Developments in rehabilitation psychiatry within the RANZCP and the creation of a mental health rehabilitation curriculum.

OBJECTIVE: This paper describes the initial development of a mental health rehabilitation curriculum for Australian mental health settings and for psychiatrists and trainees wishing to develop specialist skills in mental health rehabilitation. METHOD: Members of the Section of Social Cultural and Rehabilitation Psychiatry (SSCRP) established an expert working group under the auspices of the RANZCP. Existing college training resources were reviewed, and a gap analysis was conducted to guide development of new training modules. RESULTS: A tiered curriculum structure was created that allows a staged development of rehabilitation knowledge, skills and attitudes required to be a specialist in mental health rehabilitation. An introductory module was developed to establish the principles of modern mental health rehabilitation. Most of the curriculum was based on existing resources that are relevant to rehabilitation practice. Finalisation of a draft for review was undertaken with the assistance of the RANZCP education project advisors and curriculum experts. CONCLUSIONS: As a national body responsible for training psychiatric registrars and maintenance of training for psychiatrists, the RANZCP is well situated to train the specialist medical mental health workforce required to lead rehabilitation services in Australia. The RANZCP mental health rehabilitation curriculum will provide a platform to train the skilled workforce that will enable these services to be fully realised.

Translocation of Loline Alkaloids in Epichloë-Infected Cereal and Pasture Grasses: What the Insects Tell Us.

Aphids are major pests of cereal and pasture grasses throughout the world, vectoring disease and reducing plant production. There are few control options other than insecticides. Epichloë endophytes that produce loline alkaloids in their hosts provide a possible mechanism of control, with both meadow fescue and tall fescue naturally infected with loline-producing endophytes showing a resistance to Rhopalosiphum padi. We screened Elymus spp. naturally infected with endophytes that produced loline alkaloids at concentrations known to affect aphids on fescue but found no effect on these insects infesting Elymus. A synthetic loline-producing endophyte association with rye also had no effect on the aphids. After hypothesizing that the lolines were being translocated in the xylem in Elymus and rye rather than the phloem, we tested the rye and meadow fescue infected with loline-producing endophytes against a xylem feeding spittlebug. The endophyte in rye inhibited the feeding of the insect and reduced its survival, whereas the endophyte-infected meadow fescue had no effect on the spittlebug but reduced the number of aphids. Lolines applied to the potting medium of endophyte-free and endophyte-infected rye, ryegrass, and tall fescue resulted in a decrease in the aphid populations on the endophyte-free pasture grasses relative to the untreated controls but had no effect on aphid numbers on the rye. We tentatively conclude that lolines, produced in both natural and synthetic association with Elymus and rye, are partitioned in the xylem rather than the phloem, where they are inaccessible to aphids.

Genetic Manipulation of the Ergot Alkaloid Pathway in Epichloë festucae var. lolii and Its Effect on Black Beetle Feeding Deterrence.

Epichloë endophytes are filamentous fungi (family Clavicipitaceae) that live in symbiotic associations with grasses in the sub family Poöideae. In New Zealand, E. festucae var. lolii confers significant resistance to perennial ryegrass (Lolium perenne) against insect and animal herbivory and is an essential component of pastoral agriculture, where ryegrass is a major forage species. The fungus produces in planta a range of bioactive secondary metabolites, including ergovaline, which has demonstrated bioactivity against the important pasture pest black beetle, but can also cause mammalian toxicosis. We genetically modified E. festucae var. lolii strain AR5 to eliminate key enzymatic steps in the ergovaline pathway to determine if intermediate ergot alkaloid compounds can still provide insecticidal benefits in the absence of the toxic end product ergovaline. Four genes (dmaW, easG, cloA, and lpsB) spanning the pathway were deleted and each deletion mutant was inoculated into five different plant genotypes of perennial ryegrass, which were later harvested for a full chemical analysis of the ergot alkaloid compounds produced. These associations were also used in a black beetle feeding deterrence study. Deterrence was seen with just chanoclavine present, but was cumulative as more intermediate compounds in the pathway were made available. Ergovaline was not detected in any of the deletion associations, indicating that bioactivity towards black beetle can be obtained in the absence of this mammalian toxin.

