providers were explored using patient-level data in a historical cohort study between 2007–2008 and 2016–2017. An increase in the number of detention episodes initiated per fiscal year was observed at both sites. The rise was accompanied by an increase in the number of active patients; the proportion of active patients detained per year remained relatively stable. Findings suggest that the rise in the number of detentions reflects the rise of the number of people receiving secondary mental healthcare.
This work describes exploration of mitigating the parasitic amorphous alumina (Al2O3) shell of aluminum nanoparticles (n-Al) and modifying the surface using different plasmas, leading to n-Al with thinner shell and different coatings including carbons and oxidizing salt called aluminum iodate hexahydrate (AIH), respectively. The approach exploits a prototype atmospheric non-thermal plasma reactor with dielectric barrier discharge (DBD) configuration for nanoparticle surface modifications using n-Al of 80 nm average diameter as an example. Preliminary results indicate that the amorphous Al2O3 shell surrounding the active aluminum core can be mitigated with inert plasmas by as much as 40% using either helium (He) or argon (Ar). The particle surface becomes carbon-rich with carbon monoxide (CO) / He plasmas. By immersing the plasma-treated n-Al in an iodic acid (HIO3) solution, AIH crystals can be formed on the n-Al surface. Transmission electron microscopy (TEM) is used as a major tool to study the details of the modified surface morphologies, diffraction patterns, and chemical composition of the modified n-Al. The results demonstrate effective surface passivation of n-Al via atmospheric plasma techniques.
Switching antipsychotic medications is common in patients with schizophrenia who are experiencing persistent symptoms or tolerability issues associated with their current drug regimen. This analysis assessed the safety of switching from an oral antipsychotic to the long-acting injectable antipsychotic aripiprazole lauroxil (AL).
This was a post hoc analysis of outpatients with schizophrenia who were prescribed an oral antipsychotic and who enrolled in an international, open-label, long-term (52-week) safety study of AL. The analysis focused on the first 3 injections of AL 882 mg over 12 weeks, divided into the immediate 4-week crossover period between the first and second AL injections (initiation phase) and the subsequent 8 weeks (stabilization phase). Patients were grouped by preswitch oral antipsychotic medication, and safety and clinical symptoms were assessed.
In total, 190 patients had switched from one of the following oral antipsychotic medications: aripiprazole, conventional antipsychotics, risperidone/paliperidone, olanzapine, or quetiapine. The 12-week completion rate was high (92.1%) and similar across the different preswitch oral antipsychotic groups. Overall, adverse event (AE) rates experienced over 12 weeks were modest; no AEs were considered serious. The most common AEs in the initiation phase were injection site pain (5.8%), insomnia (5.8%), and akathisia (3.2%). No apparent relationship was observed between preswitch medication and early-onset AEs. Mean Positive and Negative Syndrome Scale total scores remained stable during this period across preswitch antipsychotic groups.
Switching from an oral antipsychotic to AL was feasible in an outpatient setting for patients with schizophrenia, and the 12-week retention rate was favorable.
Serious mental illness (SMI, including schizophrenia, schizoaffective disorder, and bipolar disorder) is associated with worse general health. However, admissions to general hospitals have received little investigation. We sought to delineate frequencies of and causes for non-psychiatric hospital admissions in SMI and compare with the general population in the same area.
Records of 18 380 individuals with SMI aged ⩾20 years in southeast London were linked to hospitalisation data. Age- and gender-standardised admission ratios (SARs) were calculated by primary discharge diagnoses in the 10th edition of the World Health Organization International Classification of Diseases (ICD-10) codes, referencing geographic catchment data.
Commonest discharge diagnosis categories in the SMI cohort were urinary conditions, digestive conditions, unclassified symptoms, neoplasms, and respiratory conditions. SARs were raised for most major categories, except neoplasms for a significantly lower risk. Hospitalisation risks were specifically higher for poisoning and external causes, injury, endocrine/metabolic conditions, haematological, neurological, dermatological, infectious and non-specific (‘Z-code’) causes. The five commonest specific ICD-10 diagnoses at discharge were ‘chronic renal failure’ (N18), a non-specific code (Z04), ‘dental caries’ (K02), ‘other disorders of the urinary system’ (N39), and ‘pain in throat and chest’ (R07), all of which were higher than expected (SARs ranging 1.57–6.66).
A range of reasons for non-psychiatric hospitalisation in SMI is apparent, with self-harm, self-neglect and/or reduced healthcare access, and medically unexplained symptoms as potential underlying explanations.
Supraglacial streams are important hydrologic features in glaciated environments as they are conduits for the transport of aeolian debris, meltwater, solutes and microbial communities. We characterized the basic geomorphology, hydrology and biogeochemistry of the Cotton Glacier supraglacial stream located in the McMurdo Dry Valleys of Antarctica. The distinctive geomorphology of the stream is driven by accumulated aeolian sediment from the Transantarctic Mountains, while solar radiation and summer temperatures govern melt in the system. The hydrologic functioning of the Cotton Glacier stream is largely controlled by the formation of ice dams that lead to vastly different annual flow regimes and extreme flushing events. Stream water is chemically dilute and lacks a detectable humic signature. However, the fluorescent signature of dissolved organic matter (DOM) in the stream does demonstrate an extremely transitory red-shifted signal found only in near-stream sediment leachates and during the initial flushing of the system at the onset of flow. This suggests that episodic physical flushing drives pulses of DOM with variable quality in this stream. This is the first description of a large Antarctic supraglacial stream and our results provide evidence that the hydrology and geomorphology of supraglacial streams drive resident microbial community composition and biogeochemical cycling.
