A pioneer in the management of Australian psychiatric services: Dr Richard Greenup (1803-1866).

OBJECTIVES: To provide a brief biography of Dr Richard Greenup and to explore the legacy he has left to one of Australia's longest operating psychiatric services. METHODS: This history was obtained by consulting staff working within Cumberland Hospital, New South Wales and by examining primary and secondary sources. RESULTS: Greenup was the second surgeon superintendent of 'The Parramatta Lunatic Asylum' from 1852 until 1866 when he was fatally stabbed with a pair of scissors by a patient. Greenup was involved in establishing The University of Sydney and advocated for expanded and improved services for people diagnosed with mental disorders. CONCLUSIONS: Greenup recognised the needs of the mentally ill and sought to address similar social and demographic determinants of health to those that we face today. The challenges he faced, and his tragic end remind us of the importance of delivering patient-centred care whilst being mindful of associated risks.

Complex direct comb spectroscopy with a virtually imaged phased array.

We demonstrate a simple interferometric technique to directly measure the complex optical transmittance over a large spectral range using a frequency-comb spectrometer based on a virtually imaged phased array. A Michelson interferometer encodes the phase deviations induced by a sample contained in one of its arms into an interferogram image. When combined with an additional image taken from each arm separately, along with a frequency-calibration image, this allows full reconstruction of the sample's optical transfer function. We demonstrate the technique with a vapor cell containing H13C14N, producing transmittance and phase spectra spanning 2.9 THz (∼23 nm) with ∼1 GHz resolution.

Bidirectional microwave and optical signal dissemination.

We describe a technique to disseminate highly stable microwave and optical signals from physically separated frequency standards to multiple locations. We demonstrate our technique by transferring the frequency stability performance of a microwave frequency reference to the repetition-rate stability of an optical frequency comb in a different location. The stabilized optical frequency comb becomes available in both locations for measurements of both optical and microwave signals. We show a microwave frequency stability of 4×10(-15) in both locations for integration times beyond 100 s. The control system uses only a standard Ethernet connection.

A portrait of prefrontal lobotomy performed at the Royal Prince Alfred Hospital in Sydney by Dr Rex Money.

OBJECTIVE: The objective of this article is to provide a portrait of prefrontal lobotomy performed at the Royal Prince Alfred Hospital, Sydney by the Head of Neurosurgery Dr Rex Money and to describe Dr Money's role in the promotion of psychosurgery in Sydney. METHODS: We draw attention to an oral presentation by Dr Rex Money in 1951, a journal article written by Money, archival information held at the Royal Prince Alfred Hospital, including Dr Money's accounts of his travels and his reports regarding neurosurgery - both internationally and in Australia. RESULTS: Dr Rex Money performed a series of 13 prefrontal lobotomies between 1945 and 1951, and presented the theoretical basis for his series, his operative procedures and the outcomes at the annual meeting of its medical officers' association. CONCLUSION: Notwithstanding various deficiencies in his clinical research, Money's descriptions give a relatively comprehensive account of one of the first series of prefrontal lobotomies performed in Australia. The current article also describes Dr Money's contributions to the promotion of psychosurgery in Sydney, and illustrates the participation of a senior neurosurgeon and of a major Sydney teaching hospital during the psychosurgery saga.

The advent of psychosurgery in Australia-with particular attention to its introduction into Sydney.

OBJECTIVE: The objective of this study was to describe the advent of prefrontal lobotomy in Sydney and, less comprehensively, its introduction into Australia. METHOD: Reference to journal articles, books, reports and archival data held at the Royal Prince Alfred Hospital and via internet searches, interviews and personal memory. RESULT: This paper describes the arrival of psychosurgery in Sydney in the mid-1940s, and less comprehensively, its arrival in other Australian cities. CONCLUSIONS: In New South Wales, from 1945 or 1946, prefrontal lobotomies were conducted in private clinics and in public hospitals but, because of legal and practical hurdles, it is unlikely that psychosurgery was performed in mental hospitals prior to December 1958. This paper gives some details regarding the participation of neurosurgeons and of the major public hospitals in psychosurgery, and touches on the attitudes within the Australian medical profession towards this dramatic new therapy.

