Although the rumen fluke, Calicophoron daubneyi is now very common and widespread throughout Western Europe, reports of clinical cases are still rare. This study explores the epidemiological background to a severe rumen fluke outbreak in 6-month-old heifers on a dairy farm in Ireland. Sequence analysis of the cytochrome oxidase subunit 1 (Cox1) gene of the rumen fluke metacercariae on pasture failed to identify predominant, possibly pathogenic subtypes. However, estimates of metacercarial load indicated that the animals were exposed to a daily dose of about 5334 C. daubneyi metacercariae for a period of 3 weeks resulting in the build-up of very large numbers of immature worms in the small intestine. It is hypothesized that specific environmental conditions may favour this parasite over its competitor, the liver fluke, Fasciola hepatica, possibly by allowing it to emerge earlier. The possibility that C. daubneyi may be better adapted to the Irish climate than F. hepatica together with the fact that selective treatment against F. hepatica effectively frees the niche for C. daubneyi, may result in the gradual replacement of F. hepatica by C. daubneyi.

The anatomy and pollination of subterranean cleistogamous flowers of Benghal dayflower (Commelina benghalensis) is described as a contribution to understanding its reproductive biology. Subterranean stems bear one spathe per node, each enclosing a single cleistogamous flower. Only the three anterior stamens produce functional pollen; the posterior three stamens are staminodes. Tapetum is amoeboid and endothecium is present. The three-carpellate superior ovary bears five dimorphic orthotropous ovules. Nearly mature flowers have straight to somewhat curved styles; at maturity, styles elongate and coil. Our observations indicate that coiled style growth causes rupture of anthers and brings pollen into contact with stigmas. Pollen tubes were observed in styles that had previously undergone coiling, located within mucilaginous secretions of the mature stylar canal. The subterranean cleistogamous flowers of Benghal dayflower and their apparently unique mode of pollination, viewed together with reproductive capacity of its aerial chasmogamous flowers, underscore the complexity and flexibility of the reproductive biology of this noxious weed species.

Cognitive measures that are sensitive to biological markers of Alzheimer disease (AD) pathology are needed to (a) facilitate preclinical staging, (b) identify individuals who are at the highest risk for developing clinical symptoms, and (c) serve as endpoints for evaluating the efficacy of interventions. The present study assesses the utility of two cognitive composite scores of attentional control and episodic memory as markers for preclinical AD pathology in a group of cognitively normal older adults (N=238), as part of the Adult Children Study. All participants were given a baseline cognitive assessment and follow-up assessments every 3 years over an 8-year period, as well as a lumbar puncture within 2 years of the initial assessment to collect cerebrospinal fluid (CSF) and amyloid tracer Pittsburgh compound-B scan for amyloid imaging. Results indicated that attentional control was correlated with levels of Aβ42 at the initial assessment whereas episodic memory was not. Longitudinally, individuals with high CSF tau exhibited a decline in both attention and episodic memory over the course of the study. These results indicate that measures of attentional control and episodic memory can be used to evaluate cognitive decline in preclinical AD and provide support that CSF tau may be a key mechanism driving longitudinal cognitive change. (JINS, 2015, 21, 573–583)

Objective: To retrospectively examine the case-notes of all children and adolescents admitted with deliberate self-harm (DSH) or suicidal ideation during the study period 1993-2003. The study aimed to identify underlying reasons why children and adolescents engage in DSH, and to identify common psychiatric, psychosocial and familial factors which may predispose or contribute to an individual's engagement in such behaviour.

Method: All children presenting to the hospital with DSH or suicidal ideation were identified and data collected from their case notes. A study specific questionnaire was designed to collect demographic details, details on clinical presentation, past attempts, comorbid psychiatry disorders, family history and family circumstances. Information was also recorded on hospital stay and discharge planning.

Results: During the 11-year period, 231 children presented with suicidal ideation or behaviour. The mean age was 12.85 with an age range from 6-17 years, with a female:male ratio of 2.5:1. Overdose was the most common method (81.2%) and paracetamol most commonly the drug of choice. More than half of the group (55.7%) expressed a wish to die. More than half (51.8%) had expressed suicidal ideation in the past, 31% had made a previous attempt, and 11.7% had been previously admitted. Of the children 8% presented with suicidal behaviour more than once over the study period. There was a family history of completed suicide in 6.6%.

Conclusion: Deliberate self-harm in young people is a significant public health problem in Ireland. During the period of this study, rates have continued to increase. There is an urgent need for national bodies such as the National Suicide Review Group to extend their focus to include those under age 18 and for services to be developed that might reduce DSH behaviours. More research is needed in the area of childhood suicidal behaviour.

Objectives: Structured professional judgement is now the most widely accepted approach to clinical risk assessment and risk management. The Suicide Risk Assessment and Management Manual (S-RAMM) is a new structured professional judgement tool closely modelled on the HCR-20. This is the first prospective validation study for this instrument.

