The Concept of Diminished Responsibility in Supranational Criminal Law (Psychiatric Approach)

The role of the community management order (CMO) in the management of mental illness has been associated with controversy. There is uncertainty as to the effectiveness of such involuntary treatment. Review of outcomes of involuntary community treatment has shown varied results, and in the remote areas of Australia the issue becomes more complex, and outcomes more difficult to measure. The Northern Territory's Mental Health Act 2000 has broadened criteria for detention. The decision to impose follow-up and case management on an individual (who may reside in a community several hundred kilometres from an in-patient facility) requires careful consideration of its ethical, professional and psychosocial implications. The trend toward increasing use of mental health legislation in the Northern Territory — particularly for Indigenous people — deserves close scrutiny in order that culturally appropriate and sensitive treatment plans are developed.     

Prediction of two month modified Rankin Scale with an ordinal prediction model in patients with aneurysmal subarachnoid haemorrhage

Background  

Aneurysmal subarachnoid haemorrhage (aSAH) is a devastating event with a frequently disabling outcome. Our aim was to develop a prognostic model to predict an ordinal clinical outcome at two months in patients with aSAH.     

Demography of sleep disturbances associated with circadian rhythm disorders in Japan

To clarify the demography of delayed sleep phase syndrome (DSPS), non-24-h sleep-wake syndrome, and irregular sleep-wake pattern in Japan, a cross-sectional nationwide epidemiological survey was conducted. 1525 adults (age: 15-59 years) were randomly sampled from telephone directories, and they received screening questions over the phone. Persons who were suspected of having the disorders were requested to fill out the second questionnaire, and asked to keep a sleep log for 4 weeks. Diagnoses were made according to the International Classification of Sleep Disorders criteria. As a result, the prevalence of DSPS was estimated to be 0.13%.     

6q deletions define distinct clinico-pathologic subsets of non- Hodgkin's lymphoma

Commonly observed in lymphoid neoplasms, deletions of 6q have been correlated with histologic and clinical subsets of non-Hodgkin's lymphoma (NHL). Our recent analysis of loss of heterozygosity of 6q loci in NHL showed two regions of minimal molecular deletion (RMD), an RMD1 at 6q25-27 and an RMD2 at 6q21-23. To establish correlations between these RMDs and regions of minimal cytogenetic deletions (RCDs) on 6q, and to define associations between RCDs and clinico-pathologic features, we have analyzed chromosome 6 abnormalities in 459 consecutively ascertained, karyotypically abnormal cases of NHL. Among these, 126 (27.5%) cases had structural abnormalities of chromosome 6, of which 94 were deletions. Analysis of these deletions identified three RCDs. An RCD1 encompassing 6q25-27 was seen in 45 intermediate- grade NHL. An RCD2 at 6q21 was observed in 11 high-grade NHL, 9 of which were of the immunoblastic subtype. An RCD3 at 6q23 was noted in 18 low-grade NHL lacking a t(14;18) translocation. Of these 18 cases, 12 were small lymphocytic NHL and, in 2 of these, del(6q) was the sole karyotypic abnormality. In 20 cases of low-grade NHL with t(14;18), the deletions spanned both RCD1 and RCD3. These data suggested the presence of at least 3 tumor suppressor genes on 6q within RCD1, RCD2, and RCD3; they also showed associations between RCDs in 6q and subsets of NHL, including a specific association between a group of well-differentiated lymphoid neoplasms and RCD3. The apparent heterogeneity of breakpoints when all NHLs are considered together explains the inability of previous studies to reliably establish correlations between recurring 6q deletions and histologic and clinical features of NHL.     

Ultrasound evaluation of the multifetal gestation

With the increasing incidence of multifetal gestations, it is essential for the clinician to appreciate the benefit of ultrasound evaluation in these pregnancies. Multifetal gestation pregnancies are at increased risk for a range of both antepartum and intrapartum complications, such as intrauterine growth restriction, premature delivery, congenital anomalies, cord accidents, malpresentations, placenta previa, and abruptio placentae. First-trimester ultrasonic evaluation, amniotic fluid assessment, monitoring of fetal growth, diagnosing the twin-to-twin transfusion syndrome, and assessment of fetal anomalies will be reviewed. An early and accurate assessment of amnionicity and chorionicity are paramount in these gestations. The impact of chorionicity, in particular, can have profound consequences in the management of multifetal gestations. The determination of chorionicity onultrasonic evaluation in a multifetal gestations. The determination of chorionicity on ultrasonic evaluation in a multifetal pregnancy should be determined in a systematic way between 10-14 weeks' gestation. The amniotic fluid volume should be routinely assessed when performing an ultrasonic evaluation in a multifetal pregnancy. Amniotic fluid changes may serve as the only useful indicator to a potential pathological condition. In addition, evaluation of fetal growth in twins is essential, because these pregnancies are at increased risk for growth restriction and increased perinatal mortality rates compared to singletons. Finally, a careful anatomical evaluation in mulitifetal gestation is important because twin pregnancies have higher rates of anomalies than their singleton counterparts.     

Total but not resting energy expenditure is increased in infants with ventricular septal defects

OBJECTIVE: The purpose of this study was to determine the effect of left-to-right shunting on the resting energy expenditure (REE), total energy expenditure (TEE), and energy intake in a group of 3- to 5-month-old infants with moderate to large unrepaired ventricular septal defects (VSDs) compared with age-matched, healthy infants. METHODS: Eight infants with VSDs and 10 healthy controls between 3 to 5 months of age participated in the study. Indirect calorimetry was used to measure REE and the doubly-labeled water method was used to measure TEE and energy intake. An echocardiogram and anthropometric measurements were performed on all study participants. Daily urine samples were collected at home for 7 days. Samples were analyzed by isotope ratio mass spectrometry. Data were compared using analysis of variance. RESULTS: No significant differences were found in REE (VSD, 42.2 +/- 8.7 kcal/kg/d; control, 43.9 +/- 14.1 kcal/kg/d) or energy intake (VSD, 90.8 +/- 19.9 kcal/kg/d; control, 87.1 +/- 11.7 kcal/kg/d) between the groups. The percent total body water was significantly higher in the VSD infants and the percent fat mass was significantly lower. TEE was 40% higher in the VSD group (VSD, 87.6 +/- 10.8 kcal/kg/d; control, 61.9 +/- 10.3 kcal/kg/d). The difference between TEE and REE, reflecting the energy of activity, was 2.5 times greater in the VSD group. CONCLUSIONS: REE and energy intake are virtually identical between the two groups. Despite this, infants with VSDs have substantially higher TEE than age-matched healthy infants. The large difference between TEE and REE in VSD infants suggests a substantially elevated energy cost of physical activity in these infants. These results demonstrate that, although infants with VSDs may match the energy intake of healthy infants, they are unable to meet their increased energy demands, resulting in growth retardation.