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This paper provides a description of a structured template which allows review of the operation of the Mental Health Act 2001 at St Patrick's Mental Health Services (incorporating St Patrick's University Hospital, St Edmundsbury Hospital and Willow Grove Adolescent Unit). These structured processes were implemented to ensure rigorous monitoring of all clinical governance activities associated with adherence to the Mental Health Act (MHA) 2001. The paper describes in detail the information contained in the St Patrick's Mental Health Services dashboard for 2012. The dashboard displays the key performance indicators that are monitored and the paper describes how these were reviewed by the Hospital's Clinical Governance Committee on a weekly basis for the three approved centres. The dashboard has also been used by the Clinical Governance Committee to provide ongoing education and engagement with staff in order to improve the operation of the MHA 2001. The use of this structured monitoring process has allowed the hospital to measure adherence to the MHA 2001 and also to measure activities that impact directly on the care and treatment of patients detained under the Act. The use of structured monitoring tools (i.e. the dashboard) to review the operation of the MHA 2001 allows for coherent observation of key events and issues which can cause concern in terms of the operation of the Act.
Nests of leaf-cutting ants (Hymenoptera: Formicidae: Attini) are abundant disturbances in Neotropical rain forests, and could affect the plant community both while the nests are active and after they are abandoned. We measured the diversity and abundance of understorey plants (>1 m in height) in the area around active and abandoned nests of leaf-cutting ants (Atta cephalotes) at the La Selva Biological Station in Costa Rica. Sampel quadrats on active nests had reduced diversity (number of morphospecies) and abundance of both small (height >10 cm) and large (10 cm–1 m) understorey plants, when compared to the nearby forest floor (3 and 13 m from the nest edge). Abandoned nests had greater diversity and marginally greater abundance of small understorey plants relative to nearby forest; there was no difference in diversity or abundance of large understorey plants. Leaf-cutting ant nests create gaps in the plant understorey when active, but serve as centres of recruitment for small plants after they are abandoned. Thus, like canopy gaps, ant nests could play an important role in recruitment of new individuals and maintenance of plant species diversity in tropical forests.
Panic disorder is associated with neuroendocrinological abnormalities, some of which overlap with those seen in major depression. To date, there has been little assessment of the role of cholinergic mechanisms in this disorder.
Sixteen patients with DSM–III–R panic disorder and an age and gender-matched comparison group were administered 120 mg of the acetylcholinesterase inhibitor pyridostigmine. Growth hormone (GH) responses over a three-hour period were monitored.
Mean ΔGH, the difference between basal and the maximum pyridostigmine levels, was significantly greater in patients with panic disorder than in the comparison group.
This may reflect increased cholinergic responsivity in panic disorder.
Theorists have extrapolated the cholinergic supersensitivity theory of affective disorder from a convincing and broad spectrum of clinical observation and research. This hypothesis is tested using a neuroendocrine probe approach with the challenge drug pyridostigmine, an indirect cholinergic agent thought to release growth hormone (GH) by decreasing inhibitory somatostatin tone. The consequent increments in plasma GH were considered to reflect central acetylcholine responsivity. Fifty-four volunteers were tested: 27 DSM-III-R major depressives (18 women and 9 men) and 27 age- and sex-matched healthy controls. Subjects were cannulated at 9.00 h following an overnight fast and two baseline samples were taken at 15 min intervals. Pyridostigmine 120 mg was administered orally and thereafter samples were taken at the time points +60, +90, +120 and +180 min. GH responses were significantly greater in depressives than controls and this effect was more marked for men than women. These results support the proposal that muscarinic upregulation and/or supersensitivity is associated with depression.
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