Dreamlike events are correlated with the length of sleep mentation reports.

We investigated the relationship between length and dreamlike quality in sleep mentation reports. Reports were obtained by waking subjects at sleep onset (SO) and at 5 and 10 minutes into the second (REMP2) and fourth REM periods (REMP4). Reports were recorded, transcribed, and scored blindly for total word count (TWC) and dreamlike quality as measured by a composite dream scale score (CDS). Dreamlike quality was strongly correlated with TWC; both CDS and TWC scores increased across successively later awakenings. Significant differences were found in both TWC and CDS between SO and REMP4 and also between REMP2 and REMP4; however, differences were not significant between SO and REMP2 or between the 5 and 10 minute awakenings in REMPs 2 and 4. These findings provide further evidence that the amount of dreamlike mentation is related to the within-sleep arousal level rather than to REMP duration and that the dreamlike quality of reports increases as they become longer.

Nitrogen management is essential to prevent tropical oil palm plantations from causing ground-level ozone pollution.

More than half the world's rainforest has been lost to agriculture since the Industrial Revolution. Among the most widespread tropical crops is oil palm (Elaeis guineensis): global production now exceeds 35 million tonnes per year. In Malaysia, for example, 13% of land area is now oil palm plantation, compared with 1% in 1974. There are enormous pressures to increase palm oil production for food, domestic products, and, especially, biofuels. Greater use of palm oil for biofuel production is predicated on the assumption that palm oil is an "environmentally friendly" fuel feedstock. Here we show, using measurements and models, that oil palm plantations in Malaysia directly emit more oxides of nitrogen and volatile organic compounds than rainforest. These compounds lead to the production of ground-level ozone (O(3)), an air pollutant that damages human health, plants, and materials, reduces crop productivity, and has effects on the Earth's climate. Our measurements show that, at present, O(3) concentrations do not differ significantly over rainforest and adjacent oil palm plantation landscapes. However, our model calculations predict that if concentrations of oxides of nitrogen in Borneo are allowed to reach those currently seen over rural North America and Europe, ground-level O(3) concentrations will reach 100 parts per billion (10(9)) volume (ppbv) and exceed levels known to be harmful to human health. Our study provides an early warning of the urgent need to develop policies that manage nitrogen emissions if the detrimental effects of palm oil production on air quality and climate are to be avoided.

Mineral and biological ice-nucleating particles above the South East of the British Isles.

A small fraction of aerosol particles known as Ice-Nucleating Particles (INPs) have the potential to trigger ice formation in cloud droplets at higher temperatures than homogeneous freezing. INPs can strongly reduce the water content and albedo of shallow mixed-phase clouds and also influence the development of convective clouds. Therefore, it is important to understand which aerosol types serve as INPs and how effectively they nucleate ice. Using a combination of INP measurements and Scanning Electron Microscopy with Energy Dispersive Spectroscopy (SEM-EDS), we quantify both the INP concentrations over a range of activation temperatures and the size-resolved composition. We show that the INP population of aerosol samples collected from an aircraft over the UK during July of 2017 is consistent with ice-nucleation on mineral dust below about -20 °C, but some other INP type must account for ice-nucleation at higher temperatures. Biological aerosol particles above ∼2 µm were detected based on visual detection of their morphological features in all the analysed samples at concentrations of at least 10 to 100 L-1 in the boundary layer. We suggest that given the presence of biological material, it could substantially contribute to the enhanced ice-nucleation ability of the samples at above -20 °C. Organic material attached to mineral dust could be responsible for at least part of this enhancement. These results are consistent with a growing body of data which suggests mineral dust alone cannot explain the INP population in the mid-latitude terrestrial atmosphere and that biological ice nucleating particles are most likely important for cloud glaciation.

Iceland is an episodic source of atmospheric ice-nucleating particles relevant for mixed-phase clouds.

