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This quality improvement project was a collaboration between an adult, inpatient female psychiatric intensive care unit (PICU) in South London and the Sexual and Reproductive Health Rights, Inclusion and Empowerment (SHRINE) programme. SHRINE is a London-based programme delivering SRH care to any individual with serious mental illness, substance misuse and/or learning disability.
The primary aim of this quality improvement project was to assess patients’ sexual and reproductive (SRH) needs, and the acceptability of providing SRH assessments in a female PICU setting. Secondary aims were to explore the barriers to access and the feasibility of providing SRH assessments and SHRINE interventions in the PICU.
A bi-monthly SRH in-reach clinic and a nurse led SRH referral pathway were implemented on the PICU over a seven-month period. Within a quality improvement framework, a staff training needs assessment was performed, training delivered, a protocol developed, staff attitudes explored, and patient and carer engagement sought.
30% of women were identified as having unmet SRH needs and proceeded to a specialist appointment, representing a 2.5-fold increase in unmet need detection. 42% of women were assessed, representing a 3.5-fold increase in uptake. 21% of women initiated SRH interventions of which 14% had all their SRH needs met.
Results identified SRH needs for PICU admissions are greater than realised. Staff highlighted the acceptability and importance of SRH care, if interventions are appropriately timed and the patient’s individual risk profile considered. Providing a nurse-led referral pathway for an SRH in-reach clinic is acceptable, feasible and beneficial for PICU patients.
To assess the sexual and reproductive health (SRH) needs of women admitted to a psychiatric intensive care unit (PICU), and acceptability of delivering specialist SRH assessments and interventions in this setting. Within a quality improvement framework, staff were trained, a clinical protocol developed and clinical interventions made accessible.
Thirty per cent of women were identified as having unmet SRH needs and proceeded to a specialist appointment, representing a 2.5-fold increase in unmet need detection. Forty-two per cent of women were assessed, representing a 3.5-fold increase in uptake. Twenty-one per cent of women initiated SRH interventions, of which 14% had all their SRH needs met. Staff, patients and carers highlighted the acceptability and importance of SRH care, if interventions were appropriately timed and patients’ individual risk profiles were considered. Barriers to access included lack of routine enquiry, illness acuity and impact of the COVID-19 pandemic.
SRH needs for PICU admissions are greater than previously realised. Providing a nurse-led SRH assessment is acceptable, feasible and beneficial for PICU patients.
To assess the sexual and reproductive health (SRH) needs of women admitted to a psychiatric intensive care unit (PICU), and acceptability of delivering specialist SRH assessments/interventions in this setting. Secondary aims were to explore the barriers to access and the feasibility of providing SRH assessments and interventions in the PICU.
A retrospective analysis of fifteen months’ activity data found that only 25 SRH referrals had been made across 205 PICU admissions. This low referral rate of 12% likely reflected pathway barriers and was unlikely to represent the actual clinical need in female PICU patients. A bi-monthly SRH in-reach clinic and a nurse led SRH referral pathway were implemented on the PICU over a seven-month period. Within a quality improvement framework, a staff training needs assessment was performed, training delivered, a protocol developed, staff attitudes explored, and patient and carer engagement sought.
A quality improvement approach streamlined SRH assessments on the PICU and resulted in 42% of women being assessed and a 3.5-fold increase in uptake. At least 30% of the women in the PICU had unmet SRH needs identified and proceeded to a specialist appointment. This amounts to a minimum 2.5-fold increase in SRH unmet need detection.
The most common SRH needs were complex gynaecological issues (such as period problems, pelvic pain, vaginal discharge), STI advice/testing and contraception advice/options. 21% of women initiated SRH interventions, and 14% completed all the interventions required for their needs. The most common interventions were in the areas of contraception advice/family planning and STI advice/testing.
Staff confidence on assessing SRH topics was identified as a barrier to access with a positive shift noted after bespoke SRH training was implemented and a protocol introduced: on a scale of 0-10 (with 10 being high), 81.3% of staff rated their confidence 8 or above in relation to discussing contraception/sexually transmitted infections (pre-training: 25.0%), and 93.8% in relation to discussing risky behaviours (pre-training: 18.8%). All 11 patient and carer participants felt it was important to have a forum to talk about SRH and 8 (72.7%) agreed it was important in the PICU.
