Forging successful partnerships in psychosis research: lessons from the Cavan-Monaghan First Episode Psychosis Study.

Embedding psychosis research within community mental services is highly desirable from several perspectives but can be difficult to establish and sustain, especially when the clinical service has a rural location at a distance from academic settings with established research expertise. In this article, we share the experience of a successful partnership in psychosis research between a rural Irish mental health service and the academic department of a Dublin medical school that has lasted over 30 years. We describe the origins and evolution of this relationship, the benefits that accrued and the challenges encountered, from the overlapping perspectives of the academic department, the mental health service and psychiatric training. We discuss the potential learning that arose from the initiative, particularly for national programme planning for early intervention in psychosis, and we explore the opportunities for enhanced training, career development and professional reward that can emerge from this type of partnership.

Mindfulness-based cognitive therapy for psycho-oncology patients: an exploratory study.

OBJECTIVES: Mindfulness-based cognitive therapy (MBCT) is a group-based intervention similar to mindfulness-based stress reduction, but which includes cognitive therapy techniques. This study investigates its usefulness in the treatment of depressive, anxiety and stress/distress symptoms in cancer patients referred to a psycho-oncology service. It also examines whether effect on depression is mediated by self-compassion. METHOD: In phase 1 of this study, 16 cancer patients with mild/moderate psychological distress were randomised to MBCT (n=8) or treatment as usual (TAU; n=8), and assessed pre- and post-treatment. Analysis of variance was performed to examine the effect of treatment on anxiety and depression. In phase 2, the TAU group received the intervention, and results of pre- and post-MBCT assessments were combined with those receiving MBCT in phase 1. Finally, both groups were followed up at 3 months. RESULTS: In phase 1, the MBCT group had a significant improvement in mindfulness and a decrease in anxiety. Statistically significant improvements in both depression and anxiety were found at 3 month follow-up. Self-compassion appeared to mediate the effect on anxiety/depression. CONCLUSION: This small pilot study suggests that MBCT may have a beneficial effect on psychological variables often adversely affected in cancer in a heterogeneous cancer population.

Diagnostic trajectory, interplay and convergence/divergence across all 12 DSM-IV psychotic diagnoses: 6-year follow-up of the Cavan-Monaghan First Episode Psychosis Study (CAMFEPS).

BACKGROUND: The boundaries of psychotic illness and the extent to which operational diagnostic categories are distinct in the long term remain poorly understood. Clarification of these issues requires prospective evaluation of diagnostic trajectory, interplay and convergence/divergence across psychotic illness, without a priori diagnostic or other restrictions. METHOD: The Cavan-Monaghan First Episode Psychosis Study (CAMFEPS), conducted using methods to attain the closest approximation to epidemiological completeness, incepts all 12 DSM-IV psychotic diagnoses. In this study we applied methodologies to achieve diagnostic reassessments on follow-up, at a mean of 6.4 years after first presentation, for 196 (97%) of the first 202 cases, with quantification of prospective and retrospective consistency. RESULTS: Over 6 years, the 12 initial psychotic diagnoses were characterized by numerous transitions but only limited convergence towards a smaller number of more stable diagnostic nodes. In particular, for initial brief psychotic disorder (BrP), in 85% of cases this was the harbinger of long-term evolution to serious psychotic illness of diagnostic diversity; for initial major depressive disorder with psychotic features (MDDP), in 18% of cases this was associated with mortality of diverse causality; and for initial psychotic disorder not otherwise specified (PNOS), 31% of cases continued to defy DSM-IV criteria. CONCLUSIONS: CAMFEPS methodology revealed, on an individual case basis, a diversity of stabilities in, and transitions between, all 12 DSM-IV psychotic diagnoses over 6 years; thus, psychotic illness showed longitudinal disrespect to current nosology and may be better accommodated by a dimensional model. In particular, a first episode of BrP or MDDP may benefit from more vigorous, sustained interventions.

Acoustic divergence in two cryptic Hipposideros species: a role for social selection?

We present evidence that a relatively widespread and common bat from South East Asia comprises two morphologically cryptic but acoustically divergent species. A population of the bicoloured leaf-nosed bat (Hipposideros bicolor) from Peninsular Malaysia exhibits a bimodal distribution of echolocation call frequencies, with peaks in the frequency of maximum energy at ca. 131 and 142 kHz. The two phonic types are genetically distinct, with a cytochrome b sequence divergence of just under 7%. We consider the mechanisms by which acoustic divergence in these species might arise. Differences in call frequency are not likely to effect resource partitioning by detectable prey size or functional range. However, ecological segregation may be achieved by differences in microhabitat use; the 131kHz H. bicolor is characterized by significantly longer forearms, lower wing loading, a lower aspect ratio and a more rounded wingtip, features that are associated with greater manoeuvrability in flight that may enable it to forage in more cluttered environments relative to the 142 kHz phonic type. We suggest that acoustic divergence in these species is a consequence of social selection for a clear communication channel, which is mediated by the close link between the acoustic signal and receptor systems imposed by the highly specialized nature of the hipposiderid and rhinolophid echolocation system.

