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The crystal structure of a natural, ordered IIb-4 triclinic clinochlore has been refined in space group C1̄ from 4282 unique X-ray intensity measurements of which 3833 are greater than 3 times the statistical counting error (3σ). Unit cell parameters are a = 5.3262(6) Å; b = 9.226(1) Å; c = 14.334(3) Å; α = 90.56(2)°; β = 97.47(2)°; and γ = 89.979(9)°, which represents the greatest deviation from mono-clinic symmetry yet recorded for a triclinic chlorite. The final weighted R is 0.059 for reflections with I > 3σ and 0.064 for all reflections. The chemical formula is (Mg0.966Fe0.034)MI(Mg0.962Fe0.038)M22(Si2.96Al1.04)O10 (OH)2(Mg0.996Fe0.004)M32(Al0.841FeIII0.102Cr0.004Ti0.004)M4(OH)6, which is consistent with electron microprobe (EMP), wet chemical analyses, Mössbauer spectroscopy and X-ray structure refinement. The high degree of ordering of the divalent versus trivalent octahedral cations in the interlayer is noteworthy, with FeIII and Al in M4 and virtually no Fe in M3. In the 2:1 layer, M1 and M2 each contain similar amounts of Fe. The 2 tetrahedral sites have nearly identical mean oxygen distances and volumes, and thus show no evidence of long-range cation ordering.
The number of people over the age of 65 attending Emergency Departments (ED) in the United Kingdom (UK) is increasing. Those who attend with a mental health related problem may be referred to liaison psychiatry for assessment. Improving responsiveness and integration of liaison psychiatry in general hospital settings is a national priority. To do this psychiatry teams must be adequately resourced and organised. However, it is unknown how trends in the number of referrals of older people to liaison psychiatry teams by EDs are changing, making this difficult.
Method
We performed a national multi-centre retrospective service evaluation, analysing existing psychiatry referral data from EDs of people over 65. Sites were selected from a convenience sample of older peoples liaison psychiatry departments. Departments from all regions of the UK were invited to participate via the RCPsych liaison and older peoples faculty email distribution lists. From departments who returned data, we combined the date and described trends in the number and rate of referrals over a 7 year period.
Result
Referral data from up to 28 EDs across England and Scotland over a 7 year period were analysed (n = 18828 referrals). There is a general trend towards increasing numbers of older people referred to liaison psychiatry year on year. Rates rose year on year from 1.4 referrals per 1000 ED attenders (>65 years) in 2011 to 4.5 in 2019 . There is inter and intra site variability in referral numbers per 1000 ED attendances between different departments, ranging from 0.1 - 24.3.
Conclusion
To plan an effective healthcare system we need to understand the population it serves, and have appropriate structures and processes within it. The overarching message of this study is clear; older peoples mental health emergencies presenting in ED are common and appear to be increasingly so. Without appropriate investment either in EDs or community mental health services, this is unlikely to improve.
The data also suggest very variable inter-departmental referral rates. It is not possible to establish why rates from one department to another are so different, or whether outcomes for the population they serve are better or worse. The data does however highlight the importance of asking further questions about why the departments are different, and what impact that has on the patients they serve.
The state of Maryland identified its first case of coronavirus disease 2019 (COVID-19) on March 5, 2020. The Baltimore Convention Center (BCCFH) quickly became a selected location to set up a 250-bed inpatient field hospital and alternate care site. In contrast to other field hospitals throughout the United States, the BCCFH remained open throughout the pandemic and took on additional COVID-19 missions, including community severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) diagnostic testing, monoclonal antibody infusions for COVID-19 outpatients, and community COVID-19 vaccinations.
To prevent the spread of pathogens during operations, infection prevention and control guidelines were essential to ensure the safety of staff and patients. Through multi-agency collaboration, use of infection prevention best practices, and answering what we describe as PPE-ESP, an operational framework was established to reduce infection risks for those providing or receiving care at the BCCFH during the COVID-19 pandemic.
We examined non-medical use (NMU) of olanzapine among adults on methadone treatment. Information was collected on patient demographics and NMU of olanzapine. The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) was administered to assess risk among current users of olanzapine.
Results
Ninety-two clients participated and 30% reported lifetime history of NMU of olanzapine. Nine people reported doses of 30 mg or higher on a typical day of use, with three typically using 100 mg. The most common reasons for use were to relieve anxiety and to aid sleep, but a quarter used it to ‘get stoned’. Eleven participants (12%) reported NMU of olanzapine in the preceding month. Eight completed the ASSIST with four scoring in the high-risk zone.
