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Antineuronal antibodies are associated with psychosis, although their clinical significance in first episode of psychosis (FEP) is undetermined.
To examine all patients admitted for treatment of FEP for antineuronal antibodies and describe clinical presentations and treatment outcomes in those who were antibody positive.
Individuals admitted for FEP to six mental health units in Queensland, Australia, were prospectively tested for serum antineuronal antibodies. Antibody-positive patients were referred for neurological and immunological assessment and therapy.
Of 113 consenting participants, six had antineuronal antibodies (anti-N-methyl-D-aspartate receptor antibodies [n = 4], voltage-gated potassium channel antibodies [n = 1] and antibodies against uncharacterised antigen [n = 1]). Five received immunotherapy, which prompted resolution of psychosis in four.
A small subgroup of patients admitted to hospital with FEP have antineuronal antibodies detectable in serum and are responsive to immunotherapy. Early diagnosis and treatment is critical to optimise recovery.
Bovine tuberculosis (bTB) is an important disease of cattle caused by infection with Mycobacterium bovis, a pathogen that may be extremely difficult to eradicate in the presence of a true wildlife reservoir. Our objective was to identify and review relevant literature and provide a succinct summary of current knowledge of risk factors for transmission of infection of cattle. Search strings were developed to identify publications from electronic databases to February 2015. Abstracts of 4255 papers identified were reviewed by three reviewers to determine whether the entire article was likely to contain relevant information. Risk factors could be broadly grouped as follows: animal (including nutrition and genetics), herd (including bTB and testing history), environment, wildlife and social factors. Many risk factors are inter-related and study designs often do not enable differentiation between cause and consequence of infection. Despite differences in study design and location, some risk factors are consistently identified, e.g. herd size, bTB history, presence of infected wildlife, whereas the evidence for others is less consistent and coherent, e.g. nutrition, local cattle movements. We have identified knowledge gaps where further research may result in an improved understanding of bTB transmission dynamics. The application of targeted, multifactorial disease control regimens that address a range of risk factors simultaneously is likely to be a key to effective, evidence-informed control strategies.
Children in care often have poor outcomes. There is a lack of evaluative
research into intervention options.
To examine the efficacy of Multidimensional Treatment Foster Care for
Adolescents (MTFC-A) compared with usual care for young people at risk in
foster care in England.
A two-arm single (assessor) blinded randomised controlled trial (RCT)
embedded within an observational quasi-experimental case–control study
involving 219 young people aged 11–16 years (trial registration: ISRCTN
68038570). The primary outcome was the Child Global Assessment Scale
(CGAS). Secondary outcomes were ratings of educational attendance,
achievement and rate of offending.
The MTFC-A group showed a non-significant improvement in CGAS outcome in
both the randomised cohort (n = 34, adjusted mean
difference 1.3, 95% CI −7.1 to 9.7, P = 0.75) and in the
trimmed observational cohort (n = 185, adjusted mean
difference 0.95, 95% CI −2.38 to 4.29, P = 0.57). No
significant effects were seen in secondary outcomes. There was a possible
differential effect of the intervention according to antisocial
There was no evidence that the use of MTFC-A resulted in better outcomes
than usual care. The intervention may be more beneficial for young people
with antisocial behaviour but less beneficial than usual treatment for
Although existing research has shown that depression in parents has a negative effect on parent–child interactions, the mechanisms underpinning impaired parenting are still unknown. In this editorial, we review core difficulties that have been noted in depressed individuals including reduced positive and increased negative affect, poor emotion regulation, executive function deficits, reduced motivation and rumination, and discuss how each of these can alter parenting. We suggest that these causal processes are inter-related and can interact with one another in affecting parenting. We conclude that an improved understanding of these processes will have implications for the development of more specific and potentially more effective treatments that have the potential to break the intergenerational transmission of psychopathology.
