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Severe longitudinally extensive transverse myelitis (LETM) can cause quadriplegia, marked sensory dysfunction, and respiratory failure. Some patients are unresponsive to conventional immune therapy. We report two cases of severe immune-mediated LETM requiring intensive care admission that failed to respond to high-dose corticosteroids, plasma exchange, intravenous immunoglobulin, and rituximab. Disease cessation and significant recovery was achieved after cyclophosphamide induction. In patients with severe acute immune-mediated LETM who fail to respond to corticosteroids and plasma exchange, cyclophosphamide induction should be considered. This agent and regimen provides a robust immunosuppressive response and can be induced rapidly. Cyclophosphamide effects and supportive evidence are discussed.
With the continued implementation of the personalisation policy, Personal Budgets (PBs) have moved to the mainstream in adult social care in England. The relationship between the policy goals of personalisation and safeguarding is contentious. Some have argued that PBs have the potential to empower recipients, while others believe PBs, especially Direct Payments, might increase the risk of abuse.
This paper provides empirical evidence about levels of uptake of PBs and safeguarding referrals in England based on in-depth analysis of national data at aggregate, local council level in England, covering 152 Councils. This is complemented by analysis of 2,209 individual referral records obtained from three purposively selected study sites. The aim is to explore whether available data could provide evidence of association between the uptake of PBs and safeguarding referrals. Analysis of the national dataset found no significant relationships between PB uptake and the level and type of alleged abuse. However, analysis of individual-level referral data, from the three selected sites did find some significant associations particularly with financial abuse; and found the main perpetrators of the alleged abuse to be home-care employees. The findings are discussed within the context of current policy and practice.
Altitudinal transects of biodiversity are important to understanding macro-ecological patterns. Hump-shaped altitudinal profiles in species richness are a common pattern in terrestrial small-mammal communities studied previously mostly in New World mountain ranges. Based on capture–mark–recapture live-trapping conducted over four seasons (four nights per session) along an altitudinal transect from 1000 to 1747 m asl on the southern slopes of the Soutpansberg Mountains of northern South Africa, we recorded 12 species of small mammal, including nine rodents, two shrews and one elephant shrew (sengi). Three species of rodent and the sengi dominated the communities whilst six species were recorded with three or fewer captures. Although we found no effect of season, we found a significant linear increase in terrestrial small-mammal richness (but not Simpson's diversity, D) with altitude in the Soutpansberg Mountains located just north of the Tropic of Capricorn in South Africa. This trend could best be explained by an increase in the proportion of rocky cover and a change in vegetation from savanna to grassland. Peak densities of three common rodent species and one common insectivore varied from 10 ha−1 (Elephantulus myurus) to 54 ha−1 (Micaelamys namaquensis) and density showed no significant variation with season. However, density either declined (Aethomys ineptus) or increased (Rhabdomys dilectus and Elephantulus myurus) significantly with altitude; this variation was best explained by the proportion of rocky cover. Seasonal variation had a significant effect on body mass of two rodent species. A review of small-mammal studies from major mountain ranges in Africa and Madagascar found that the hump-shaped pattern is not common. Declines in richness with increasing altitude as well as cases of no significant altitudinal change were the most common patterns noted. Tropical African mountains (including the Soutpansberg with 27 species) have far higher small-mammal diversity than temperate African mountains.
Little is known about how age influences the ways in which cardiac fibroblasts interact with the extracellular matrix. We investigated the deformation of collagen substrates by neonatal and adult rat cardiac fibroblasts in monolayer and three-dimensional (3D) cultures, and quantified the expression of three collagen receptors [discoidin domain receptor (DDR)1, DDR2, and β1 integrin] and the contractile protein alpha smooth muscle actin (α-SMA) in these cells. We report that adult fibroblasts contracted 3D collagen substrates significantly less than their neonate counterparts, whereas no differences were observed in monolayer cultures. Adult cells had lower expression of β1 integrin and α-SMA than neonate cultures, and we detected significant correlations between the expression of α-SMA and each of the collagen receptors in neonate cells but not in adult cells. Consistent with recent work demonstrating age-dependent interactions with myocytes, our results indicate that interactions between cardiac fibroblasts and the extracellular matrix change with age.