Resource partitioning in rhinolophoid bats revisited.

We assessed the ecomorphological structure of a guild of rhinolophoid bats in a Malaysian rainforest first described by Heller and von Helversen (1989). These authors found that the distribution of echolocation call frequencies used by 12 syntopic species was more even than expected from allometric relationships or in randomly generated communities, and that the observed minimal ratio was greater than expected by chance alone. In this study we were able to expand their guild to 15 species, but in doing so it became apparent that call frequencies might be less evenly distributed across the total frequency range than previously proposed. We replicated Heller and von Helversen's (1989) analyses with the full 15-species complement but were unable to support their suggestion that rhinolophoid bats exhibit resource partitioning through differences in frequency bands. We adopted a multivariate approach and incorporated measures of body size and wing morphology into the analysis. We used phylogenetic autocorrelation to ensure that the species were statistically independentand principal component analysis to describe the morphological space occupied by the 15 species in the community and four additional species representing the extremes of phenotypic variation. We derived interspecific Euclidean distances and tested the mean values and SDs of these distances against those of 100 guilds of "synthetic" species created randomly within the principal component space. The guild of Rhinolophoidea was not distributed randomly in multivariate space. Instead we found evidence of morphological overdispersion of the most similar species, which suggests niche differentiation in response to competition. Less similar species were nearer in morphological space than expected, and we suggest this is a consequence of ecological constraints on parameter combinations. Despite this underdispersion, many of the more distant neighbours were evenly rather than randomly spaced or clumped in morphospace, suggesting that, given the environmental constraints on morphology, species in this guild do experience limits to their similarity. Finally, we tested the influence of the relative abundance of species on morphological displacement, and found no evidence that abundant, spatially correlated species reduce interspecific overlap in morphological space.

On the role of 5-HT1B/1D receptors in modulating transmission in a spinal reflex pathway in the decerebrated rabbit.

1. In decerebrated rabbits, the selective 5-HT1B/1D receptor antagonist GR 127,935 had no significant effects on reflexes evoked in medial gastrocnemius motoneurones by electrical stimulation of the sural nerve, or on arterial blood pressure or heart rate when given by the intrathecal (up to 543 nmol cumulative) or intravenous (up to 1.8 micromol cumulative) routes. 2. In decerebrated, spinalized rabbits, intrathecal GR 127,935 in doses of up to 543 nmol, had no effect on the sural-gastrocnemius reflex. Furthermore, this drug failed to alter enhancement of the sural-gastrocnemius reflex induced by 8-hydroxy-2-(di-n-propyl)aminotetralin (8-OH-DPAT), given at 300 nmol kg-1 i.v. 3. In decerebrated, spinalized rabbits, the selective 5-HT1B/1D receptor agonists L-694,247 (cumulative doses of 2 - 243 nmol kg-1 i.v.) and L-741,604 (cumulative doses of 3 - 307 nmol kg-1 i.v.), each caused the sural-gastrocnemius reflex to increase to 140% of pre-drug levels, and arterial blood pressure to rise by about 10 mmHg. Subsequent administration of GR 127,935 at 0.9 - 1.8 micromol kg-1 reversed the pressor effect of the agonists but not the increase in reflexes. The 5-HT1A receptor antagonist WAY-100,635 (185 nmol kg-1 i.v.) also failed to reverse the increase in reflexes, but the 5-HT1B/1D/5-HT2/5-HT7 ligand ritanserin (1.6 micromol kg-1 i.v.) restored reflexes to pre-drug control values after L-741,604 (it was not tested against L-694,247). 4. These data indicate that 5-HT1B/1D receptors do not significantly modulate transmission in the sural-gastrocnemius reflex pathway, and that the enhancement of reflexes by 8-OH-DPAT and L-741,604 is probably mediated by 5-HT7 receptors.

Effect of breed of cattle on transmission rate and innate resistance to infection with Babesia bovis and B bigemina transmitted by Boophilus microplus.