The scientific literature contains evidence suggesting that women who have been treated for breast cancer may, as a result of their diagnosis, increase their phyto-oestrogen (PE) intake. In the present paper, we describe the creation of a dietary analysis database (based on Dietplan6) for the determination of dietary intakes of specific PE (daidzein, genistein, glycitein, formononetin, biochanin A, coumestrol, matairesinol and secoisolariciresinol), in a group of women previously diagnosed and treated for postmenopausal breast cancer. The design of the database, data evaluation criteria, literature data entry for 551 foods and primary analysis by LC–MS/MS of an additional thirty-four foods for which there were no published data are described. The dietary intake of 316 women previously treated for postmenopausal breast cancer informed the identification of potential food and beverage sources of PE and the bespoke dietary analysis database was created to, ultimately, quantify their PE intake. In order that PE exposure could be comprehensively described, fifty-four of the 316 subjects completed a 24 h urine collection, and their urinary excretion results allowed for the description of exposure to include those identified as ‘equol producers’.
In this paper we shall look at a technique, known as impurity free vacancy diffusion (IFVD) for selectively altering the optoelectronic response of quantum well material after growth with a view to monolithic device integration. We will discuss the mechanism, practical considerations and some possible applications.
The aim of this study was to estimate the amount of childhood hepatitis B virus transmission in children born in the UK, a very low-prevalence country, that is preventable only by universal hepatitis B immunization of infants. Oral fluid specimens were collected from schoolchildren aged 7–11 years in four inner city multi-ethnic areas and tested for the presence of antibody to hepatitis B core antigen (anti-HBc). Those found positive or indeterminate were followed up with testing on serum to confirm their hepatitis B status. The overall prevalence of anti-HBc in children was low [0·26%, 95% confidence interval (CI) 0·14–0·44]. The estimated average annual incidence of hepatitis B was estimated to be 29·26/100 000 children (95% CI 16·00–49·08). The total incidence that is preventable only by a universal infant immunization programme in the UK was estimated to be between 5·00 and 12·49/100 000. The study demonstrates that the extent of horizontal childhood hepatitis B virus transmission is low in children born in the UK and suggests that schools in the UK are an uncommon setting for the transmission of the virus. Targeted hepatitis B testing and immunization of migrants from intermediate- and high-prevalence countries is likely to be a more effective measure to reduce childhood transmission than a universal infant immunization programme.
The performance of many Si/SiGe devices, particularly those involving modulation doped quantum wells, will depend on the quality of the matrix and doping interfaces involved. These may be adversely affected by profile smearing of Ge and the dopant. A study of boron incorporation in SiGe, as a function of substrate temperature and Ge fraction, shows a marked difference in profile smearing for boron in Si and in the SiGe alloy. This is shown to be associated with a reduction in the temperature for transition from equilibrium to kinetically limited accumulation in the alloy.
A high temperature, elemental boron evaporation source has been used for the study of the boron doping behaviour in Si as a function of growth temperature and doping level. Significant profile smearing of boron at doping levels below 5×1018cm−3 is observed. Profile smearing is more severe in higher doped samples for growth temperatures above 600°C at a growth rate of 0.28 nms−1. This is interpreted as arising from the formation of a surface phase of boron at higher doping levels. The marked improvement in profile abruptness at low temperatures suggests significant benefits associated with the use of an elemental boron source for the growth of high resolution Si/Si1−xGex device structures.
This paper reviews the diverse methods used to achieve doping during MBE of Si and SiGe, and the incorporation processes involved. The optimum choice of dopant and methodology depends on the most appropriate growth conditions for a given structure. At growth temperatures exceeding 750°C, Potential Enhanced n-type doping of coevaporated Sb is capable of achieving high resolution structures, at doping levels up to mid-1019 cm−3. At lower temperatures, such as those most suited to SiGe growth, Sb-doping becomes a formidable challenge, due to the high accumulated equilibrium coverages required. Low energy ion implantation appears to be the favoured route for good control, p-type B-doping can readily be achieved by coevaporation of compounds or, to avoid oxygen incorporation at low temperatures, the element. A “designer” chart for B-doping of Si is presented.
