On the Edge: a drama‐based mental health education programme on early psychosis for schools

Aims: On the Edge is a mental health education programme designed to support early intervention by increasing knowledge and understanding of early psychosis, reducing the stigma associated with mental health issues and improving awareness of avenues of help. The target audience was young people aged 14–22 years in schools and colleges. Methods: An interactive drama programme was developed through collaborative working across psychiatry, applied drama and those with direct experience of psychosis. A national tour engaged 2500 students in 71 performances that took place in 51 schools and colleges. The programme was evaluated against its aims with data collected both during and after the tour. Results: Quantitative and qualitative evaluation found significant gains with respect to all three aims. Thirty‐one schools developed supportive links with local mental health services. Conclusions: This programme shows the value and effectiveness of delivering health education on early psychosis through the medium of applied drama, and offers a model for a programme that can be incorporated into early intervention services. Lessons learned through delivering this programme are a valuable contribution towards future developments of mental health education programmes for schools.     

Management of the pregnant opiate user

Increasing numbers of women are seeking help for drug misuse. In addition to problems associated with drug dependence, there are also problems concerning child care, pregnancy and women's health. In this paper we discuss the management of the pregnant opiate user, effects of opiate use in utero and postpartum and ways in which non-drug services can assist in the early identification and treatment of these women.     

Neurochemical mechanisms mediating the behavioral and cognitive effects of nicotine

Data are reviewed, largely from experiments in the authors'laboratory, that suggest three modes of action of systemic nicotine in producing three different types of effect upon behavior and cognitive function. (1) Preexposure of a stimulus without consequence makes it harder subsequently to form associations to that stimulus, a form of selective attention known as latent inhibition. Latent inhibition is blocked by nicotine, an effect that is apparently mediated by a nicotine-induced increase in dopamine release in the nucleus accumbens. (2) A single dose of nicotine proactively increases the partial reinforcement extinction effect measured several weeks later: that is, resistance to extinction is decreased by nicotine in animals that have been trained on a continuous reinforcement schedule, and increased in animals trained on a partial reinforcement schedule. This effect appears to be due to increased synthesis of tyrosine hydroxylase in the cell bodies of noradrenergic neurons in the locus coeruleus, followed by axonal transport to the hippocampus and increased synthesis and release of noradrenaline in that structure. (3) Nicotine improves vigilance in animals with cognitive deficits due to destruction of the forebrain cholinergic projection system, either as a consequence of excitotoxic lesions of the nuclei of origin of this system or after prolonged alcohol consumption; and also in human subjects with Alzheimer's disease (in which this system undergoes degeneration). This effect is most likely due to an action at denervated cholinergic synapses in the hippocampus and neocortex. © 1994 Wiley-Liss, Inc.     

Maize NDC80 is a constitutive feature of the central kinetochore

In yeast and animals, Nuclear Division Cycle 80 (NDC80) is an important kinetochore protein that binds to microtubules and mediates chromosome movement. Its localization pattern is unusual, since it is generally not viewed as either an inner (centromeric chromatin) or outer (regulatory) component of the kinetochore. Here we report the characterization of NDC80 in a higher plant. By taking advantage of the large meiotic kinetochores of maize, we were able to show that NDC80 localizes outside of the constitutive kinetochore protein CENP-C. Further, a detailed analysis of mitosis indicates that NDC80 is stably present on kinetochores throughout the cell cycle. The quantity of NDC80 positively correlates with measured quantities of DNA and CENP-C, suggesting that NDC80 rapidly associates with DNA following replication and is stably maintained at centromeres during cell division. The data suggest that in plants NDC80 is on par with ‘foundation’ kinetochore proteins such as CENH3 and CENP-C.     

Robotic endoscopic surgery in a porcine model of the infant neck

Minimally invasive surgery is rapidly becoming the desired surgical standard, especially for pediatric patients. Infants and children are a particular technical challenge, however, because of the small size of target anatomical structures and the small surgical workspace. Computer-assisted robot-enhanced surgical telemanipulators may overcome these challenges by facilitating surgery in a small workspace. We studied the feasibility of performing robotic endoscopic neck surgery on a porcine model of the human infant neck. The study design was a prospective, feasibility pilot study of a small cohort for proof of concept and for a survival model. Sixteen non-survival piglets weighing 4.5–10 kg were used to develop the surgical approach and operative technique. Eight piglets aged 3–6 weeks old and weighing 4.0–9.1 kg underwent survival thyroidectomy by a cervical endoscopic approach using the Zeus surgical robot, which includes the Aesop endoscope holder and “Microwrist” microdissecting instruments. We succeeded in performing endoscopic robotic neck surgery on a piglet as small as 4 kg, in an operative pocket as small as 2 cm³. Total incision length for all three ports was ≤23 mm. There were no major complications, no major robotic instrument malfunctions or breakages, and no procedures required conversion to open surgery. These results support the feasibility of robotic endoscopic neck surgery on a neck the size of a human infant’s. Electronic supplementary material The online version of this article (doi: ) contains supplementary material, which is available to authorized users.     