Methods: Two post-membership registrars jointly interviewed 81 of 83 current inpatients to rate the S-RAMM. Two assistant psychologists independently rated the HCR-20, GAF and PANSS. All incidents of self-harm, attempted suicide, suicide and violence to others were collated from hospital reporting of critical incidents over the next six months supplemented by examination of other records.

Results: For combined self-harm and suicide outcomes, the S-RAMM total score using the receiver operating characteristic had an area under the curve AUC=0.89, (95% CI 0.79 to 0.99). The S-RAMM performed as well for the prediction of self-harm and suicide as the HCR-20 did for violence, and better than measures of mental state (PANSS total score) and global function (GAF).

Conclusions: The S-RAMM has better than minimum acceptable characteristics for use as a clinical or research tool for suicide risk assessment, and performs almost as well as the HCR-20 does for violence. Further prospective studies are now required, in other populations.

As part of a restructuring program at a large, acute care hospital, a new, collaborative form of clinical management called triads has been initiated. Members of these collaborative management teams are being collectively empowered to better enable them to establish a continuously improving, cost-effective clinical service. This article describes the impact of this new structure on the capital budgeting process in changing a centralized, committee-based system of decision making with limited clinical nursing input to one that is increasingly decentralized, interdisciplinary, and focused on patients.

Methadone substitution improves maternal and neonatal outcomes. However methadone induced neonatal abstinence syndrome (NAS) is common. Buprenorphine-exposed neonates may be at a lower risk of NAS. Currently in the Republic of Ireland, buprenorphine does not have a special licence for use in pregnancy. We describe here the history and neonatal outcomes of the first Irish woman maintained on buprenorphine during two pregnancies.

Supervised urinanalysis on this mother between and throughout both pregnancies did not reveal any illicit drug use. She delivered two post-term babies of normal birth weight and length. The second infant required treatment for NAS for 21 days with morphine sulphate. Although the use of buprenorphine in pregnancy does not remove the possibility of NAS, neonatal outcomes of buprenorphine-maintained women compares favourably to methadone. As the use of buprenorphine becomes more established in Ireland, the management of buprenorphine-exposed neonates will become more common.

Objectives: To describe the drug history and co-existing psycho-social problems among under-19 year olds accessing treatment for opiate dependency, including methadone maintenance, and examine for any gender differences.

Method: A descriptive study of under-19 years assessed at the largest drug treatment clinic in Dublin, Ireland, between October 2000 and September 2006. Data was obtained through review of case notes, assessment questionnaires and urine drug screens.

Results: Eighty-six young people were included. Their mean age was 16.8 years. Forty-six (54%) were female. Only 26 (30%) reported an intact family of origin. Twenty-three (27%) had been in care. Mean age for first use of any illicit drug was 12.4 years, and for heroin was 14.8 years. The mean age of leaving school was 14.4 years; 42 (49%) first tried heroin after leaving school. Forty-one (48%) had a history of homelessness. Forty-four (51%) had previously injected; 26 (30%) were currently injecting. Fifty-six (65%) had not been screened for blood-borne diseases; twenty-one (24%) subsequently tested positive for hepatitis C. Thirty-eight (48%) had previous convictions; 33 (38%) were facing charges. Forty-five (52%) had previously seen a psychiatrist; nine (11%) had received inpatient psychiatric treatment. Boys were more likely to leave school early, have a substance-abusing sibling, and to have a past conviction. Girls were more likely to have a partner, and have taken a deliberate overdose.

Conclusions: This study highlights the multiple and complex needs of teenagers abusing opiates. Services seeking to meet their needs will require a broad range of interventions and excellent interagency co-operation.

Recent excavations at the Cross Creek site (CA-SLO-1797) on the central coast of California revealed a stratigraphically discrete midden component dating between ca. 8350 and 7700 cal B.C., making it the oldest mainland shell midden on the west coast of North America. A large recovery volume revealed an assemblage dominated by grinding implements (handstones and milling slabs) and crude core and flake tools typical of California's Milling Stone horizon, but the Cross Creek findings extend the antiquity of Milling Stone back to the terminal Pleistocene. The tools and associated faunal remains suggest a gathering economy profoundly different from the terminal Pleistocene big-game hunting of interior North America. This variation is difficult to reconcile as a simple adaptive outgrowth from late Pleistocene hunting and may reflect a separate coastal migration route into the New World.

A vestibular schwannoma in an only hearing ear is a difficult management problem. A case is presented of a patient who had a Nucleus-22 channel device implanted into a nonfuctioning ear and auditory rehabilitation prior to resection of a large vestibular schwannoma in the contralateral ear.

The erroneous identification of a fluted projectile point associated with the earliest radiocarbon date at Fort Rock Cave is noted. Contrary to what has been stated in the literature, no fluted or Folsom-like projectile points have been found associated with early radiocarbon dates at Fort Rock Cave.