Kava drinking in traditional settings: Towards understanding effects on cognitive function.

BACKGROUND: Kava drinking is a tradition among Pacific Island people, although growing in popularity with other ethnicities. However, drinking substantial quantities of kava has raised concerns regarding physical manifestations of slow response and lack of precision in bodily control. These impairments can have significant consequences when after consuming large volumes of kava an individual makes a choice to drive. AIMS: The objective of this study was to measure selected cognitive functions following high traditionally consumed kava volumes (greater than 2,000 mg of kavalactones) aimed at identifying potential risks for kava drink-drivers. METHODS: The reaction and divided attention of 20 control participants was assessed against 20 active kava-drinking participants during and following a 6-hr kava session in a "naturalised" setting. Assessment measures were drawn from Vienna Test System-Traffic's test battery. RESULTS/OUTCOMES: Results showed no statistical significant difference between control and active participants at any measurement point over a 6-hr testing period regardless that the movements and speech of the active participants were observed to slow as the test session and kava consumption progressed. CONCLUSION: Inconsistencies between test results and observations during testing and by road policing officers demonstrate an urgent need for more research in this field.

Intermolecular structure and hydrogen-bonding in liquid 1,2-propylene carbonate and 1,2-glycerol carbonate determined by neutron scattering.

Neutron diffraction with isotopic substitution has been used to investigate the liquid structures of propylene carbonate and glycerol carbonate. C-HO[double bond, length as m-dash]C hydrogen-bonding motifs dominate the local structure of propylene carbonate, giving rise to the formation of head-to-tail correlated chains of molecules. In contrast, glycerol carbonate exhibits a more disordered structure with no overall dominant interactions in which the pendant hydroxyl function disrupts structure-making correlations present in propylene carbonate.

Elder suicides: A reminder from the forgotten generation .

Elder suicide is a significant public health issue in many countries. This reflects the complex underlying psychosocial, mental and physical health issues that older adults face. Increased life expectancy in developing countries has resulted in a gradual transition to an ageing population. Furthermore, in countries such as Sri Lanka, the transition occurs at a lower per capita income than in developed countries. This will negatively impact the availability of resources and service delivery to at-risk individuals. Thus, addressing elder suicide and concerns of elders are timely issues. This paper looks at the underlying risk factors associated with elder suicide and strategies that can be implemented in preventing elder suicide in the South Asian context, with reference to Sri Lanka.

An ionic liquid process for mercury removal from natural gas.

Efficient scrubbing of mercury vapour from natural gas streams has been demonstrated both in the laboratory and on an industrial scale, using chlorocuprate(II) ionic liquids impregnated on high surface area porous solid supports, resulting in the effective removal of mercury vapour from natural gas streams. This material has been commercialised for use within the petroleum gas production industry, and has currently been running continuously for three years on a natural gas plant in Malaysia. Here we report on the chemistry underlying this process, and demonstrate the transfer of this technology from gram to ton scale.

Selective homogeneous synthesis of dimethyl ether from methanol.

Selected Brønsted acidic ionic liquids were tested as homogeneous catalysts for the dehydration of methanol to dimethyl ether. Ionic liquids incorporating an alkanesulfonic acid as a part of the cation, a complex acidic anion, [A(2)H](-), or both, proved to be good catalysts for this process, providing high conversions and selectivities. Homogeneous catalysis in the liquid state represents a novel approach to dimethyl ether synthesis.

The democratisation of psychiatry.

OBJECTIVE: To explore the decline in expertise of the consultant psychiatrist and its replacement by a range of professional colleagues. CONCLUSION: Averting a devaluing of expertise in Australasia requires thoughtfulness, willingness to quietly and confidently contribute, and professional behaviour. There are early promising developments.

Building an ECT service: an outcomes-equivalent approach.

OBJECTIVE: Specific guidelines, ongoing controversies in technique and audit reviews have made clinicians wary about continuing in electroconvulsive therapy (ECT). This paper attempts to reassure practitioners by incorporating such changes into a simple approach to ECT based on outcomes equivalence. METHOD: A selected compilation of the recent literature was used to describe a model for starting and/or continuing an effective ECT service. RESULTS: It was suggested that a useful way of approaching ECT service delivery is to focus on what is actually important, getting patients better, and to do so within the context and capability of each hospital. CONCLUSIONS: ECT is a changing field. Remaining true to the core principles of clinical practice, patient selection and technique, provides a basis for beginning, continuing and further developing an effective ECT service.