A quantitative mode-resolved frequency comb spectrometer.

We have developed a frequency-comb spectrometer that records 35-nm (4 THz) spectra with 2-pm (250 MHz) spectral sampling and an absolute frequency accuracy of 2 kHz. We achieve a signal-to-noise ratio of ~400 in a measurement time of 8.2 s. The spectrometer is based on a commercial frequency comb decimated by a variable-length, low-finesse Fabry Pérot filter cavity to fully resolve the comb modes as imaged by a virtually imaged phased array (VIPA), diffraction grating and near-IR camera. By tuning the cavity length, spectra derived from all unique decimated combs are acquired and then interleaved to achieve frequency sampling at the comb repetition rate of 250 MHz. We have validated the performance of the spectrometer by comparison with a previous high-precision absorption measurement of H13C14N near 1543 nm. We find excellent agreement, with deviations from the expected line centers and widths of, at most, 1 pm (125 MHz) and 3 pm (360 MHz), respectively.

Sir John Macpherson, the first but sometimes overlooked Professor of Psychiatry at the University of Sydney.

OBJECTIVE: To chronicle the creation of the Chair of Psychiatry at the University of Sydney, and the career and legacy, in New South Wales, of the first incumbent, Professor Sir John Macpherson CB MD FRCPE. CONCLUSIONS: The creation of the Chair, Macpherson's appointment, and his contributions to psychiatry in Sydney during the 52 months of his tenure, are well documented in contemporaneous sources and demonstrate that he was a very worthy Foundation Professor of Psychiatry at the University of Sydney. There are several possible reasons why Macpherson has been overlooked, including an erroneous statement in The World History of Psychiatry (1975) that William Siegfried Dawson, his successor from 1927 to 1952, was the first Professor of Psychiatry.

Cascaded Raman shifting of high-peak-power nanosecond pulses in As2S3 and As2Se3 optical fibers.

We report efficient cascaded Raman scattering of near-IR nanosecond pulses in large-core (65 µm diameter) As2S3 and As2Se3 optical fibers. Raman scattering dominates other spectral broadening mechanisms, such as four-wave mixing, modulation instability, and soliton dynamics, because the fibers have large normal group-velocity dispersion in the spectral range of interest. With ~2 ns pump pulses at a wavelength of 1.9 µm, four Stokes peaks, all with peak powers greater than 1 kW, have been measured.

Driving down the detection limit in microstructured fiber-based chemical dip sensors.

We present improvements to fluorescence sensing in soft-glass microstructured optical fibers that result in significantly improved sensitivity relative to previously published results. Concentrations of CdSe quantum dots down to 10 pM levels have been demonstrated. We show that the primary limitation to the sensitivity of these systems is the intrinsic fluorescence of the glass itself.

A Multimodal Interdisciplinary QI Intervention Is Associated with Reduction in After Hours Inpatient Endoscopy Cases.

BACKGROUND AND AIMS: Increasing demand for inpatient endoscopic services results in performing more non-emergent endoscopic cases after-hours, which poses risks to patient safety and negatively impacts patient and provider satisfaction. This study sought to quantify the existing state using quality improvement (QI) methodology, design targeted interventions, and determine their effectiveness. METHODS: We conducted an existing state evaluation through a process map, time-series study, and caseload analysis from 7/2017-12/2018. Using end-of-workday (EOW) as a proxy for patient/provider dissatisfaction and risk for patient safety events, we performed a prospective evaluation of a staged interdisciplinary multimodal intervention aimed to decrease the proportion of days with EOW after 7PM, decrease the proportion of cases begun after 5PM, and decrease EOW variability. The post-intervention period was 6/2019-2/2020. RESULTS: Based on existing state analyses, we implemented a series of targeted interventions: (1) provider workflow tips, (2) expedited transport for select patients, (3) pathway to reschedule appropriate cases to outpatient endoscopy, and (4) increased staffing for high caseload days through resource pooling. The proportion of days with EOW after 7PM decreased from 42.4% to 29.3% (caseload-adjusted odds ratio of 0.39, p< 0.001). Despite increased caseload, cases begun after 5PM decreased from 17.5% to 14.2% (OR 0.75, p = 0.009). EOW SD decreased from 2:20 hours to 1:36 hours. CONCLUSIONS: The multimodal intervention reduced days with EOW after 7PM and the proportion of cases begun after 5PM, despite increased caseload. This study shows how applying research methods to implement QI interventions successfully decreases late inpatient endoscopic cases.