From the Cover: Rice yields in tropical/subtropical Asia exhibit large but opposing sensitivities to minimum and maximum temperatures

Data from farmer-managed fields have not been used previously to disentangle the impacts of daily minimum and maximum temperatures and solar radiation on rice yields in tropical/subtropical Asia. We used a multiple regression model to analyze data from 227 intensively managed irrigated rice farms in six important rice-producing countries. The farm-level detail, observed over multiple growing seasons, enabled us to construct farm-specific weather variables, control for unobserved factors that either were unique to each farm but did not vary over time or were common to all farms at a given site but varied by season and year, and obtain more precise estimates by including farm- and site-specific economic variables. Temperature and radiation had statistically significant impacts during both the vegetative and ripening phases of the rice plant. Higher minimum temperature reduced yield, whereas higher maximum temperature raised it; radiation impact varied by growth phase. Combined, these effects imply that yield at most sites would have grown more rapidly during the high-yielding season but less rapidly during the low-yielding season if observed temperature and radiation trends at the end of the 20th century had not occurred, with temperature trends being more influential. Looking ahead, they imply a net negative impact on yield from moderate warming in coming decades. Beyond that, the impact would likely become more negative, because prior research indicates that the impact of maximum temperature becomes negative at higher levels. Diurnal temperature variation must be considered when investigating the impacts of climate change on irrigated rice in Asia.     

Ultrasound-guided percutaneous splenic biopsy using an 18-G core biopsy needle: our experience with 52 cases

Objective:

The spleen is more commonly affected in multiorgan disease, but alternative sites are selected for biopsy owing to perceived haemorrhage risk. If these sites are inaccessible or, less commonly, the spleen is the only disease site, then splenic biopsy is considered, with most studies using a 20- to 22-G needle. The primary aim of biopsy is to exclude underlying malignancy or to obtain histological analysis in known malignancy, usually lymphoma, when reclassification is required for therapy. We present, to our knowledge, the largest series of 18-G ultrasound-guided splenic core needle biopsy assessing diagnostic and complication rates.

Methods:

All ultrasound-guided splenic biopsy cases from May 1990 to May 2015 were identified on the radiology information system. Histological diagnosis and complications were identified from laboratory reports, case notes and discharge summaries to assess diagnostic positive and complication rates. Haemorrhages requiring transfusion, embolization or splenectomy, pneumothorax, other significant intra-abdominal injury or death are classified as major complications, whilst conservative haemorrhage management is considered a minor complication.

Results:

A total of 52 splenic biopsies were performed in 47 patients. A positive diagnostic yield for all biopsies was 90.4%. The major and minor complication rates were 0% and 1.9% (1/52), respectively.

Conclusion:

Ultrasound-guided 18-G splenic biopsy is a safe and accurate procedure with no added risk of complications when compared with smaller needles or biopsy of other abdominal organs.

Advances in knowledge:

This is the largest case series of ultrasound-guided splenic biopsy with an 18-G needle, and our experience confirms a high diagnostic yield and a complication rate which compares favourably with the biopsy of other abdominal organs.     

Opportunities to say ‘yes’: Rare speech automatisms in a case of progressive nonfluent aphasia and apraxia

We describe the investigation of speech automatisms in a man with progressive nonfluent aphasia and apraxias. Occurrence of the automatisms yes and right, were analysed across a range of speech tasks varying in length, propositionality, lexical and articulatory complexity, whether tasks engaged internal generation or external triggering and articulatory distortions, and while completing pantomimes/gestures. No differences were found in occurrence across most tasks but there was a significant interaction between automatism production and apraxic speech errors and during limb praxic tasks, suggesting that production of the automatism was unrelated to linguistic or lexical variables, but was related to the presence of speech apraxia coupled with disinhibition.