Identification and Structure Elucidation of Epoxyjanthitrems from Lolium perenne Infected with the Endophytic Fungus Epichloë festucae var. lolii and Determination of the Tremorgenic and Anti-Insect Activity of Epoxyjanthitrem I.

Epoxyjanthitrems I-IV (1-4) and epoxyjanthitriol (5) were isolated from seed of perennial ryegrass (Lolium perenne) infected with the endophytic fungus Epichloë festucae var. lolii. Although structures for epoxyjanthitrems I-IV have previously been proposed in the literature, this is the first report of a full structural elucidation yielding NMR (Nuclear magnetic resonance) assignments for all five epoxyjanthitrem compounds, and additionally, it is the first isolation of epoxyjanthitriol (5). Epoxyjanthitrem I induced tremors in mice and gave a dose dependent reduction in weight gain and feeding for porina (Wiseana cervinata), a common pasture pest in New Zealand. These data suggest that epoxyjanthitrems are involved in the observed effects of the AR37 endophyte on livestock and insect pests.

Root Herbivory: Grass Species, Epichloë Endophytes and Moisture Status Make a Difference.

The root-feeding scarab insect Costelytra giveni causes severe damage to pasture ecosystems in New Zealand. Loline alkaloids produced by some Epichloë endophytes deter this insect. In two experiments, tall fescue infected with E. coenophiala, strain AR584, and endophyte-free (Nil) controls were subjected to pulse drought stress (DS) or well-watered conditions (WW). The second experiment also included meadow fescue infected with E. uncinata. After 4-6 weeks exposure to the different conditions, roots were excised and fed to C. giveni larvae for 7 days. Relative root consumption (RC), frass production, and relative weight change (RWC) of larvae were measured and the loline content of roots determined. RC and frass output were higher for larvae feeding on Nil DS tall fescue than WW and reduced by AR584. RWC was also greater on DS than on WW Nil plants but reduced by endophyte only in DS plants. RC, frass output, and RWC of larvae were reduced by endophyte in DS and WW meadow fescue, but the effect was greater for WW plants. Loline alkaloid concentration in roots was significantly higher in DS than WW tall fescue in Experiment I but higher in WW than DS meadow fescue in Experiment II. These experiments have demonstrated that moisture status interacts with endophyte to differentially affect root herbivory in tall fescue and meadow fescue.

Comparison of earthworm and chemical assays of the bioavailability of aged 1,1-dichloro-2,2-bis(p-chlorophenyl)ethylene, 1,1,1-trichloro-2,2-bis(p-chlorophenyl)ethane, and heavy metals in orchard soils.

Orchard soils can contain elevated concentrations of 1,1-dichloro-2,2-bis(p-chlorophenyl)ethylene (p,p'-DDE), 1,1,1-trichloro-2,2-bis(p-chlorophenyl)ethane (p,p'-DDT), and heavy metals as a result of historical agrichemical applications. The bioavailability of p,p'-DDE, p,p'-DDT, As, Cd, Cu, and Pb from five field-aged New Zealand orchards and three grazing soils was assessed by using a 28-d bioassay with Aporrectodea caliginosa and chemical assays. Significant relationships were found between total soil and earthworm tissue concentrations for p,p'-DDE (p < 0.001), p,p'-DDT (p < 0.001), Cu (p < 0.001), and Pb (p < 0.01). Two neutral salt solutions, 0.01 M CaCl(2) and 1 M NH(4)NO(3), were used as surrogate measures of the bioavailability of heavy metals. Copper was the only heavy metal for which significant correlations were found between neutral-salt-extractable and earthworm tissue concentrations (p < 0.001). Up to 28% of the aged DDT residues were released from the soils by Tenax over a 24-h extraction period. Significant relationships (p < 0.01) between the Tenax-extractable and earthworm tissue concentrations for p,p'-DDE and p,p'-DDT showed that Tenax provides a good surrogate measure of the bioavailability of these compounds to A. caliginosa. Surprisingly, there was a similarly significant relationship (p < 0.001) between the total soil and earthworm tissue concentrations for p,p'-DDE and p,p'-DDT, suggesting that total soil concentrations alone were sufficient to predict uptake by A. caliginosa. These results demonstrate that the aged agrichemical residues in orchard soils, and particularly p,p'-DDE and p,p'-DDT, remain highly bioavailable to A. caliginosa despite decades of weathering and continue to present an environmental risk.