The continental shelf waters around the UK and Ireland cover an area of over 1,500,000 km2, nearly five times that of the land area. Much of this remains unexplored, but with recent advances in technology we are beginning to get a picture of a complex area with vast sedimentary plains and dramatic underwater mountain ranges and canyons. For too long the seas have been regarded as an indestructible and inexhaustible resource, but it is now becoming increasingly apparent that we have been systematically damaging it and we are rapidly reaching the point where irreversible damage may have been done.
In the last 20 years, significant measures have been taken to address some of these abuses, and the UK Marine and Coastal Access Act, together with the Marine (Scotland) Bill promise even greater powers to manage activities in the marine environment and protect the most fragile and special habitat and communities with Marine Protected Areas. There is, however, still further work required, as to how broad-scale conservation and protection can be achieved. This progress is not before time, but it occurs in the face of the even greater challenges of climate change and ocean acidification. It is important, having recognised these threats and their implications for the basis of marine ecosystems, that action is taken now to minimise the inevitable impact.
Standing on the shore, looking out to sea with an uninterrupted view, a person of average height can see to the horizon about 5 km away.
Aerial surveys of harbour seals (Phoca vitulina) are usually carried out to provide an index of population size. This can be normalized, either by design or by post-hoc analysis to reduce the effects that date, time of day, tide and weather might have on the number of seals counted. In order for long-term trends to be determined from these counts it is assumed that the mean number of seals at a particular site does not vary during the survey period, and that the start and duration of the survey window does not vary with location or between years. This study used a combination of repeat land-based and aerial surveys to test the assumption for constancy of counts during the survey period. The study focused on harbour seal abundance at haul-out sites around the Isle of Skye in north-west Scotland. The coefficient of variation in these counts was estimated to be 15%, based on repeat aerial surveys using thermal imaging. Land-based counts were used to examine the effect of covariates on seal numbers using generalized additive modelling. This site-specific model predicted that the current aerial survey window for harbour seals in the UK, which is a three-week period during the moult, is about a week too early and that count variation could be reduced by surveying 1 1/2 hours earlier in the tidal cycle. Furthermore, the pupping period showed even higher (though more variable) abundance of hauled out seals than during the moult.
Screening for alcohol use disorders identifies a wide range of needs, varying from hazardous and harmful drinking to alcohol dependence. Stepped care offers a potentially resource-efficient way of meeting these needs, but requires evaluation in a randomised controlled trial.
To evaluate the feasibility, effectiveness and cost-effectiveness of opportunistic screening and a stepped care intervention in primary care.
A total of 1794 male primary care attendees at six practices in South Wales were screened using the Alcohol Use Disorders Identification Test (AUDIT). Of these, 112 participants who scored 8 or more on the AUDIT and who consented to enter the study were randomised to receive either 5 minutes of minimal intervention delivered by a practice nurse (control group) or stepped care intervention consisting of three successive steps (intervention group): a single session of behaviour change counselling delivered by a practice nurse; four 50-minute sessions of motivational enhancement therapy delivered by a trained alcohol counsellor; and referral to a community alcohol treatment agency.
Both groups reduced alcohol consumption 6 months after randomisation with a greater, although not significant, improvement for the stepped care intervention. Motivation to change was greater following the stepped care intervention. The stepped care intervention resulted in greater cost savings compared with the minimal intervention.
Stepped care was feasible to implement in the primary care setting and resulted in greater cost savings compared with minimal intervention.
King Alfred's version of St Augustine's Soliloquies contains a famous allusion to the process of tenurial patronage:
Every man likes, when he has built up a farm on his lord's lease with his help, to stay there some time … and to work for himself on the lease both on sea and on land, until the time when he shall earn bookland and eternal inheritance through his lord's kindness.
This paper is concerned with the various forms of patronage to which Alfred alludes: bookland, land which was not bookland, and leased land (Old English lænland). Its argument comes in two halves. The first half sketches a model of land tenure in late Anglo-Saxon England which stresses the importance of land leased to royal officials on an ex officio basis for the duration of their period in office, and offers a corrective to the view, implicit in much of the literature, that grants by royal diploma were the principal instrument of royal patronage in late Anglo-Saxon England. The second half uses a case study of Bampton hundred in Oxfordshire in the tenth and eleventh centuries to illustrate some of the points made in the first. Bampton hundred has been selected because it affords remarkably clear evidence that late Anglo-Saxon kings could exercise patronage in various ways, for numerous beneficiaries, in a powerful and well co-ordinated manner. It also supplies an unusually well documented example of one of the most important developments in the tenurial structure of late Anglo-Saxon England: the process of manorial fission which caused large tenurial units to fragment into much smaller units of lordship.
