The triangular treatment paradigm in dual‐diagnosis clients with a mental illness

Research evidence suggests that a large number of individuals with substance misuse problems also have accompanying psychopathology. Some of those individuals diagnosed with schizophrenia may warrant a dual‐diagnosis. The clinical area of psychiatric ‘dual diagnosis' – that is, serious mental illness associated with substance misuse – is often linked to the ‘revolving door’ admissions of individuals with this complex comorbidity picture. Often, there is limited sharing of information and cooperation between statutory agencies with reference to this highly vulnerable client group. The shortfall in appropriate clinical response to this client group has been highlighted by previous researchers. This article looks at the role of the specialist dual‐diagnosis worker in North Wales and how the appointee to this role has been able to facilitate the seamless transition of these individuals through the ‘system’ of mental health care. This process has been facilitated by the development of an Integrated Pathway of Care, which has been devised by the authors and called the Triangular Treatment Paradigm.     

高中学生眼屈光状态相关因素的等级回归分析

目的探讨影响眼屈光状态的主要因素。方法以某中学高中部高一至高三的219名学生为研究对象,分问卷调查和眼生物测量两个部分。问卷调查内容包括年龄、性别、年级、民族、遗传背景、是否主动休息、目本距离、每天学习时间、每天玩电脑时间等。眼生物学测量包括：角膜屈折力CD（cornea diopter）、前房深度AC（anterior chamber depth）、晶状体厚度LENS（lens thickness）、玻璃体腔深度VITR（vitreous depth）、眼轴长度AL（ocular axis longitude）等。将所有可能的因素同时纳入研究,应用逐步等级回归方法,依次排除相关性不大的因素。结果完成全部体检项目的共有182名,占全部学生的83.5%;与眼屈光不正发生最为紧密的相关因素有：年龄、性别、平均角膜屈率、前房深度、晶状体厚度和玻璃体深度等因素。各等级累积概率的回归方程分别是：Link远视概率=61.012-（0.199×年龄＋0.813×性别取值＋0.581×平均角膜屈率＋1.076×前房深度＋1.953×晶状体厚度＋1.643×玻璃体深度）;Link正视累积概率=65.396-（0.199×年龄＋0.813×性别取值＋0.581×平均角膜屈率＋1.076×前房深度＋1.953×晶状体厚度＋1.643×玻璃体深度）;Link低度近视累积概率=67.957-（0.199×年龄＋0.813×性别取值＋0.581×平均角膜屈率＋1.076×前房深度＋1.953×晶状体厚度＋1.643×玻璃体深度）;Link中度近视累积概率=70.370-（0.199×年龄＋0.813×性别取值＋0.581×平均角膜屈率＋1.076×前房深度＋1.953×晶状体厚度＋1.643×玻璃体深度）。根据频数分布表,求得预测准确率为68.68%。结论用年龄、性别、平均角膜屈率、前房深度、晶状体厚度和玻璃体腔深度等6个因素来预测眼的屈光状态,其准确率将近70%,因而这6个因素是决定眼屈光状态的主要因素。     

Stability of Artemisinin in Aqueous Environments: Impact on its Cytotoxic Action to Ehrlich Ascites Tumour Cells

We have recently shown artemisinin to be cytotoxic against Ehrlich ascites tumour cells. The aim of this study was to investigate the stability of this compound in the aqueous environment of the in-vitro Ehrlich ascites tumour cell system (RPMI 1640 cell culture medium supplemented with 10% foetal bovine serum (RPMI/FBS) with reference to its cytotoxic action. Literature data show that artemisinin can react with Fe²⁺ yielding reactive intermediates leaving artemisinin G as a major end-product. The current study showed that only excess addition of Fe²⁺ to artemisinin in distilled water, phosphate-buffered saline (PBS) and RPMI/FBS and incubation for 24 h led to degradation of artemisinin and yielded artemisinin G. If Fe²⁺ was not added results from HPLC analysis were indicative of complete recovery of artemisinin from distilled water and RPMI/FBS, with or without cells, at 37°C for at least 24 h. In addition, incubation of artemisinin in RPMI/FBS with or without cells at 37°C for 24 h before cytotoxicity assay did not change its cytotoxic action. On the basis of these results, we suggest that cytotoxicity to tumour cells was caused by unchanged artemisinin. This is not so for the antimalarial activity of artemisinin and derivatives, for which the presence of a pool of (haem) Fe²⁺ is a prerequisite resulting in free radicals or electrophilic intermediates or both.     

