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The term ‘mood stabiliser’ is ill-defined and lacks clinical utility. We propose a framework to evaluate medications and effectively communicate their mood stabilising properties – their acute and prophylactic efficacy across the domains of mania and depression. The standardised framework provides a common definition to facilitate research and clinical practice.
Declaration of interest
The Treatment Algorithm Group (TAG) was supported logistically by Servier who provided financial assistance with travel and accommodation for those TAG members travelling interstate or overseas to attend the meeting in Sydney (held on 18 November 2017). None of the committee were paid to participate in this project and Servier have not had any input into the content, format or outputs from this project.
Psychiatric in-patients are often transferred to an emergency department for care of minor wounds, incurring significant distress to the patient and cost to the service.
To improve superficial wound management in psychiatric in-patients and reduce transfers to the emergency department.
Thirty-four trainees attended two peer-led suturing and wound management teaching sessions, and a suturing kit box was compiled and stored at the Royal Edinburgh Hospital. Teaching was evaluated using Kirkpatrick's model, and patient transfer numbers were acquired by reviewing in-patient Datix reports and emergency department case notes for 6 months before and after teaching.
The proportion of patients transferred to the emergency department decreased significantly from 90% 6 months before the workshop to 30% 6 months after (P < 0.05). Trainees engaged positively and there was a significant increase in self-confidence rating following the workshop (P < 0.05). The estimated cost saving per transfer was £183.76.
The combination of a peer-led workshop and on-site suturing kit box was effective in reducing transfers to the emergency department and provided a substantial cost saving.
Collagen associated with bone samples is frequently used for radiocarbon (14C) dating of bones recovered from archaeological sites. However, submersion and exposure to moisture favors the degradation of collagen, which leads to difficulty in reliably dating bones from tropical, humid, or previously submerged archaeological sites. In this paper, we characterized the preservation state of a series of bones, through parameters such as %C, %N, C/N ratio, and collagen recovery. We performed 14C analyses of three collagen fractions obtained through the pretreatment steps (total, ultrafiltered, and insoluble collagen) in order to link the preservation state and the reproducibility of 14C values obtained from the three fractions. Collagen ultrafiltration resulted in a decrease of C/N ratio, although collagen yield was reduced. When two or three collagen fractions were obtained, ages were reproducible and consistent with expected values, according to archaeological or hydrogeological criteria. The pretreatment steps were monitored by infrared spectroscopy in order to analyze the collagen fractions at the molecular level. The presence of collagen in the total and insoluble fractions was confirmed. Since many of the Mexican samples had poor ultrafiltered collagen yield (<3%) or nonexistent yield, our results show that if additional contextual information is carefully considered, the remnant collagen in the total and insoluble fraction can be dated, especially from sites where no other datable fraction exists.
Pale soft exudative pork (PSE) is a major problem affecting swine industries worldwide that results in significant economic loss because it reduces processing and saleable product yields. The PSE condition results from a rapid rate of muscle glycolysis early postmortem and a rapid drop in muscle pH while the temperature of the carcass is still high. Stress prior to slaughter can increase the rate of glycolysis and postmortem acidification. Blood acid-base has been used as an indicator of stress in pigs. The objective of this experiment was to investigate the relationship between blood acid-base status at slaughter and fresh meat quality in pigs.
We present δ13C, δ15N, and δ34S measurements on archaeological human and animal bone collagen samples from a shell midden dating to the Neolithic ca. 4000–3500 cal BC, together with measurements on modern fish and shellfish. These data were used in conjunction with the Bayesian mixing model, Food Reconstruction Using Isotopic Transferred Signals (FRUITS), to reconstruct human diet at the site. We demonstrate the importance of using a geographically appropriate faunal baseline in stable isotope paleodietary studies, and suggest that Neolithic individuals at this site consumed up to ca. 21% of dietary protein from marine resources, despite stable isotope ratios that imply a wholly terrestrial diet. This marine resource consumption does not significantly shift the radiocarbon (14C) dates of these individuals, so although we must consider the use of marine resources at the site, the chronology that has previously been established is secure. The δ13C and δ15N measurements from the archaeological herbivore bone collagen indicate that it is unlikely they ate plants enriched with fertilisers such as manure or seaweed. The δ34S values reveal a sea-spray effect; therefore, in this instance, δ34S cannot be used as a dietary indicator but can be used to demonstrate the likely locality of the fauna.