An unlinked anonymous survey was conducted to measure the prevalence of selected markers for HIV, hepatitis B and C infection in recruits to the UK Armed Forces to inform future screening and hepatitis B vaccination policies. During 2007, nearly 14 000 left-over samples taken from new recruits for blood typing were collected, unlinked from identifiers and anonymously tested for HIV, hepatitis C and current and past cleared hepatitis B infection. Overall, serological evidence of HIV and hepatitis C was found in 0·06% and 0·06% of recruits, respectively. Evidence of past cleared and current hepatitis B infection was found in 3·63% and 0·37% of recruits, respectively. Overall, prevalence rates were broadly consistent with UK population estimates of infection. However, HIV and hepatitis B prevalence was higher in recruits of African origin than in those from the UK (P<0·0001). Screening for these infections is an option that could be considered for those entering Services from high-prevalence countries.
The new Core-XAS (X-ray absorption spectroscopy) beamline (B18) at Diamond aims to provide a reliable spectrometer for a broad scientific community. With this in mind, B18 has been built as a general-purpose beamline and offers to users a variety of sample environments and detection methods. Here we will present the first commissioning results and some of the capabilities of this versatile instrument.
Dietary intake of isothiocyanates (ITC) has been associated with reduced cancer risk. The dietary phenethyl ITC (PEITC) has previously been shown to decrease the phosphorylation of the translation regulator 4E binding protein 1 (4E-BP1). Decreased 4E-BP1 phosphorylation has been linked to the inhibition of cancer cell survival and decreased activity of the transcription factor hypoxia-inducible factor (HIF), a key positive regulator of angiogenesis, and may therefore contribute to potential anti-cancer effects of PEITC. In the present study, we have investigated the in vitro and in vivo effects of watercress, which is a rich source of PEITC. We first demonstrated that, similar to PEITC, crude watercress extracts inhibited cancer cell growth and HIF activity in vitro. To examine the effects of dietary intake of watercress, we obtained plasma and peripheral blood mononuclear cells following the ingestion of an 80 g portion of watercress from healthy participants who had previously been treated for breast cancer. Analysis of PEITC in plasma samples from nine participants demonstrated a mean maximum plasma concentration of 297 nm following the ingestion of watercress. Flow cytometric analysis of 4E-BP1 phosphorylation in peripheral blood cells from four participants demonstrated significantly reduced 4E-BP1 phosphorylation at 6 and 8 h following the ingestion of watercress. Although further investigations with larger numbers of participants are required to confirm these findings, this pilot study suggests that flow cytometry may be a suitable approach to measure changes in 4E-BP1 phosphorylation following the ingestion of watercress, and that dietary intake of watercress may be sufficient to modulate this potential anti-cancer pathway.
The degerming effect of a 3 min handwash with 2% triclosan, or 4% chlorhexidine, in detergent and enhanced efficacy of either antiseptic in isopropyl alcohol, was evaluated in volunteers. Handwashing with either antiseptic preparation reduced the normal flora by a factor of 10; alcohol rubbing by approximately a factor of 1000. Both regimens eliminated Micrococcus roseus, artificially inoculated before every procedure. The sustained action of the same detergent preparations was further studied in gloved and ungloved hands by the Vinson's ‘finger imprint test’. In the gloved hand both antiseptics inhibited Staphylococcus epidermidis for 4 h. In the ungloved hand however, triclosan remained active longer than chlorhexidine. Whilst the activity of chlorhexidine was short-lived against a clinical isolate of S. aureus, particularly in the ungloved hand, the sustained effect of triclosan against the same strain persisted for 4 h on either hand.
An outbreak of hepatitis A involved more than 50 residents of a group of villages in the late spring and summer of 1989. The only food that was common to all the laboratory-confirmed cases was bread, purchased either unwrapped or as rolls, sandwiches or filled rolls, and supplied either directly from one shop or indirectly through its subsidiary outlets. It was concluded that this bread was the most likely vehicle of transmission of the hepatitis A virus and that the bread was contaminated by soiled hands which were inadequately washed because of painful skin lesions. Comprehensive control measures were successful in limiting further spread of the infection. This outbreak highlights the transmissibility of hepatitis A virus on food. The use of disposable gloves when handling food which is to be consumed without further cooking would prevent transmission of this or other infectious agents by this route.