Clinical implications
Self-medication is the dominant motivator for NMU of olanzapine, but hedonic motivations also occur. A small minority show features of dependency. All doctors should be aware of the potential NMU of olanzapine, especially among patients with history of addiction.
Employers of business graduates require them to be effective communicators and team members in twenty-first century work environments. As a means of developing these skills, we believe group work is important to an undergraduate business teaching pedagogy preparing graduates for the challenges of modern workplaces. Student responses to a series of qualitative and quantitative focus group activities highlighted the ‘big issues’ encountered in group activities involving an increasingly internationalised and diverse cohort of students. These issues related mainly to communication within the group and the fear of social-loafers. These insights established the basis on which proactive strategies were introduced in a subsequent teaching period to nurture and advance the quality of the learning experience within a tertiary undergraduate business education setting. Given that reduced Government funding to Australian universities has prompted the management of institutions to look to full-fee paying international students to offset shortfalls in their operating budgets, this paper explores the particular impact of increasing numbers of English as a Second Language (ESL) students on the quality of, and student receptiveness to, group based study activities.
Current prescriptions for welfare reform and increased reliance on the voluntary sector often base their appeal on the lessons of history, in particular the apparent successes of Victorian philanthropy in combating ‘pauperism’. This article looks at how this message has become influential in the USA and the UK among the ruling parties of right and left through the particular prism of the neo-conservative appreciation of the work of Thomas Chalmers, the early nineteenth-century Scottish churchman and authority on poverty. The attraction of Chalmers, both to the Charity Organization Society then and neo-conservatives today, lies in the practical application of his idea of the ‘godly commonwealth’ in Glasgow and Edinburgh where voluntary effort, organized through the church, replaced the statutory obligations of the poor law. While Chalmers, and his followers, declared his ‘experiments’ to be great successes, modern Scottish historians have revealed these claims to be false and his efforts failures. Only by completely ignoring the evidence presented by this historiography and continuing to rely on Chalmers's own writings and earlier hagiographies can the neo-conservative approbation of Chalmers be sustained. Such wilful neglect raises questions both about their approach to history and their proposed remedies for tackling poverty today.
This article examines the role played by local councillors in constructing new housing in Scotland during the inter-war period. Rather than view local authorities as simply the objective agency of central government's ambitions to construct council houses, we argue that the self-interest and motivations of councillors have to be recognized as significant factors in this process. It is argued also that the concerns of private landlords were neither ignored nor sacrificed in the rush to build new housing. Rather, given that councils remained dominated by local business men, many of whom were private landlords, councillors acted in ways to protect their own material and class interests. In so doing, they consciously, if implicitly, shaped the social geography of twentieth-century Scotland.
A series of editorials in this Journal have argued that psychiatry is in the midst of a crisis. The various solutions proposed would all involve a strengthening of psychiatry's identity as essentially ‘applied neuroscience’. Although not discounting the importance of the brain sciences and psychopharmacology, we argue that psychiatry needs to move beyond the dominance of the current, technological paradigm. This would be more in keeping with the evidence about how positive outcomes are achieved and could also serve to foster more meaningful collaboration with the growing service user movement.
Malignant mesothelioma is a rare, highly aggressive cancer arising from mesothelial cells that line the pleural cavities. Approximately 80% of mesothelioma cases can be directly attributed to asbestos exposure. Additional suspected causes or co-carcinogens include other mineral fibres, simian virus 40 (SV40) and radiation. A mesothelioma epidemic in Turkey has demonstrated a probable genetic predisposition to mineral fibre carcinogenesis and studies of human tissues and animal models of mesothelioma have demonstrated genetic and epigenetic events that contribute to the multistep process of mineral fibre carcinogenesis. Several growth factors and their receptors have a significant role in the oncogenesis, progression and resistance to therapy of mesothelioma. Epidermal growth factor (EGF), hepatocyte growth factor (HGF), vascular endothelial growth factor (VEGF) and insulin-like growth factor (IGF) have been shown as targets for therapy based on promising preclinical data. However, clinical trials of tyrosine kinase inhibitors in mesothelioma have been disappointing. Bcl-XL is an important antiapoptotic member of the Bcl-2 family and is overexpressed in several solid tumours, including mesothelioma. Reduction of Bcl-XL expression in mesothelioma induces apoptosis and engenders sensitisation to cytotoxic chemotherapeutic agents. Pharmacological inhibitors of antiapoptotic Bcl-2 family members continue to undergo refinement and have shown promise in mesothelioma.