Bone is frequently dated in archaeological studies and, especially for very old bones (more than 40,000 years old), it is critical to have an accurate and precise measure of the material-specific background value and its associated uncertainty. The SUERC Radiocarbon Laboratory has obtained a mammoth bone as a background bone standard and an appropriate number are now routinely prepared and measured in each AMS batch, resulting in the accumulation of a large number of background bone results over a two-year period. Additionally, information on which of the two accelerator mass spectrometry (AMS) instruments was used to make the radiocarbon (14C) measurements, and which sample pretreatment method (modified Longin or modified ultrafiltration) was used to extract and purify the collagen, is recorded for each sample. These data have been used to estimate the laboratory bone background (to be subtracted from each unknown bone sample prepared in the laboratory) and its associated analytical uncertainty. The statistical analysis of the bone results has made use of a linear mixed effects model to examine the variation, and to apportion the overall variation between and within batches on both AMS instruments, and the different pretreatment methods used at SUERC.
The SUERC Radiocarbon Laboratory employs a one-step “background subtraction” method when calculating 14C ages. An interglacial wood (VIRI Sample K) is employed as the non-bone organic background standard, while a mammoth bone (LQH12) from Latton Quarry is used as the bone background standard. Results over several years demonstrate that the bone background is consistently around a factor of two higher and more variable than the wood background. As a result, the uncertainty on routine bone measurements is higher than for other sample types. This study investigates the factors that may contribute to the difference in F14C values and the higher variability. Preparations of collagen using modified Longin or ultrafiltration methods show no significant difference, nor does eliminating the collagen dissolution step. Two bone samples of known infinite age with respect to radiocarbon are compared and again no significant difference is observed. Finally, the quantity and age of the organic matter in the water used during the pretreatment is investigated and it is shown that there is insufficient organic matter in the reverse osmosis water to influence background values significantly. The attention is now on determining if incomplete demineralization could lead to contaminants being retained by the phosphate in the hydroxyapatite.
Targets have been developed to measure supersonic radiation transport in aerogel foams using absorption spectroscopy. The target consists of an aerogel foam uniformly doped with either titanium or scandium inserted into an undoped aerogel foam package. This creates a localized doped foam region to provide spatial resolution for the measurement. Development and characterization of the foams is a key challenge in addition to machining and assembling the two foams so they mate without gaps. The foam package is inserted into a beryllium sleeve and mounted on a gold hohlraum. The target is mounted to a holder created using additive manufacturing and mounted on a stalk. The manufacturing of the components, along with assembly and metrology of the target are described here.
Radiocarbon (14C) dating is used widely in many projects as a basis for the creation and testing of chronological constructs. 14C measurements are by their nature complex and the degree of sample pretreatment varies considerably depending on the material. Within the United Kingdom and Europe, there are a number of well-established laboratories and increasingly, archaeologists are not just commissioning new dates, but also using statistical modelling of assemblages of dates, perhaps measured in different laboratories, to provide formal date estimates for their sites. The issue of comparability of measurements (and thus bias, accuracy and precision of measurement) from the diverse laboratories is one which has been the focus of some attention both within the 14C community and the wider user communities for some time. As a result of this but also as part of laboratory benchmarking and quality assurance, the 14C community has undertaken a wide-scale, far-reaching, and evolving program of intercomparisons, to the benefit of laboratories and users alike. This paper summarizes the most recent exercise, the Sixth International Radiocarbon Intercomparison (SIRI).