Ice-nucleating particles (INPs) have the potential to remove much of the liquid water in climatically important mid- to high-latitude shallow supercooled clouds, markedly reducing their albedo. The INP sources at these latitudes are very poorly defined, but it is known that there are substantial dust sources across the high latitudes, such as Iceland. Here, we show that Icelandic dust emissions are sporadically an important source of INPs at mid to high latitudes by combining ice-nucleating active site density measurements of aircraft-collected Icelandic dust samples with a global aerosol model. Because Iceland is only one of many high-latitude dust sources, we anticipate that the combined effect of all these sources may strongly contribute to the INP population in the mid- and high-latitude northern hemisphere. This is important because these emissions are directly relevant for the cloud-phase climate feedback and because high-latitude dust emissions are expected to increase in a warmer climate.

Contributions of biogenic material to the atmospheric ice-nucleating particle population in North Western Europe.

A minute fraction of atmospheric particles exert a disproportionate effect on the phase of mixed-phase clouds by acting as ice-nucleating particles (INPs). To understand the effects of these particles on weather and climate, both now and into the future, we must first develop a quantitative understanding of the major INP sources worldwide. Previous work has demonstrated that aerosols such as desert dusts are globally important INPs, but the role of biogenic INPs is unclear, with conflicting evidence for their importance. Here, we show that at a temperate site all INPs active above -18 °C at concentrations >0.1 L-1 are destroyed on heating, consistent with these INPs being of biological origin. Furthermore, we show that a global model of desert dust INPs dramatically underestimates the measured INP concentrations, but is consistent with the thermally-stable component. Notably, the heat sensitive INPs are active at temperatures where shallow cloud layers in Northern Europe are frequently observed to glaciate. Hence, we suggest that biogenic material is important for primary ice production in this region. The prevalence of heat sensitive, most likely biogenic, INPs in this region highlights that, as a community, we need to quantify the sources and transport of these particles as well as determine their atmospheric abundance across the globe and at cloud altitudes.

Panic disorder in the primary care setting: comorbidity, disability, service utilization, and treatment.

BACKGROUND: Increased medical service utilization in patients with panic disorder has been described in epidemiologic studies, although service use in primary care panic patients relative to other primary care patients is less well characterized. Inadequate recognition of panic has been shown in several primary care studies, although the nature of usual care for panic in this setting has not been well documented. This study aimed to document increased service use in panic patients relative to other primary care patients and to characterize the nature of their usual care for panic and their outcome. METHOD: Using a waiting room screening questionnaire and follow-up telephone interview with the Composite International Diagnostic Interview, we identified a convenience sample of 81 patients with panic disorder (DSM-IV) and a control group of 183 psychiatrically healthy patients in 3 primary care settings on the West Coast and determined psychiatric diagnostic comorbidity, panic characteristics, disability, and medical and mental health service use, including medications. A subsample (N = 41) of panic patients was reinterviewed 4-10 months later to determine the persistence of panic and the adequacy of intervening treatment received using the Harvard/Brown Anxiety Disorders Research Program study criteria for cognitive-behavioral therapy (CBT) and an algorithm developed by the authors for medications. RESULTS: Seventy percent of panic patients had a comorbid psychiatric diagnosis. Patients had more disability in the last month (days missed or cut down activities) (p < .01), more utilization of emergency room and medical provider visits (p < .01), and more mental health visits (p < .05). Despite the latter, only 42% received psychotropic medication, 36% psychotherapy, and 64% any treatment. On follow-up, 85% still met diagnostic criteria for panic, and only 22% had received adequate medication (type and/or dose) and 12% adequate (i.e., CBT) psychotherapy. CONCLUSION: These findings suggest a need for improved treatment interventions for panic disorder in the primary care setting to decrease disability and potentially inappropriate medical service utilization.

Depression screening in a women's clinic: using automated Spanish- and English-language voice recognition.