The aim of the present study was to report the survival outcomes and late toxicity of high-dose-rate brachytherapy (HDRBT) boost for dose escalation in patients with intermediate-to-high-risk prostate cancer.
Materials and methods
Retrospective data were collected from 137 patients who had undergone definitive radiotherapy for prostate cancer between 2006 and 2010. All patients had external-beam radiotherapy (median dose 46Gy) and HDRBT. Brachytherapy dose was 19Gy in two fractions (6 hours apart) with one implant using Ir-192.
There were 94 high-risk and 43 intermediate-risk patients (NCCN classification). The median follow-up period was 60 months. The 5-year biochemical progression-free survival was 92 and 76% for intermediate- and high-risk groups, respectively. Prostate cancer-specific survival for the intermediate-risk group was 100% and for the high-risk group it was 92% at 5 years. For the entire cohort, the 5-year rate of urethral stricture formation was 13%, and the 5-year rate of late grade 2 and grade 3 gastrointestinal toxicity was 4·7 and 4·6%, respectively. There was no grade 3 or greater genitourinary toxicity.
Our data add to the growing body of literature supporting the use of HDRBT in prostate cancer. Late toxicity rates were marginally higher than that expected.
Nasolacrimal duct obstruction is common and is usually a result of benign stricture formation. Although neoplasia near or around the lacrimal system may produce epiphora, the incidence of neoplasia from within the lacrimal system as a cause of nasolacrimal duct obstruction is not well documented.
A retrospective study was performed on all patients undergoing dacryocystorhinostomy with a history of epiphora. The incidence of patients with operative findings of intra-lacrimal neoplasm was sought. Histopathologically confirmed cases were included.
The study comprised 537 patients, who underwent a total of 631 endoscopic dacryocystorhinostomy procedures between January 1998 and July 2013. Non-stenotic causes of nasolacrimal duct obstruction were encountered in 3.01 per cent of dacryocystorhinostomy procedures, and included neoplastic, inflammatory and infectious pathologies. Inverted papilloma was the most common cause, encountered in 0.79 per cent of dacryocystorhinostomy operations.
These findings suggest that neoplasia is an uncommon but not a rare cause of nasolacrimal duct obstruction. Surgical teams performing high numbers of dacryocystorhinostomy procedures should be aware of such pathology and patients counselled appropriately.
A radio-frequency magnetron sputtering technique and subsequent rapid thermal annealing (RTA) at 600, 700, 800, and 900 °C were implemented to grow high-quality Ga-doped MgxZn1-xO (GMZO) epi-layers. The GMZO films were deposited using a radio-frequency magnetron sputtering system and a 4 inch ZnO/MgO/Ga2O3 (75/20/5 wt %) target. The Hall results, X-ray diffraction (XRD), and transmittance were determined and are reported in this paper. The Hall results indicated that the increase in mobility was likely caused by the improved crystallization in the GMZO films after thermal annealing. The XRD results revealed that MgxZn1-xO (111) and MgO2 (200) peaks were obtained in the GMZO films. The absorption edges of the as-grown and annealed GMZO films shifted toward the short wavelength of 373 nm at a transmittance of 90%. According to these results, GMZO films are feasible for forming transparent contact layers for near-ultraviolet light-emitting diodes.
Correlating patient perception of nasal obstruction sidedness to causative anatomy is important in surgical planning. The accuracy of patient-perceived asymmetry of nasal obstruction, as regards objective measures, is described.
Cross-sectional study of patients undergoing nasal airflow assessment. Unilateral obstruction was assessed using visual analogue scale scores and anterior rhinomanometry, without decongestion. Subjective obstruction asymmetry was defined using either the absolute score difference (right vs left) or the minimal clinically important difference, derived statistically. Correlation between subjective and objective obstruction measures was assessed.
In 145 patients (mean age ± standard deviation, 42.8 ± 16.6 years; 54.5 per cent female), objective obstruction was right-sided in 32.4 per cent, left-sided in 36.6 per cent and symmetrical in 31.0 per cent. Subjective perception of obstruction sidedness had a sensitivity and specificity of 86.9 and 41.1 per cent, respectively, using the minimal clinically important difference. Positive predictive value was 59.4 per cent using absolute score difference and 53.7 per cent using minimal clinically important difference. Receiver operator characteristic curve analysis indicated correlation between subjective and objective measures (p < 0.001).
Subjective perception of nasal obstruction asymmetry has limited accuracy. Corroboration with objective airway assessment may be helpful in patients whose symptoms are incongruous with clinical findings.