Cryogenic detectors for gravitational wave astronomy promise greatly improved sensitivity over room temperature detectors. The 3 mK detector which we have under construction should give an improvement of 106 over existing detectors. The cryogenic antennae are described and the calculated low temperature performance is detailed. New superconducting instrumentation is described.
Older people with dementia are at increased risk of physical decline and falls. Balance and mood are significant predictors of falls in this population. The aim of this study was to determine the effect of a tailored home-based exercise program in community-dwelling older people with dementia.
Forty-two participants with mild to moderate dementia were recruited from routine health services. All participants were offered a six-month home-based, carer-enhanced, progressive, and individually tailored exercise program. Physical activity, quality of life, physical, and psychological assessments were administered at the beginning and end of the trial.
Of 33 participants (78.6%) who completed the six-month reassessment ten (30%) reported falls and six (18%) multiple falls during the follow-up period. At reassessment, participants had better balance (sway on floor and foam), reduced concern about falls, increased planned physical activity, but worse knee extension strength and no change in depression scores. The average adherence to the prescribed exercise sessions was 45% and 22 participants (52%) were still exercising at trial completion. Those who adhered to ≥70% of prescribed sessions had significantly better balance at reassessment compared with those who adhered to <70% of sessions.
This trial of a tailored home-based exercise intervention presents preliminary evidence that this intervention can improve balance, concern about falls, and planned physical activity in community-dwelling older people with dementia. Future research should determine whether exercise interventions are effective in reducing falls and elucidate strategies for enhancing uptake and adherence in this population.
There are growing calls to reduce, and where possible eliminate, the use of seclusion and restraint in mental health settings, but the attitudes and beliefs of consumers, carers and mental health professionals towards these practices are not well understood. The aim of this study was to compare the attitudes of mental health service consumers, carers and mental health professionals towards seclusion and restraint in mental health settings. In particular, it aimed to explore beliefs regarding whether elimination of seclusion and restraint was desirable and possible.
In 2014, an online survey was developed and widely advertised in Australia via the National Mental Health Commission and through mental health networks. The survey adopted a mixed-methods design, including both quantitative and qualitative questions concerning participants’ demographic details, the use of seclusion and restraint in practice and their views on strategies for reducing and eliminating these practices.
In total 1150 survey responses were analysed. A large majority of participants believed that seclusion and restraint practices were likely to cause harm, breach human rights, compromise trust and potentially cause or trigger past trauma. Consumers were more likely than professionals to view these practices as harmful. The vast majority of participants believed that it was both desirable and feasible to eliminate mechanical restraint. Many participants, particularly professionals, believed that seclusion and some forms of restraint were likely to produce some benefits, including increasing consumer safety, increasing the safety of staff and others and setting behavioural boundaries.
There was strong agreement across participant groups that the use of seclusion and restraint is harmful, breaches human rights and compromises the therapeutic relationship and trust between mental health service providers and those who experience these restrictive practices. However, some benefits were also identified, particularly by professionals. Participants had mixed views regarding the feasibility and desirability of eliminating these practices.
The radiocarbon results (and Bayesian modeling) of 15 samples of carbonized food residues removed from the external surface of rim sherds of cooking pots indicate that shellyware pottery first appeared in Perth, Scotland, around cal AD 910–1020 (95% probability) and that it had disappeared by cal AD 1020–1140 (95% probability). Previously, it had been suggested that this pottery could not date to before AD 1150. These data, together with 14C analyses carried out on leather artifacts and a sample of wattle from a ditch lining, also demonstrate that there was occupation in Perth about 100 yr or more prior to the granting of royal burgh status to Perth in the 1120s.