Anesthetic efficacy of a repeated intraosseous injection following a primary intraosseous injection.

The purpose of this prospective, randomized, single-blinded study was to determine the anesthetic efficacy of a repeated intraosseous injection given 30 minutes after a primary intraosseous injection. Using a crossover design, 55 subjects randomly received a primary X-tip intraosseous injection (Dentsply Inc, York, PA) of 1.4 mL of 2% lidocaine with epinephrine (using the Wand; Milestone Scientific, Deerfield, IL) and a repeated intraosseous or mock injection at 30 minutes in two appointments. The first molar and adjacent teeth were pulp tested every 2 minutes for a total of 120 minutes. Success was defined as obtaining two consecutive 80 readings with the electric pulp tester. Success of the initial intraosseous injection was 100% for the first molar. The repeated intraosseous injection mimicked the initial intraosseous injection in terms of pulpal anesthesia and statistically provided another 15 minutes of pulpal anesthesia. In conclusion, using the methodology presented, repeating the intraosseous injection 30 minutes after an initial intraosseous injection will provide an additional 15 minutes of pulpal anesthesia.

Parotid abscess due to salmonella enteritidis: A case report.

BACKGROUND: Salmonella infection of the parotid gland is rare. CASE: An instance in a 50-year-old man of Salmonella enteritidis parotiditis initially recognized by microbial culture of a fine needle aspiration cytology material is described. The identified predisposing factor was chronic alcoholic abuse. For the infection source, a carrier state of salmonella parotitis was postulated, which progressed to focal abscess and was subsequently complicated by bacteremia and hematogenous spread to the liver, spleen and lungs. CONCLUSION: Salmonella should be included in the differential consideration of head and neck abscesses in immunocompromised individuals and treated aggressively.

HIV and HHV-8 negative primary effusion lymphoma in a patient with hepatitis C virus-related liver cirrhosis.

Primary effusion lymphoma (PEL) or body cavity-based lymphoma (BCBL) is a unique subgroup of B-cell lymphomas that exhibits exclusive or dominant involvement of serous body cavities without a detectable tumor mass. We present a case of a PEL/BCBL that exclusively involved the peritoneal cavity of a 58-year-old immunocompetent male with hepatitis C virus (HCV)-related liver cirrhosis. The lymphoma cells were large, highly atypical and expressed CD19, CD20, CD22, CD10, HLA-DR, and CD45 with kappa light chain restriction. Unlike typical PEL/BCBL, human herpesvirus type 8/Kaposi sarcoma herpes virus (HHV-8/KSHV) genomic sequence was not present in the lymphoma cells and there was no serologic evidence of human immunodeficiency virus (HIV) infection. This is the fourth reported case of HHV-8 negative, HIV negative PEL/BCBL in a patient with associated HCV-related cirrhosis and review of these cases showed some consistent clinicopathological features, i.e. exclusive involvement of the peritoneal cavity and phenotypic expression of B-cell associated antigens in contrast to the generally null phenotype PEL/BCBL. The occurrence of these cases suggests that HCV may play an etiological role in a subcategory of PEL/BCBL not associated with HHV-8.