Lipid membrane permeability of modified c[D-Pen2, D-pen5]enkephalin peptides

Permeability coefficients of a series of analogues of a potent opioid peptide, c[D-Pen², D-Pen⁵]enkephalin, were measured in a model membrane system. The analogues included hydrophobic amino acid substitutions on position 3. Liposomes of a mixed composition consisting of zwitterionic lipids and cholesterol served as the model membranes. The obtained permeability coefficients range between 0.38 × 10^?12 and 2.9 × l0^?12 cm/s. These data were correlated with the hydrophobicity scale of Nozaki and Tanford (J. Biol. Chem. 246, 1971, 2211-2217) (correlation coefficient = 0.9933) and with determinations of lipid order perturbation by differential scanning calorimetry (correlation coefficient = -0.9779). The reasonably good correlation obtained within the family of analogues substituted on position 3 (Gly, Ala, Leu, Phe) indicates that changes in permeabilities are primarily related to increases in the partition coefficient of the peptide. However, Phe residue added on the N-terminal end of the peptide (position 0) does not appear to follow the observed trend, showing stronger lipid perturbation and lower permeability compared to the Phe³ analog. This observation demonstrates that each class of peptide modifications requires a new basis of permeability analysis and predictions. © Munksgaard 1996.     

Tobacco health warnings and smoking-related cognitions and behaviours

Aims. To explore whether the introduction onto cigarette packs of new larger, more prominent health warnings in black on white would lead to an increase in: noticing warnings, thoughts about the effects of smoking, and consequent behaviours of not smoking a planned cigarette and/or prematurely stubbing out one already lit. In addition evidence was sought linking these effect to smoking cessation. Design. Two national cross-sectional surveys of broadly representative samples of smokers: one about 2 weeks before the mandated introduction date of the warnings, and a follow-up 6 months later, pan-way through implementation. A longitudinal subsample of smokers from the initial baseline survey was resurveyed at follow-up. Setting. In Australia, new health warnings and strengthened contents labelling of cigarette packets were mandated for cigarettes manufactured from 1 January 1995. Participants. Broadly representative samples of Australian smokers: 510 at baseline, and 512 at follow-up. Two hundred and forty-three of the baseline sample were also resurveyed. Measurements. Self-report on effects of warnings and smoking cessation activity. Findings. In the cross-sectional sample at follow-Up, 66% of smokers reported at least sometimes noticing the health warnings when taking out a cigarette (compared with 37% at baseline), and 14% reported they had refrained from smoking on at least one occasion as a result (compared with 7% at baseline). Not smoking as a result of noticing the (old) warnings at baseline was predictive of quitting at follow-up. Frequency of stubbing out cigarettes before they were finished as a result of thinking about smoking-related harm was not affected by the new warnings, but was predictive of making quit attempts. Conclusions. The new health warnings were more potent at stimulating both thoughts about negative effects of smoking and the appropriate consequent action of not smoking the planned cigarette. This is important as spontaneous rejection of cigarettes predicted subsequent cessation.     

Intracoronary Irradiation with 186/188Rhenium Following Balloon Overstretch Injury Reduces Neointima But Does Not Impair Vasoreactivity of Porcine Coronary Arteries

Objective: The purpose of this study was to assess the effect of ^186/188rhenium (^186/188Re) on the neointimal proliferation and on the vasomotion of irradiated porcine coronary arteries following balloon injury. Background: Intracoronary radiation (IR) at doses of 10–25 Gy reduces intimal hyperplasia in animal models and lowers restenosis in clinical trials. The response of coronary arteries to acetylcholine (ACh) has been used to examine endothelial function, but this has not been reported in porcine coronary arteries subjected to overstretch balloon injury (BI) and subsequent IR. Methods: Vasomotor response was studied at baseline and at 2 weeks in 20 swine. Baseline vasomotor study without BI was carried out in six animals (12 arteries; Group I, no injury, no radiation). Subsequently the left anterior descending (LAD) and the left circumflex (LCX) arteries of 11 animals were subjected to BI. Eight of these animals (15 arteries) were subjected to IR with ^186/188Re in the LAD and LCX arteries in doses of 15 Gy followed by vasomotor studies at 2 weeks (Group II, BI, radiation). Three animals, (six arteries) of the BI group were not subjected to IR and their vasomotor functions assessed two weeks later (Group HI, BI, no radiation). Endothelium dependent vasomotion was assessed by Doppler flow wire and by quantitative coronary angiography (QCA) following selective infusion of serial doses of ACh proximal to the injured and irradiated segments. Nitroglycerin (200 μg) was injected intracoronary to detect endothelium independent vasodilatation. Histomorphometry and QCA analysis was performed to confirm the effect of IR on intimal area (IA), and IA corrected for fracture length (IA/FL). Results: Responses to ACh infusion and coronary flow reserve were similar at baseline before injury and at 2 weeks following injury with and without radiation. The irradiated vessels demonstrated normal vasodilatation responses to nitroglycerin. The irradiated vessels showed a marked reduction in IA and IA/FL. Conclusion: The vasoreactivity of irradiated coronary arteries is preserved at doses that inhibit neointima formation in the porcine model.