Effective tissue removal techniques are essential in endoscopic skull base surgery. Improvements in technology permit more accurate application of CO2 laser and coblation during endonasal procedures. This study assessed the thermal injury patterns associated with fibre CO2 laser and coblation.
Fresh frozen cadaveric heads were used. Mucosal removal was performed at the ethmoid roof. Structured lesions were created using either CO2 laser or coblation. The corresponding thermal injury patterns on dural tissue were assessed and compared between the two groups.
Five cadaveric heads were obtained; five sides received CO2 laser lesions and five coblation lesions. Forty per cent (n = two sides) of the CO2 specimens had macroscopic foci of grey-black discolouration on the dural aspect. No macroscopic dural changes were seen in the coblation specimens.
Dural injury was seen following CO2 laser use despite attempts to avoid it. Both CO2 laser and coblation have their advantages; however, the lower thermal working power of coblation and superior depth control may make it more suitable for endoscopic endonasal periorbital and peridural surgery.
To assess the clinical and radiological characteristics of the posterior prolongation of the cartilaginous nasal septum, an under-utilised source of autologous cartilage for nasal reconstruction.
Materials and methods:
Consecutive patients undergoing primary, external approach rhinoplasty were included. The septal cartilage was assessed intra-operatively prior to routine harvest. Cartilage use was recorded and post-operative cosmesis noted. Computed tomography scans from a separate patient group, with no septal surgery, were used to assess septal cartilage dimensions.
Of the 25 rhinoplasty patients studied, 24 had harvestable septal cartilage, with a posterior prolongation mean length ± standard deviation of 24.3 ± 8.40 mm, mean height of 4.33 ± 0.34 mm and mean width of 1.1 ± 0.35 mm. The mean post-operative cosmesis score was +2.41 ± 0.71 at a mean follow up of 45 ± 8.7 weeks. All 25 radiology patients had visible posterior prolongations on computed tomography (mean length, 18.1 ± 5.1 mm; mean height, 4.2 ± 1.1 mm; mean width 1.5 ± 0.63 mm).
Harvesting of the posterior prolongation would increase by 25 per cent the cartilage area available for autologous grafts. Endoscopic guidance aids this process. Cartilage is most commonly used for overlay grafts, with good cosmesis. The posterior prolongation is demonstrated on computed tomography, although dimensions may be underestimated.
The formation and strength of dislocations in the hexagonal closed-packed material are studied through dislocation junctions and the critical stress required to completely break them. Dislocation dynamics calculations of junctions are compared to an analytical line tension approximation in order to verify the simulations. Results show agreements between the models. Also the critical shear stress necessary to break a short and a long dislocation junction is computed numerically. Unzipping envelopes are mapped out for these junctions to describe their stability regions as functions of resolved shear stresses on the glide planes. The example of two non-coplanar binary dislocation junctions with slip systems [2 -1 -1 0] (0 1 -1 0) and [-1 2 -1 0] (0 0 0 1) corresponding to a prismatic and basal slip respectively is chosen to verify and validate our implementation.
Disruption of cell membranes triggers rapid metabolic energy exhaustion, then acute cellular necrosis. Cell membrane dysfunction due to loss of structure integrity is the pathology of tissue death in trauma, muscular dystrophies, reperfusion injuries and common diseases. It is now established that certain PEG-based biocompatible polymers, such as Poloxamer 188, Poloxamine 1107 and PEG, are effective in sealing of injured cell membranes, and thus can prevent acute necrosis if delivered within a few hours after injury. Despite these broad applications of PEG-based polymers for human health, the fundamental mechanisms of how PEG-based polymers interact with cell membranes are still under debate. Here, the effects of PEG-based biocompatible polymers on phospholipid membrane integrity under external stimuli (osmotic stress and oxidative stress) were explored using giant unilamellar vesicles (GUVs) as model cell membranes. Through fluorescence leakage assays and time-lapse fluorescence microscopy, we directly observed that the surface-adsorbed P188 can efficiently inhibits the loss of structural integrity of giant unilamellar vesicles (GUVs) under hypo-osmotic stress. We propose that the adsorption of polymers on the membrane surface is responsible for the cell membrane resealing process, while the insertion of the hydrophobic portion of the polymers increases membrane permeability. To elucidate the mechanism by which hydrophilic polymers help restore membrane integrity while their hydrophobic counterparts disrupt it, 1H Overhauser Dynamic Nuclear Polarization (ODNP)-NMR spectroscopy, a newly developed NMR technique that provides unprecedented resolution for differentiating weak surface adsorption versus translocation of polymers to membranes, was employed to sensitively detect polymer-lipid membrane interactions through the modulation of local hydration dynamics in lipid membranes. Our study shows that P188—the most hydrophilic poloxamer known as a membrane sealant—weakly adsorbs onto the membrane surface, yet effectively retards membrane hydration dynamics. Contrarily, P181—the most hydrophobic poloxamer known as a membrane permeabilizer—initially penetrates past lipid headgroups and enhances intrabilayer water diffusivity. Consequently, our results illustrate that the relative hydrophilic/hydrophobic ratio of the polymer dictates its functions. These findings gleaned from local hydration dynamics are well supported by our thermodynamics and fluorescence data.