Hepatitis C is a global health problem and in the UK seroprevalence studies have mainly concentrated on specific high-risk groups. The aim of this study was to determine changes in the prevalence of antibody to hepatitis C virus in England using residual specimens collected between 1986 and 2000 reflecting the general population. A cross-sectional study design using a convenience collection of serum specimens from adult patients submitted to laboratories in the years 1986, 1991, 1996 and 2000 from a total of 19 laboratories around England were investigated. The main outcome was to determine anti-HCV prevalence and the average incidence occurring between 1986 and 2000 and factors associated with infection. Multivariable analysis of results from all years showed there was a significant difference in prevalence between males and females (P<0·001), birth cohort (P<0·001) and by health region (P<0·001). An average of 0·72% (95% CI 0–1·65%) of those susceptible to HCV born between 1950 and 1970 were estimated to have acquired the infection between 1986 and 2000. Analysis of this convenience serum collection suggests that HCV prevalence is low in the general population, and is associated with period of birth, gender and health region. There was evidence to support a low incidence of HCV infection in those born between 1950 and 1970 over the period 1986–2000 which, at the population level, equated to a substantial burden of infection (~106 000 persons). Continued surveillance and prevention targeted at injecting drug users are essential for the control of hepatitis C in the UK.
Surveillance reports and prevalence studies have indicated that injecting drug users (IDUs) contribute more to the hepatitis C epidemic in the United Kingdom than any other risk group. Information on both the prevalence and incidence of hepatitis C in IDUs is therefore essential to understanding the epidemiology of this infection. The prevalence of hepatitis C in specimens from the Unlinked Anonymous Prevalence Monitoring Programme collected in 1995, 1996, 1998, 1999, 2000, and 2001 was determined using residual syphilis serology specimens from IDUs attending 15 genitourinary medicine (GUM) clinics in and outside London. These specimens were tested for antibodies to hepatitis C virus (anti-HCV). Using this cross-sectional design, anti-HCV-negative specimens were tested for HCV RNA to identify incident infections during the ‘window’ period of infection, and thus to estimate HCV incidence. Results of the multivariable analysis showed that there was marked variation in prevalence by clinic (P<0·0001) and age (P<0·0001). Overall the majority of infections were in males and the overall prevalence in injectors declined over the study period from 36·9% to 28·7%. The annual incidence in these injectors was estimated as being 3·01% (95% CI 1·25–6·73). Over the study period HCV incidence decreased by 1·2% per year. Genotyping of the incident infections identified the most common genotype as type 1 with type 3 being more frequently seen after 1998. Of the prevalent infections, genotype 1 was the most common. The study has confirmed a higher prevalence of anti-HCV in IDUs in the London area compared to those outside London. How representative of the current injecting drug user population are IDUs attending GUM clinics is unclear. Even so, such studies allow prevalence and incidence to be estimated in individuals who have ever injected drugs and inform ongoing public health surveillance.
The prevalence of serious infections caused by multidrug-resistant pathogens transmitted in the hospital setting has reached alarming levels, despite intensified interventions. In the context of mandates that hospitals ensure compliance with disinfection procedures of surfaces in the environment surrounding the patient, we implemented a multihospital project to both evaluate and improve current cleaning practices.
Thirty-six acute care hospitals in the United States ranging in size from 25 to 721 beds.
We used a fluorescent targeting method to objectively evaluate the thoroughness of terminal room disinfection cleaning before and after structured educational and procedural interventions.
Of 20,646 standardized environmental surfaces (14 types of objects), only 9,910 (48%) were cleaned at baseline (95% confidence interval, 43.4-51.8). Thoroughness of cleaning at baseline correlated only with hospital expenditures for environmental services personnel (P = .02). After implementation of interventions and provision of objective performance feedback to the environmental services staff, it was determined that 7,287 (77%) of 9,464 standardized environmental surfaces were cleaned (P < .001). Improvement was unrelated to any demographic, fiscal, or staffing parameter but was related to the degree to which cleaning was suboptimal at baseline (P < .001).
Significant improvements in disinfection cleaning can be achieved in most hospitals, without a substantial added fiscal commitment, by the use of a structured approach that incorporates a simple, highly objective surface targeting method, repeated performance feedback to environmental services personnel, and administrative interventions. However, administrative leadership and institutional flexibility are necessary to achieve success, and sustainability requires an ongoing programmatic commitment from each institution.