Randomised controlled trial of efficacy of teaching patients with bipolar disorder to identify early symptoms of relapse and obtain treatment

OBJECTIVE: To determine the efficacy of teaching patients with bipolar disorder (manic-depressive psychosis) to identify early symptoms of relapse and seek prompt treatment from health services. DESIGN: Single blind randomised controlled trial with matching on four baseline variables using a minimisation algorithm. SETTING: Mental health services in four NHS trusts (one teaching, three non-teaching). SUBJECTS: 69 patients with bipolar disorder who had had a relapse in the previous 12 months. INTERVENTIONS: Seven to 12 individual treatment sessions from a research psychologist plus routine care or routine care alone. MAIN OUTCOME MEASURES: Time to first manic or depressive relapse, number of manic or depressive relapses, and social functioning examined by standardised interviews every six months for 18 months. RESULTS: 25th centile time to first manic relapse in experimental group was 65 weeks compared with 17 weeks in the control group. Event curves of time to first manic relapse significantly differed between experimental and control groups (log rank 7.04, df=1, P=0.008), with significant reductions in the number of manic relapses over 18 months (median difference 30% (95% confidence interval 8% to 52%), P=0.013). The experimental treatment had no effect on time to first relapse or number of relapses with depression, but it significantly improved overall social functioning (mean difference 2.0 (0.7 to 3.2), P=0.003) and employment (mean difference 0.7 (0.1 to 1.3), P=0.030) by 18 months. CONCLUSION: Teaching patients to recognise early symptoms of manic relapse and seek early treatment is associated with important clinical improvements in time to first manic relapse, social functioning, and employment.     

Progression into and out of binge drinking among high school students.

The current study examined binge drinking among high school students over an academic year. Adolescent drinkers (N?=?621; 58% female) were grouped into 4 trajectories: drinkers (35%), increasers (14%), decreasers (16%), and persistent binge drinkers (35%). Prospective analyses indicated several factors that predicted escalation and de-escalation of binge drinking. Increasers were more likely to regularly use alcohol and cigarettes at a younger age than drinkers. Compared with decreasers, persistent binge drinkers reported regular alcohol and marijuana use at younger ages. Lower levels of perceived student drinking appeared to be a protective factor for onset of binge drinking. The results highlight the need to study precursors to the naturally occurring fluctuations in binge drinking and suggest factors that may accentuate the risk of binge drinking. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The deformation of magnetite films forming on mild steel

Crack-detection techniques, developed for room temperature studies, have been applied to the study of magnetite layers growing on mild steel in NaOH solutions at 573 K and 10 MN/m² pressure, when subjected to varying tensile or compressive strains. It has been found that these films are extremely resistant to failure in compression but that they crack in tension at strains of 0·05–0·08%.Strains, below those necessary to cause cracking, result in changes in the rate of the electrochemical reactions associated with the oxidation process.     

A classification of food properties

Abstract

Proper classification and terminology comprise an essential basis for avoiding confusion or imprecision. Classification will assist in recording available data, setting up a global database and developing predictive relationships. In this paper, an attempt to develop a well‐accepted classification of and terminology for food properties is made. The proposed four classes of food properties are: physical and physico‐chemical properties, kinetic properties, sensory properties, and health properties.     

GTP cyclohydrolase deficiency; intrafamilial variation in clinical phenotype, including levodopa responsiveness

Traditional Chinese drugs (TCDs) have played a key role for Chinese people in the treatment of diseases since ancient times. The use of TCDs has generated a great amount of information in the past thousand years about the relationship between natural products and the human body. However, up to now, our understanding on the mode of action of the TCD is still limited. Considering that the basic mechanism of all drug function involves the interaction between the drug and biological receptors at the molecular level, we propose to connect TCDs with modern medicine theory through molecular structures. We propose to explain functions of TCDs by using the knowledge developed in modern molecular biology, pharmacology, computer chemistry, and biochemistry. We are working on a computer-aided Chinese drug study that is discussed in this paper. A short introduction on the progress of our research is also given.     

The feasibility of a mixed reality surgical training environment

The Sheffield knee arthroscopy training system (SKATS) was originally a visual-based virtual environment without haptic feedback, but has been further developed as a mixed reality-training environment through the use of tactile augmentation (or passive haptics). The design of the new system is outlined and then tested. In the first experiment described, the effect of tactile augmentation on performance is considered by comparing novice performance using the original and mixed reality system. In the second experiment the mixed reality system is assessed in terms of construct validity by comparing the performance of users with differing levels of surgical expertise. The results are discussed in terms of the validity of a mixed reality environment for training knee arthroscopy.     

Modification of a receptor-binding surface of epidermal growth factor (EGF): analogs with enhanced receptor affinity at low pH or at neutrality

Six mutants of human epidermal growth factor (EGF), which carry single point substitutions within a surface patch proposed to juxtapose the bound receptor, were prepared and characterized for receptor affinity and mitogenicity. Receptor affinities relative to EGF are G12Q > H16D > Y13W > Q43A approximately = H16A approximately = EGF >> L15A. Notably, the reduced receptor affinity of mutant L15A indicates that Leu15 probably contributes substantially to receptor binding whereas unaltered receptor affinities observed for analogs H16A and Q43A indicate that neither His16 nor Gln43 contributes significantly to this interaction. On the other hand, the observed enhanced receptor affinities of analogs G12Q, Y13W and H16D highlight surface loci where additional productive receptor-binding contacts can be introduced. Interestingly, at acidic pH analog H16A reveals substantially greater receptor affinity than that of EGF, a property which may offer enhanced therapeutic utility in acidic environments in vivo.      

Indications and outcomes of strabismus repair in visually mature patients

OBJECTIVE: To identify and examine the indications, outcomes and potential risks of strabismus surgery in visually mature patients. DESIGN: Case series. SETTING: University-based referral practice in Edmonton. PATIENTS: A total of 222 patients (115 females and 107 males) aged 9 to 69 (mean 29) years who underwent strabismus surgery for various types of strabismus (as grouped by original diagnosis). All patients were followed for at least 6 weeks postoperatively. OUTCOME MEASURES: Previous surgery and deviation in prism dioptres (delta) (distance and near), sensory status (measured by the Titmus stereotest at near) and the presence of symptoms (diplopia, abnormal head posture or asthenopia), recorded preoperatively, 6 weeks postoperatively and at the last postoperative visit. RESULTS: The patients were followed for an average of 14 months postoperatively. At the last postoperative visit 187 patients (84%) were aligned to within 15 delta of orthotropia. Overall, 116 patients (52%) demonstrated some degree of stereopsis postoperatively, compared with 78 (35%) preoperatively. A total of 116 patients (52%) had symptoms preoperatively, including diplopia, abnormal head posture or asthenopia; 88 (76%) of the 116 had complete resolution of their symptoms. Six patients (4%) without diplopia preoperatively were found to have this symptom postoperatively. CONCLUSIONS: The findings suggest that most visually mature patients under-going strabismus surgery can expect functional benefits, including improvement of alignment, preservation and occasionally restoration of sensory fusion, and elimination of diplopia, abnormal head posture and asthenopia.