We present a general construction of Salem numbers via rational functions whose zeros and poles mostly lie on the unit circle and satisfy an interlacing condition. This extends and unifies earlier work. We then consider the “obvious” limit points of the set of Salem numbers produced by our theorems and show that these are all Pisot numbers, in support of a conjecture of Boyd. We then show that all Pisot numbers arise in this way. Combining this with a theorem of Boyd, we produce all Salem numbers via an interlacing construction.
To report a large outbreak of Clostridium difficile infection (CDI; ribotype 027) between June 2007 and August 2008, describe infection control measures, and evaluate the impact of restricting the use of fluoroquinolones in controlling the outbreak.
Design.
Outbreak investigation in 3 acute care hospitals of the Northern Health and Social Care Trust in Northern Ireland.
Interventions.
Implementation of a series of CDI control measures that targeted high-risk antibiotic agents (ie, restriction of fluoroquinolones), infection control practices, and environmental hygiene.
Results.
A total of 318 cases of CDI were identified during the outbreak, which was the result of the interaction between C. difficile ribotype 027 being introduced into the affected hospitals for the first time and other predisposing risk factors (ranging from host factors to suboptimal compliance with antibiotic guidelines and infection control policies). The 30-day all-cause mortality rate was 24.5%; however, CDI was the attributable cause of death for only 2.5% of the infected patients. Time series analysis showed that restricting the use of fluoroquinolones was associated with a significant reduction in the incidence of CDI (coefficient, —0.054; lag time, 4 months; P = .003).
Conclusion.
These findings provide additional evidence to support the value of antimicrobial stewardship as an essential element of multifaceted interventions to control CDI outbreaks. The present CDI outbreak was ended following the implementation of an action plan improving communication, antibiotic stewardship, infection control practices, environmental hygiene, and surveillance.
Many areas of active research within the broad field of number theory relate to properties of polynomials, and this volume displays the most recent and most interesting work on this theme. The 2006 Number Theory and Polynomials workshop in Bristol drew together international researchers with a variety of number-theoretic interests, and the book's contents reflect the quality of the meeting. Topics covered include recent work on the Schur-Siegel-Smyth trace problem, Mahler measure and its generalisations, the merit factor problem, Barker sequences, K3-surfaces, self-inversive polynomials, Newman's inequality, algorithms for sparse polynomials, the integer transfinite diameter, divisors of polynomials, non-linear recurrence sequences, polynomial ergodic averages, and the Hansen-Mullen primitivity conjecture. With surveys and expository articles presenting the latest research, this volume is essential for graduates and researchers looking for a snapshot of current progress in polynomials and number theory.
This chapter offers a long-term perspective on the role played by council housing in tackling the ‘social evil’ of squalor within Scotland. By the mid-1970s, public sector housing – encompassing council, new town and Scottish Special Housing Association property – accommodated fully two thirds of the Scottish population (Gibb, 1989). The proportion of the population housed by the public sector in England, by contrast, was markedly less at just one third (Ravetz, 2001). So public housing in Scotland was on a markedly different scale, with a state housing sector comparable to many countries in the-then ‘Eastern Bloc’. Scotland consequently provides the ideal locus to explore the contribution that council housing has made to the post-war welfare state over the last 60 years. But given that the state's role in housing provision pre-dates other welfare state developments, the longer timeframe of this intervention demands proper consideration since it established the immediate post-war ambitions for housing policy. Further, adopting this longer timeframe adds a new dimension to current debates, which see the rapid retreat from the ambitions of the welfare state solely as a response to an overt privatisation agenda, best encapsulated by the Conservatives’ ‘Right to Buy’ legislation of the 1980s. What this chapter argues is that state housing intervention was never primarily focused on eradicating squalor, but rather on housing ‘respectable’ working-class families. Given the resultant population profile of those accommodated in council housing by the mid-1970s, it was broader societal changes and associated social policy interventions, rather than just privatisation per se, that ensured that private and individual housing responses triumphed over post-war public welfare universalism; thus, the rapid demise of council housing as a mass housing solution. Today, by contrast, council housing provides for the poor and marginalised, a situation that closely fits the dominant pre-1914 conception of who should be accommodated by local authorities. Only through having to respond to the consequences of broader social changes did council housing eventually address squalor. Throughout the chapter empirical material from both Glasgow, as Scotland's largest city, and Stirling, more typical of a smaller town, is drawn on to illustrate the local impacts of national policy.
Welfare state housing post-1945
Immediately after the Second World War, the Labour government made a commitment to build new council housing, given this was a core part of national reconstruction plans.