OBJECTIVE: To assess the effect of breed of cattle on the transmission rates of and innate resistance to Babesia bovis and B bigemina parasites transmitted by Boophilus microplus ticks. DESIGN: Groups of 56 purebred B indicus and 52 B indicus cross B taurus (50%, F1 generation) steers were placed in a paddock seeded with and also naturally infested with B microplus which were the progeny of females ticks fed on B taurus cattle specifically infected with a virulent isolate of B bovis. The cattle were placed in the infested paddock 50 days after seeding had started. PROCEDURE: Cattle were inspected from horseback daily for 50 days. Clinically ill cattle were brought to yards and assessed by monitoring fever, depression of packed-cell volume, parasitaemia and severity of clinical signs. Any animals that met preset criteria were treated for babesiosis. Blood samples were collected from all cattle on day 28, 35 and 42 after exposure and antibodies to Babesia spp and packed cell volume measured. RESULTS: All steers, except for one crossbred, seroconverted to B bovis and B bigemina by day 35 and 75% of the crossbred steers showed a maximum depression in packed cell volume of more than 15% due to infection with Babesia spp compared with only 36% of the B indicus group. Ten of the 52 crossbreds and 1 of the 56 B indicus steers showed severe clinical signs. Two of the crossbreds required treatment of which one died 2 weeks after initial treatment. CONCLUSIONS: Pure-bred B indicus cattle have a high degree of resistance to babesiosis, but crossbred cattle are sufficiently susceptible to warrant the use of preventive measures such as vaccination. Transmission rates of B bovis and B bigemina to B indicus and crossbred cattle previously unexposed to B microplus were the same.

Comparison of a competitive inhibition ELISA and the card agglutination test for detection of antibodies to Anaplasma marginale and Anaplasma centrale in cattle.

OBJECTIVE: To compare a recently developed recombinant MSP-5 competitive inhibition ELISA with a card agglutination test for detection of antibodies to Anaplasma marginale and Anaplasma centrale in Australian cattle. MATERIALS AND METHODS: The ELISA was compared with the card agglutination test using 208 sera from cattle in Anaplasma-free herds, 86 sera from cattle experimentally infected with A marginale or A centrale and 757 sera from cattle in areas endemic for A marginale. RESULTS: The specificity of the ELISA, based on testing 208 sera from cattle in Anaplasma-free areas, was 99.5%, and the sensitivities for detection of antibodies to A marginale and A centrale in sera from the experimentally infected cattle were 98.0% and 100%, respectively. For the same sets of sera, the specificity of the card agglutination test was 98.6% and the sensitivities for detection of antibodies to A marginale and A centrale were 98.0% and 100%, respectively. For the 757 sera collected from cattle in areas endemic for A marginale, the agreement between the ELISA and the card agglutination test depended on the positive threshold selected for the ELISA. The maximum achievable agreement was 91.5% (kappa = 0.73; 95% confidence interval 0.66, 0.79). CONCLUSION: We conclude that the competitive inhibition ELISA is a useful alternative to the card agglutination test for detection of A marginale or A centrale infection in cattle. The assay should be particularly useful for epidemiological applications such as prevalence studies and control programs.

Effect of breed of cattle on innate resistance to infection with Anaplasma marginale transmitted by Boophilus microplus.

OBJECTIVE: To assess the innate resistance of and transmission in naive Bos taurus cross Bos indicus and purebred Bos indicus cattle when placed in a paddock with cattle infected with Anaplasma marginale and carrying Boophilus microplus ticks. DESIGN: A group of 49 purebred B indicus, and 48 B indicus cross B taurus (50%, F1 generation) 24-month-old steers were kept in the same paddock with cattle artificially infected with a virulent isolate of A marginale and Boophilus microplus. The cattle were seronegative for A marginale at the start of the trial but had previously been exposed to Babesia bovis and B bigemina. PROCEDURE: Cattle were inspected twice weekly for 118 days. Whole blood, blood smears and serum samples were collected from the cattle on day 37 after exposure and then at regular intervals to day 83 after exposure to measure packed-cell volumes, parasitaemias and antibody titres to A marginale. Any animals that met preset criteria were treated for anaplasmosis. On day 83 all cattle were treated with an acaricide and cattle infected with A marginale were removed from the rest of the group. RESULTS: A marginale was detected in blood smears from 14 crossbred and 9 B indicus steers between days 56 and 72 after exposure. Five and two of the infected crossbred and B indicus steers required treatment, respectively. One of the Bos indicus cattle died as a result of the A marginale infection despite treatment. Antibodies to A marginale were detected in the 23 infected cattle. The mean packed-cell volume depression was 40 and 37% in the affected crossbred and Bos indicus groups, respectively. There was no significant difference detected in susceptibility between these two groups. CONCLUSIONS: Innate resistance of purebred B indicus and crossbred cattle was not significantly different. The results confirm that purebred B indicus and crossbred cattle are sufficiently susceptible to warrant the use of vaccination against Anaplasma infections.