Influence of lactation history on breast nipple aspirate fluid yields and fluid composition.

Analysis of nipple aspirate fluid (NAF) can be useful for understanding the impact that various lifestyle factors have on the biology of the breast. In this study, breast NAF was obtained at baseline from premenopausal women who volunteered for a dietary intervention trial. The influence of lactation history on both fluid yields and fluid composition was explored. We examined the levels of fat-soluble micronutrients (tocopherols, carotenoids, retinol), one lipid oxidation product (8-isoprostane), cholesterol, and protein in NAF. Roughly half of the women in the trial had never lactated, but this did not affect fluid yields appreciably. Carotenoid and tocopherol levels were significantly higher in NAF from women who lactated 6 months or more versus women who had lactated for shorter periods of time or never, but 8-isoprostane, protein, and cholesterol levels were not affected appreciably by lifetime lactation history. Longer times after weaning were associated with higher cholesterol levels, and there also was a suggestion the fat-soluble micronutrients declined with time after weaning. This is of interest since high cholesterol levels in breast fluid have been associated with an increased breast cancer risk, while carotenoids and tocopherols are thought to be protective. The results of this study provide further evidence of the potential benefits of prolonged lactation via its influence on NAF composition.

Right unilateral ECT at 6x seizure threshold: is it effective in the psychoses?

OBJECTIVE: To date, right unilateral electroconvulsive therapy administered at 6x seizure threshold (6x RUL-ECT) has been described in relation to unipolar depression alone. For clinicians who have developed an experience and confidence in bilateral ECT, the effectiveness of 6x RUL-ECT in other psychiatric disorders, particularly those who are severely ill, has remained untested and therefore unknown. This article describes the results of 6x RUL-ECT in a select series of patients with a nondepressive psychotic illness. METHOD: Six patients with psychotic disorders of nondepressive origin were selected from a recent 2-year retrospective review of 6x RUL-ECT practice. The clinical presentation, ECT parameters, and responses were recorded. RESULTS: Four patients with severe psychotic disorders, two of whom met broad criteria for catatonia, responded to an index course of 6x RUL-ECT. One psychogeriatric patient who had protracted inpatient mania continues to benefit from outpatient maintenance 6x RUL-ECT over 18 months. Two elderly males, in whom seizures were difficult to elicit and maintain, responded poorly. CONCLUSION: 6x RUL-ECT was effective in 4 patients with nondepressive, psychotic disorders. While clinically viable and although memory was not assessed, it is uncertain what advantage 6x RUL-ECT confers over a bilateral electrode placement. The real focus should remain on clinical responsivity.

Does electrode placement predict time to rehospitalization?

We sought to determine whether electrode placement influenced time to rehospitalization. A retrospective review of an elderly, depressed population that had received bitemporal, bifrontal or 6 x RUL ECT was examined to determine time to rehospitalization. Bitemporal ECT was associated with a statistically significant reduction in the number of (P = 0.026) and time to (P = 0.025), rehospitalization. Bitemporal ECT may be a preferred electrode placement, not only because of its demonstrated effectiveness across a range of diagnoses, but for its previously undocumented capacity to delay rehospitalization.

Bifrontal electroconvulsive therapy in the elderly: a 2-year retrospective.

OBJECTIVES: We sought to examine the clinical effect of bifrontal (BF) electroconvulsive therapy (ECT) in depressed patients aged 65 years and older. METHODS: A retrospective chart review of all patients who received BF ECT for a depressive disorder between January 2000 and December 2002 was made. RESULTS: Fourteen patients, with a mean age of 73.9 years, received BF ECT. Nine had unipolar and 5 had bipolar depression. Twelve patients (86%) responded unequivocally after a mean of 8.5 treatments. Five (35%) experienced cognitive side effects. Ninety-two percent of patients were discharged on lithium (0.6 mmol/L) with 86% also receiving antidepressants or antipsychotics. Only 1 patient relapsed, the remainder remaining well at follow-up after a mean of 18.7 months. CONCLUSION: BF ECT was found to be clinically effective and associated with cognitive side effects in elderly patients who were experiencing a depressive episode of either unipolar or bipolar origin.