Design and optimization of fiber optical parametric oscillators for femtosecond pulse generation.

In this paper, we use a genetic algorithm and pulse-propagation analysis to design and optimize optical parametric oscillators based on soft-glass microstructured optical fibers. The maximum parametric gain, phase-match, walk-off between pump (1560 nm) and signal (880 nm) pulses, signal feedback ratio and signal-pump synchronization of the cavity are optimized. Pulse propagation analysis suggests that one can implement a fiber optical parametric oscillator capable of generating approximately 200-fs pulses at 880 nm with 43% peak-power conversion, high output pulse quality (time-bandwidth product approximately 0.43) and a wavelength tuning range that is limited only by the glass transmission windows.

Community-acquired pneumonia mortality: a potential link to antibiotic prescribing trends in general practice.

BACKGROUND: Community prescribing of antibiotics has decreased substantially in the UK in recent years. We examine the association between pneumonia mortality and recent changes in community-based antibiotic prescribing for lower respiratory tract infections (LRTI). METHODS: Retrospective analysis of aggregated data for pneumonia mortality, influenza incidence, and antibiotic prescribing for LRTI in England and Wales during 12-week winter periods between 1993/94 and 1999/2000. RESULTS: Winter antibiotic prescribing for LRTI showed a 30.0% decline since 1995/96. Over the same period, there was a 50.6% increase in winter excess pneumonia mortality adjusted for influenza incidence. Negative binomial regression analysis showed that the incidence of influenza alone had a significant association with winter pneumonia mortality (P<0.001). The analysis also showed the reduction in antibiotic prescribing had a small but significant association with mortality (P<0.001), when simultaneously modelling for influenza incidence. CONCLUSIONS: Our findings suggest an association between recent reductions in antibiotic prescribing for LRTI in general practice and an increase in pneumonia mortality in England and Wales. This retrospective study of aggregate data represents the first attempt to assess the effect of limiting antibiotic prescribing on patient outcomes, and highlights the need to identify which patients benefit from antibiotic treatment for LRTI.

The impact of HIV on maternal morbidity in the Pre-HAART era in Uganda.

OBJECTIVE: To compare maternal morbidity in HIV-infected and uninfected pregnant women. METHODS: Major maternal morbidity (severe febrile illness, illnesses requiring hospital admissions, surgical revisions, or illnesses resulting in death) was measured prospectively in a cohort of HIV-infected and uninfected women followed from 36 weeks of pregnancy to 6 weeks after delivery. Odds ratios of major morbidity and associated factors were examined using logistic regression. RESULTS: Major morbidity was observed in 46/129 (36%) and 104/390 (27%) of the HIV-infected and HIV-uninfected women, respectively, who remained in followup. In the multivariable analysis, major morbidity was independently associated with HIV infection, adjusted odds ratio (AOR) 1.7 (1.1 to 2.7), nulliparity (AOR 2.0 (1.3 to 3.0)), and lack of, or minimal, formal education (AOR 2.1 (1.1 to 3.8)). CONCLUSIONS: HIV was associated with a 70% increase in the odds of major maternal morbidity in these Ugandan mothers.

Safety of topical corticosteroids in pregnancy: a population-based cohort study.

Topical corticosteroids may be indicated in pregnant women with skin conditions, but their safety in pregnancy is unclear. We used the UK General Practice Research Database to conduct a population-based cohort study to investigate whether maternal exposure to topical corticosteroids results in adverse pregnancy outcomes. We identified 35,503 pregnant women prescribed topical corticosteroids during the period from 85 days before last menstrual period (LMP) to delivery or fetal death and 48,630 unexposed women. We found no associations of maternal exposure to topical corticosteroids with orofacial cleft (and its two subtypes, i.e., cleft lip ± palate (CLP) and cleft palate alone (CP)), preterm delivery, and fetal death (including miscarriage and stillbirth). The findings were similar when excluding exposure before LMP. In contrast, maternal exposure to potent/very potent topical corticosteroids shortly before and during pregnancy was significantly associated with fetal growth restriction (adjusted relative risk 2.08; 95% confidence interval 1.40-3.10; number needed to harm, 168), which was confirmed by a significant dose-response relationship (P=0.025) and the sensitivity analysis excluding exposure before LMP. The increased risk for fetal growth restriction should be considered when prescribing potent/very potent topical corticosteroids to pregnant women, and appropriate obstetric care should be provided.