This study follows on from previous research at Perth, Scotland, in which we dated carbonized food residues removed from the external surface of rim sherds of cooking pots of London Sandy Shellyware pottery (Museum of London Pottery Fabric Code SSW). The 15 residues that were dated produced 14C ages between 910 ± 35 and 1085 ± 40 BP. We have now carried out radiocarbon measurements on similar residues from the same fabric obtained from the Billingsgate excavations in London and the Bryggen excavations in Bergen, Norway. The London and Bergen measurements gave age ranges of 905 ± 35 to 1115 ± 35 BP and 920 ± 35 to 1055 ± 35 BP, respectively, both very similar to the Perth age range. The measurements at each site are in agreement with our Bayesian model assumption that they belong to a single phase of activity. The model estimates the introduction of London Sandy Shellyware in London to cal AD 820–1020, in Perth to cal AD 930–1020, and in Bergen to cal AD 980–1030 (95% probability). Further modeling predicts that it fell out of use in the reverse order.
Background: Cognitive dysfunction following coronary artery bypass surgery is a regular occurrence, but its cause is still unknown. In order to devise strategies to mitigate this acquired disability, a precise and quantitative description of the post-operative neurocognitive phenotype is necessary. This study is designed to assess the feasibility of using the KINARM robot to quantify the changes in the neurological function after cardaic surgery. Methods: Patients without prior history of cognitive dysfunction were recruited from the pre-operative cardiac surgery clinic, and underwent pre-operative assessment with the KINARM. The KINARM provides a quantitative assessment of the neurocognitive control of the upper limbs. During bypass surgery, brain tissue oxygen levels were measured with near-infrared spectroscopy. Patients were reassessed with the KINARM post-operatively at 3 months. Results: To date, 12 participants have been recruited (mean age = 65 years, all male). On straightforward tasks, such as visually guided reaching, the majority of patients scored within the normal range, both pre- and post-operatively. In more complex tasks, required visuospatial and executive functioning, post-operative deficits were more pronounced. Conclusions: It is feasible to use the KINARM robot to provide a quantitative measurement of the neurocognitive phenotype of patients after cardiac surgery.
We describe an X-ray polarimeter which will be flown on the SPECTRUM-X-Gamma mission. The instrument exploits three distinct physical processes to measure polarization: Bragg reflection from a graphite crystal, Thomson scattering from a metallic lithium target, and photoemission from a Cesium Iodide photocathode. These three processes allow polarization measurements over an energy band of 0.3 keV to 12 keV. The polarimeter will make possible sensitive measurements of several hundred known X-ray sources. X-ray polarization measurements will allow us to constrain the geometry of gas flow in X-ray binaries, identify nonthermal emission in supernova remnants, test current models for X-ray emission in radio pulsars, determine the radiation mechanisms in active galactic nuclei, and search for inertial frame dragging (Lense-Thirring effect) around the putative black hole in Cygnus X-1.
Previous stable isotope studies of modern and archaeological faunal samples from sites around Lake Mývatn, within the Mývatnssveit region of northeast Iceland, revealed that an overlap existed between the δ15N ranges of terrestrial herbivores and freshwater fish, while freshwater biota displayed δ13C values that were comparable with marine resources. Therefore, within this specific ecosystem, the separation of terrestrial herbivores, freshwater fish, and marine fish as components of human diet is complicated when only δ13C and δ15N are measured. δ34S measurements carried out within a previous study on animal bones from Skútustaoir, an early Viking age settlement on the south side of Lake Mývatn, showed that a clear offset existed between animals deriving their dietary resources from terrestrial, freshwater, and marine reservoirs. The present study focuses on δ13C, δ15N, and δ34S analyses and radiocarbon dating of human bone collagen from remains excavated from a churchyard at Hofstaoir, 5 km west of Lake Mývatn. The results demonstrate that a wide range of δ34S values exist within individuals, a pattern that must be the result of consumption of varying proportions of terrestrial-, freshwater-, and marine-based resources. For that proportion of the population with 14C ages that apparently predate the well-established first human settlement of Iceland (landnám) circa AD 871 ± 2, this has enabled us to explain the reason for these anomalously old ages in terms of marine and/or freshwater 14C reservoir effects.