Ureteral valves in children.

OBJECTIVES: Congenital ureteral valves are a rare cause of ureteral obstruction in children, with only 42 cases having been reported in peer-reviewed literature. Eight additional cases of ureteral valves are herein reported. METHODS: We report on the diagnosis and management of eight children with ureteral obstruction secondary to a ureteral valve. RESULTS: Eight children with congenital ureteral valves were managed by ipsilateral ureteroureterostomy, ureteropyelostomy, or longitudinal ureterotomy with excision of valve leaflets. The obstruction was relieved in all. CONCLUSIONS: Ureteral valves should be included in the differential diagnosis of ureteral obstruction in children. Reconstruction is curative.

Genotypic diversity in field isolates of Babesia bovis from cattle with babesiosis after vaccination.

OBJECTIVE: To determine whether particular genotypes of Babesia bovis were common to field isolates obtained from cattle properties in Queensland where the B bovis vaccine had apparently failed. DESIGN: A comparative study of polymerase chain reaction genotypes in different populations of B bovis. PROCEDURE: Two polymerase chain reaction assays were applied to analyse DNA extracts of B bovis vaccine (K, T and Dixie strains) and 27 field isolates from 24 properties where disease outbreaks had occurred despite the use of the vaccine. To evaluate the stability of the genotypes identified, 11 of the field isolates were inoculated into experimental cattle that had either been previously vaccinated with T strain or not vaccinated. RESULTS: No particular genotype of B bovis was responsible for the problems observed in previously vaccinated herds. None of the isolates had genotypes identical to the vaccine strains used. No geographic trends among the genotypes were observed. Isolates that originated from the same property also had different genotypes. Blood passage of the 11 field isolates in either previously vaccinated or nonvaccinated cattle did not alter the original genotype. CONCLUSION: No particular genotypes identified by the Bv80 and BvVA1 polymerase chain reaction assays could be associated with vaccine failures.

Effect of breed of cattle on innate resistance to infection with Babesia bovis, B bigemina and Anaplasma marginale.

OBJECTIVE: To assess the innate resistance of naive Bos taurus, Bos taurus cross Bos indicus and Bos indicus cattle to virulent Babesia bovis, B bigemina and Anaplasma marginale parasites. DESIGN: Groups of 10, pure B indicus, 1/2 B indicus cross, 1/4 B indicus cross and pure B taurus steers were infected with virulent B bovis, B bigemina and A marginale parasites [corrected]. PROCEDURE: Sequential infections were carried out by intravenous inoculation of infected blood containing 1 x 10(8) parasites of B bovis, followed by B bigemina and then A marginale. To assess resistance, measurements were made of parasitaemia, rectal temperature, packed cell volume and the number within a group requiring chemotherapy to control infection. There was a recovery period between each infection. RESULTS: Infection with B bovis showed that pure B indicus steers were significantly more resistant to B bovis infection than the other groups, with none of this group requiring treatment. There was no significant difference between 1/2 B indicus cross and 1/4 B indicus cross with 30% and 20%, respectively, of steers in these groups requiring treatment [corrected]. The pure B taurus steers were significantly more affected then those in the other three groups with 80% requiring treatment. Infections of B bigemina produced a mild response in comparison to that of B bovis and none of the steers required treatment. However, the pure B taurus group was significantly more affected than the other three groups for all other measurements. After the A marginale infection, B indicus steers were moderately affected with 50% requiring treatment, whereas 70% of the 1/2 B indicus group, 80% of the 1/4 B indicus cross group and 100% of the pure B taurus group required treatment [corrected]. CONCLUSIONS: All breeds of cattle, ranging from pure B indicus to pure B taurus may be at risk of severe disease if exposed to virulent A marginale. The results confirm that pure B indicus cattle are relatively resistant to B bovis, but there could be a significant risk of severe mortalities if cross-bred herds are exposed to virulent infection.

DHEA: threat to access?

AIDS: DHEA, one of the most popular potential treatments sold by HIV buyers' clubs, may be banned in the United States. DHEA advocates are particularly worried about a new government regulation that would classify DHEA as a Schedule III drug. However, contact with the Food and Drug Administration (FDA) and the Drug Enforcement Agency (DEA) revealed inconsistencies and considerable confusion about how DHEA is defined. Independent state DHEA conviction actions may encourage Federal action to enforce DHEA's ban. DHEA shows promise in the treatment of lupus and other autoimmune diseases, enhances resistance to infection, and restores immunity in mice and in older people. The promotion of DHEA as a cure-all has prompted the FDA to take action. Future access to DHEA for people with AIDS may now depend on how the DEA deals with it as an anabolic steroid.^ieng

Progesterone-induced urticaria--need it be autoimmune?