Results identify that SRH needs for PICU admissions are greater than previously realised. Staff highlighted the acceptability and importance of SRH care, if interventions are appropriately timed and the patient's individual risk profile considered. Providing a nurse led referral pathway for an SRH in-reach clinic is acceptable, feasible and beneficial for PICU patients.
This chapter summarizes the available evidence for the pharmacological management of social anxiety disorder (SAD). Monoamine oxidase inhibitors (MAOIs) were the first medications to be widely studied as a treatment for SAD. Six double-blind, placebo-controlled trials have consistently demonstrated the efficacy of phenelzine in the treatment of SAD, resulting in symptomatic and functional improvement. Compared with non-reversible MAOIs, reversible inhibitors of monoamine oxidase-A (RIMAs) have a significantly lower risk of potentiating the dangerous pressor effect of tyramine, which allows for relaxation or total elimination of dietary restrictions. Selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs) have been studied widely because of their efficacy, safety, and tolerability compared with earlier medications. The evidence from the reviewed clinical trials and meta-analyses suggests that a number of medications are efficacious in the treat.
Oil palms in parts of the oil palm belt in the Gold Coast Colony have suffered at intervals from the attacks of a leaf-mining beetle. Specimens of the adult beetle and full-grown larva were sent by Mr. W. H. Patterson, Government Entomologist to the Gold Coast, to the Imperial Bureau of Entomology in 1920. These were determined by Mr. S. Maulik as a new species of the genus Coelaenomenodera (family Hispidae) and described under the specific name elaeidis (Bull. Ent. Res., x, p. 171). This species is indigenous to the West Coast of Africa, and hitherto has not been recorded outside the Gold Coast, but no doubt occurs throughout the West Coast oil palm belt. According to Mr. Maulik, 32 species of this genus are known, of which four only are recorded from Africa, the remainder being from Madagascar.
The problem of insect infestation of stored export food commodities in southern Nigeria is discussed, and a list of insects is given. At the ports there is considerable cross-infestation between commodities produced in northern and southern Nigeria awaiting shipment.
Old sacks used for the storage and transit of groundnuts are responsible for the spread of insects to palm kernel and cocoa marketing centres in the south. After bulk shipments of a portion of the groundnut crop, sacks are repaired and distributed for the shipment of palm kernels and some of them may be used by fanners and brokers as service bags for the marketing of cocoa and local food commodities. The importance of disinfestation before distribution is realised, and a small fumigation plant is in operation at port.
Ephestia cautella and Lasioderma serricorne are the major pests of stored cocoa beans. Both originate in farmers' and brokers' stores which are rarely cleaned, and in which small parcels of low-grade beans may be retained for mixing with a following crop to conform with an exportable grade. Ephestia cautella also infests palm kernels, and the early abundance of adult moths in cocoa stores up country during the marketing season is considered to be largely due to the storage of palm kernels in the vicinity. The development of Ephestia larvae can be completed on the outside of cocoa beans, only germinated or damaged beans being penetrated.
The control methods used to protect new-crop groundnuts stored in Kano against insect attack are described.
The main method used was the spraying of aqueous suspensions of DDT directly on to the sacking of piles stored in the open and on the walls of warehouses before the nuts were stacked. The solutions were applied with a slow-moving orchard power sprayer, and 50 per cent, wettable powder applied at the rate of 360 mg./sq. ft. was found satisfactory. The BHC wettable powder applied at about 12 mg./sq. ft. was cheaper and equally as good and has now been found safe. Treatment markedly reduced the Tribolium population but had little effect on Trogoderma. Sprays of oil solutions were little used and were not very satisfactory.
This study compared perceptions of the school environment, coping and enacted support between Year 10 students identified as educationally at risk (n = 31) and a comparison group of students in the same year level (n = 97), at two periods in the school term. At-risk students perceived the school environment to show significantly less concern for students and used problem-focused coping less frequently than did comparison students. Regardless of risk status, girls used social support more frequently than boys did. At-risk girls accessed peer support more than family support ond also frequently contacted school counsellors to discuss problems. At-risk boys rarely sought support from anyone. Implications for school support programs are twofold. Teachers may need additional professional training in how to employ socially supportive practices. In addition, school counsellors may need to foster informal opportunities for social participation, in order to connect vulnerable boys to peers and adults.