Which early 'red flag' symptoms identify children with meningococcal disease in primary care?

BACKGROUND: Symptoms are part of the initial evaluation of children with acute illness, and are often used to help identify those who may have serious infections. Meningococcal disease is a rapidly progressive infection that needs to be recognised early among children presenting to primary care. AIM: To determine the diagnostic value of presenting symptoms in primary care for meningococcal disease. DESIGN OF STUDY: Data on a series of presenting symptoms were collected using a parental symptoms checklist at point of care for children presenting to a GP with acute infection. Symptom frequencies were compared with existing data on the pre-hospital features of 345 children with meningococcal disease. SETTING: UK primary care. METHOD: The study recruited a total of 1212 children aged under 16 years presenting to their GP with an acute illness, of whom 924 had an acute self-limiting infection, including 407 who were reported by parents to be febrile. Symptom frequencies were compared with those reported by parents of 345 children with meningococcal disease. Main outcome measures were diagnostic characteristics of individual symptoms for meningococcal disease. RESULTS: Five symptoms have clinically useful positive likelihood ratios (LR+) for meningococcal disease: confusion (LR+ = 24.2, 95% confidence interval [CI] = 11.5 to 51.3), leg pain (LR+ = 7.6, 95% CI = 4.9 to 11.9), photophobia (LR+ = 6.5, 95% CI = 3.8 to 11.0), rash (LR+ = 5.5, 95% CI = 4.3 to 7.1), and neck pain/stiffness (LR+ = 5.3, 95% CI = 3.5 to 8.3). Cold hands and feet had limited diagnostic value (LR+ = 2.3, 95% CI = 1.9 to 3.0), while headache (LR+ = 1.0, 95% CI = 0.8 to 1.3), and pale colour (LR+ = 0.3, 95% CI = 0.2 to 0.5) did not discriminate meningococcal disease in children. CONCLUSION: This study confirms the diagnostic value of classic 'red flag' symptoms of neck stiffness, rash, and photophobia, but also suggests that the presence of confusion or leg pain in a child with an unexplained acute febrile illness should also usually prompt a face-to-face assessment to exclude meningococcal disease. Telephone triage systems and primary care clinicians should consider these as 'red flags' for serious infection.

Heterodyne-assisted pulsed spectroscopy with a nearly Fourier-transform limited, injection-seeded optical parametric oscillator.

Narrowband pulsed 822 nm signal radiation from an injection-seeded optical parametric oscillator (OPO) system is used to record fluorescence-detected sub-Doppler two-photon excitation (TPE) spectra of atomic cesium. An optical-heterodyne technique is used to monitor the frequency chirp as well as the fluctuating central frequency of successive OPO output pulses, thereby providing a novel way to record sub-Doppler TPE spectra. The measured TPE linewidth approaches the ultimate limit imposed by the Fourier transform of the pulse's temporal profile, demonstrating the utility of this system for pulsed laser spectroscopy applications that require the highest possible resolution.

Pulsed injection-seeded optical parametric oscillator with low frequency chirp for high-resolution spectroscopy.

An injection-seeded optical parametric oscillator (OPO), based on periodically poled KTiOPO4 and pumped by a frequency-doubled, nanosecond-pulsed Nd:YAG laser, generates continuously tunable, single-longitudinal-mode, pulsed output at approximately 842 nm for high-resolution spectroscopy. Optical-heterodyne measurements show that the OPO frequency chirp increases linearly with detuning from the free-running (unseeded) OPO frequency and can be maintained as low as 10 MHz. Other factors affecting chirp are identified.