A patient with persistent urticaria related to the premenstrual phase of the menstrual cycle is presented. Although systemic administration of progesterone provoked the eruption, we were unable to confirm that there was an immunological reaction to endogenous progesterone or oestrogen. Mechanisms whereby progesterone can augment subclinical types I and IV hypersensitivity reactions are discussed.

Eruptive pyogenic granulomas: a successfully treated patient and review of the literature.

Pyogenic granuloma, also known as lobular capillary haemangioma, is a solitary, benign vascular skin tumour. Although a single pyogenic granuloma is common, multiple eruptive pyogenic granulomas are extremely rare. We report the occurrence of multiple, eruptive pyogenic granulomas in a previously healthy 17-year-old girl. Over 200 lesions appeared spontaneously over an 8-month period. Lesions were initially treated with cryotherapy, and then with the pulsed dye laser, resulting in their complete clearance.

Studies on failure of T strain live Babesia bovis vaccine.

Field investigations of the protection afforded by the Australian live Babesia bovis vaccine used in the early 1990s (T strain) revealed inadequate vaccine-induced protection in certain herds. Vaccination/challenge trials using 207 experimental cattle were conducted to evaluate the protection afforded by T strain B bovis against field isolates from these herds. The trials investigated whether isolates that could 'break-through' T strain immunity were present in the field, the ability or inability of specific cattle to develop protective immunity after vaccination with T strain and the effect of attenuation and maintenance procedures on the immunogenicity of T strain. The results showed that B bovis parasites present early in the process of attenuation of T strain were more protective than those remaining late in the process. They also showed that cattle from properties experiencing vaccine failures were less protected by T strain vaccination than Bos taurus cattle randomly selected from the general population if vaccinated with highly attenuated T strain. A hypothesis is offered to explain these findings.

A survey of cattle producers in the Boophilus microplus endemic area of Queensland to determine attitudes to the control of and vaccination against tick fever.

A survey by mail was used to determine the views of beef producers in the Boophilus microplus endemic area of Queensland on the control of and vaccination against tick fever. Data from 448 questionnaires were analysed, representing 2.7% of beef producers in the survey area. Producers considered buffalo fly (Haematobia irritans exigua) infestation as the most important problem whereas tick fever ranked sixth overall. Private veterinarians were regarded as the most important source of information on vaccines for cattle followed by a weekly rural newspaper. From the survey we estimate that about 33% of producers used the tick fever vaccine produced by the Tick Fever Research Centre of Queensland Department of Primary Industries but there were significant (P < 0.05) variations between regions and herds. Large herds (> or = 400 head) in south-east Queensland were the most likely to be vaccinated against tick fever. Of the producers who did not use the vaccine, over 70% replied that there was no need to vaccinate because of the low risk of the disease in their herds. In 52% of unvaccinated herds the treatment of animals with acaricide was considered the most important means of tick fever control and 61% of these herds comprised Bos indicus x Bos taurus or Bos indicus cattle.

Further evaluation of transurethral laser ablation of the prostate in patients treated with anticoagulant therapy.

Transurethral Nd:YAG laser ablation of the prostate gland was used to treat benign prostatic hyperplasia (BPH) in 20 patients on Warfarin anticoagulant therapy, and in two patients with abnormal coagulation parameters secondary to haematologic disorders. Preliminary results for the first 10 of these patients has been reported previously. The mean pre-operative international normalized ratio (INR) was 2.6 (range 1.19 to 5.25) and the mean prostate volume was 56 cc (13.6-112 cc). All patients had significant subjective and objective indicators of prostatic obstruction and six patients were in urinary retention. Postoperative improvement in symptom score, maximum flow rate and post-void residual was noted in 82% of patients at 3 months, 89% at 6 months and 75% at 1 year. Two patients have required revision laser or transurethral resection of the prostate (TURP) for persistent obstruction, while one patient required revision TURP for intractable haematuria. Three patients developed haematuria requiring transfusion while four patients had mild haematuria requiring no intervention. Laser ablation of the prostate can be used successfully and safely to treat prostatic obstruction in patients with abnormal coagulation parameters, or in those who are fully anticoagulated. Anticoagulation can be maintained during surgery in this group unlike TURP where pre-operative reversal is necessary with reinstitution of therapy several days postoperatively. Other authors report at least a 50% blood transfusion rate in this group. Laser prostatectomy appears the more appealing surgical option in these patients.