Sucrose polyester (SPE) is a tasteless, odourless substance which reduces plasma cholesterol concentrations and may therefore be valuable as a fat substitute in human foodstuffs. It has recently been approved for use in snack foods by the United States Federal Drug Administration. The current study was designed to investigate its effects on gastrointestinal physiology and nutrient absorption in human subjects. A 6-month (2×3-month periods) double-blind, lacebo-controlled, randomized, cross-over trial of SPE and control fat was performed in healthy free-living volunteers. Subjects consumed 20–40 g of SPE daily (mean 26·8 (se 6·8) g) which reduced the intake of total and saturated fat but had no effect on energy intake or body weight. Plasma cholesterol and triacylglycerols were reduced. The frequency of bowel movements and their urgency were increased and anal leakage occured in 7·2% of subjects. Abdominal pain was more frequent in subjects receiving SPE and was significantly greater than in the control group after 8 weeks feeding. The plasma concentrations of vitamin E and six carotenoids were significantly reduced. Routine haematology and biochemistry, other vitamins, intestinal biopsies, bile-salt retention, rectal prostaglandins, fractional Ca absorption and aminopyrine metabolism were unaffected. The ingestion of foods containing 20–40 g SPE daily provoked significant gastro-intestinal problems. This intake is greater than that to be expected from the use of SPE in savoury snack foods, for which it has been approved by the United States Federal Drug Administration. However, the favourable effects on lipid profiles must be balanced against the reduction in the concentrations of vitamins and carotenoids, as these compounds may have beneficial effects on health through protection from free-radical oxidative stress.
One of the most important mechanical features in microelectronic packaging is the nterface. Recent developments in modelling interfacial fracture and the easurement of interfacial toughness relevant to microelectronic packaging are discussed.
This article describes a novel format for enhancing the professional skills of school counsellors who are faced with increasing demands to adopt a consultancy model in order to manage their work responsibilities. The system, known as SHARK-Net, utilises the Internet in a consultancy model which links school counsellors with expert support. The purpose of this article is to describe the communication features of the system and how information is managed, and to explain its benefits to the development of consultancy skills among school counsellors.
Those involved in educational programs with Aboriginal children have noted that the parents have little contact with the schools, and feel that they are unable to help their children with their schoolwork, even where they express interest in their children's school progress.
Since the Lanxide process was advanced for forming of Al2O3 ceramic composite by directed oxidation of Al alloys, much work has been done with various mechanisms being proposed. The mechanisms have claimed that only certain dopants are essential to the growth process. Nevertheless, no united consensus has yet been reached. In the present work, Al alloy containing 5% Mg was oxidised in air for 12 hours at 1150°C with or without surface dopants of MgO or Pd. The resultant composites showed very different microstructures. Without any surface doping, the alloy did not develop any portion of composite as the initial intimate oxide film stops further oxidation. This intimate oxide film can either be broken off by mechanical means or penetrated by reaction with surface dopants, so that the composite can grow and develop. The results show that the previously reported incubation time is not only related to reaction processes but also to the initial mechanical disturbances. Doping with Pd made the composite darker in colour as the grains of the alumina ceramic matrix and inclusions of Al metal are finer. This shows that Pd may make the top oxide layer less intimate, and more nucleation sites are therefore available for oxidation. A new model is presented for oxide sustained growth based on the existence of oxygen active top surface layer and the capillary flow of molten metal around ceramic phase.
Static and impact fracture toughness of a Polybutylene terephthalate (PBT)/Polycarbonate (PC)/Impact modifier (IM) blend was studied at different temperatures. The experimental results were interpreted by the specific fracture work concept and J-integral analysis. It is found that the specific fracture work concept characterizes the impact behavior of the blend very well. In the static fracture tests the specific fracture work gives the crack initiation resistance of the blend which is consistent with the JIC value obtained. The effect of temperature was also examined and the fracture mechanisms were investigated via TEM and SEM. Extensive cavitation of the impact modifiers and plastic flow of matrix in the vicinity of the crack tip is believed to be the major toughening process of the enhanced fracture toughness.
An understanding of the mechanics involved in flake formation provides an opportunity for deriving more behavioral information from flake and flake scar morphology. The mechanics of flake formation are directly relevant to the identification of prehistoric flaking techniques and stone tool use. In this paper we provide a model of flake formation that accounts for much of the variation in flake morphology. Flakes can form in a number of ways and despite popular belief they are not all of the conchoidal variety. The bending flake is common in use wear though it is often misidentified as a conchoidal flake. A third major type of flake, the compression flake, is a common product of bipolar impact. To account for the wide variation in flake morphology we follow a tripartite scheme of flake formation comprising initiation, propagation, and termination phases, within which different mechanisms can operate.