Acetylsalicylic acid (aspirinTM; 2-acetoxybenzoic acid) has been used for >100 years for pain relief and to treat inflammatory conditions and fevers. More recently, regular intake has been associated with decreased incidence of certain cancers, particularly colon cancer. After absorption aspirin is very rapidly hydrolysed to salicylic acid (2-hydroxybenzoic acid). The anti-cancer effects of aspirin may be a result of salicylic acid reducing the transcription of prostaglandin H2-synthase and thereby the synthesis of pro-inflammatory and potentially-neoplastic prostaglandins. Salicylic acid is widely present in plants and functions as a hormonal mediator of the systemic acquired resistance response to pathogen attack and environmental stress. Thus, it is present in a large range of fruit, vegetables, herbs and spices of dietary relevance. Consequently, the recognised effect of consuming fruit and vegetables on lowering risk of colon cancer may be partly attributable to salicylates in plant-based foods. The present review discusses which types of fruit and vegetables are the richest source of salicylates and whether they are sufficiently released from the food matrix to modify the key cellular events associated with the pathogenesis of colon cancer.
People with schizophrenia make poor dietary choices.
To measure the impact of giving free fruit and vegetables for 6 months on eating habits in schizophrenia.
We randomly allocated 102 people with schizophrenia in two areas of Scotland to receive free fruit and vegetables for 6 months, supported by instruction in meal planning and food preparation; free fruit and vegetables alone; or to continue as before. Diet was assessed using the Scottish Health Survey questionnaire. Blood samples to measure micronutrients were taken and mental state, body mass index, level of physical activity and future risk of coronary heart disease (CHD) were assessed.
After the intervention, those who received free fruit and vegetables, or free fruit and vegetables and associated instruction, were consuming significantly more fruit and vegetables than those in the treatment as usual group. Consumption fell to pre-intervention levels 12 months after the intervention stopped. There was no between-group difference at any time in blood micronutrients, body mass index, physical activity or risk of CHD.
The diet of people with schizophrenia improved when they were given free fruit and vegetables but this was not sustained after withdrawal of the intervention. A support programme added no benefit.
The perceptions and expectations by referrers of assessments performed by a medium secure unit were examined in order to ascertain areas for possible improvement. All referrals to two teams at the North West Thames Regional Secure Unit were monitored over a 6-month period. A self-report questionnaire was sent to each referrer, in cases where an assessment and forensic report had been completed.
Assessments and forensic reports were completed (and questionnaires sent to referrers) in 63% of total referrals (32 out of 51). The response rate to the questionnaire was 81% (26 out of 32). Many referrers wanted the assessments and report to be completed in 2 weeks. Most referrers were satisfied with the quality of the report received and the majority were happy with the risk assessment.
Referrers want forensic assessments to be of a high quality and to be performed quickly. Recommendations for service development are suggested.
It is now well established that children construct their own explanations for the easily observed astronomical events before they receive any formal education in astronomy (see Mali & Howe, 1985; Nussbaum & Novak, 1976; Vosnaidou, 1991. It is also generally accepted that childrens notions, or ‘alternative frameworks’ are tenacious and frequently pass into adulthood (Gunstone et al, 1981). Baxter's (1989) survey revealed a hierarchy of alternative frameworks about astronomy that became less naive as age increases, but also revealed that many pupils leaving school at the age of 16 years did not explain the easily observed astronomical events within a post-Copernican framework.
Poly dor a ciliata (Johnston) is a polychaete which lives in a U-shaped tube and is found in a wide variety of substrata, ranging from soft clays or muds to hard calcareous materials. Cliona celata Grant is a siliceous sponge which inhabits tunnels and galleries it has etched out in limestone, coral or molluscan shells. The effects of these two species of boring organisms on their hosts have been studied mainly for commercially important molluscs. Hannerz (1956) is the only record of P. ciliata infectingPatella vulgata L, and there is no previous record of anyCliona spp., infections.
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