Clinical depression is frequently unrecognized, even in health care settings. This study (a) reports high levels of major depressive episodes (MDEs) and depressive symptoms in a public sector women's clinic, (b) compares computerized voice recognition with live interviews, and (c) compares Spanish and English versions of the depression-screening instruments. Patients (N = 104) completed face-to-face interviews and/or computerized voice recognition interviews in counterbalanced order; 38% scored positive for current MDE, and 67% scored positive for lifetime MDE. The mean score on the Center for Epidemiological Studies Depression scale (CES-D) was 22.1 (SD = 12.1), with 68% scoring 16 or above. No differences were found on either measure between English and Spanish speakers. Overall agreement between computer and live interviews was as follows: kappa = .82 for both current and lifetime MDE and r = .89 for CES-D scores. Kappas between the MDE Screener developed for this study and the Primary Care Evaluation of Mental Disorders were .75 for live interviews and .81 for the computerized version. Depression screening with computerized voice recognition methods yielded results comparable with those of live interviews in both English and Spanish.

A comparison of two life stress assessment approaches: prospective prediction of treatment outcome in recurrent depression.

Research on life stress has been characterized by inconsistent results, which some researchers attribute to different assessment methodologies. Generally, studies have used either self-report checklists or investigator-based interviews. To test whether different results are derived from these approaches, the authors compared information from a self-report measure of life stress with the additional data available from a follow-up investigator-based measure in prospectively predicting the outcome of treatment for recurrent major depression. The 2 approaches produced different results, with investigator-based life events predicting lower probability of remission and self-report life events either predicting increased likelihood of remission or not predicting at all. The results demonstrated that methodology may account for some of the inconsistencies in the life stress literature.

Severity of psychosocial stress and outcome of alcoholism treatment.

We examined the relation between stressful life events and drinking outcome among 129 male alcoholics who had completed an alcohol treatment program. Life events were assessed for the year prior to treatment and for the 3 months after treatment and were rated on the Psychiatric Epidemiology Research Interview and the Contextual Rating System. Approximately 40% of the pretreatment stressors were found to be directly or indirectly related to alcohol use. When stressors related to drinking were excluded from consideration, we found that men who returned to drinking after treatment experienced more severe or highly threatening stress before their relapse than men who remained abstinent during the follow-up period. These data suggest that although less severe stress may not increase risk for relapse, acute severe stressors and highly threatening chronic difficulties may be associated with elevated relapse risk.

Depression in a primary care clinic: the prevalence and impact of an unrecognized disorder.

BACKGROUND: This study assesses depression among primary care patients, the relationship between depression and functioning, and how frequently depressed individuals receive mental health treatment. METHODS: Two hundred and thirteen participants completed a diagnostic interview and measures of functional impairment and service utilization. RESULTS: Sixty-two clinic patients were depressed, and depressed individuals experienced significant functional impairment even after controlling for comorbid anxiety disorders and medical problems. However, less than 40% of depressed individuals were receiving treatment for depression. Severity of impairment was related to likelihood of receiving mental health services. LIMITATIONS: Several factors to consider when evaluating this study are the cross-sectional design, use of self-report data, and lack of random sampling. CONCLUSIONS: These results show that depression has a unique and significant impact on the functioning of primary care patients, and emphasize the need for identification of depressive disorders in primary care.

Posttraumatic stress disorder in the primary care medical setting.

Posttraumatic stress disorder (PTSD) is a prevalent disorder that adversely affects 2-5% of the general population. Little is known about PTSD in the primary care setting. The purpose of the present study was to evaluate the utility of a screening instrument for PTSD (the PCL-C) in primary care and to examine comorbidity, disability, and patterns of healthcare utilization among persons with PTSD in this setting. Adult, English-speaking patients attending for routine medical care (N=368) participated in a two-stage screening consisting of the administration of a self-report measure for posttraumatic stress disorder (the PCL-C) followed by a structured diagnostic interview. Current (1-month) prevalence of PTSD was determined, as were current comorbid disorders. Brief functional impairment and disability indices were administered, and healthcare utilization in the prior 6 months was ascertained. 11.8% (standard error 1.7%) of primary care attendees met diagnostic criteria for either full or partial PTSD. Comorbidity with major depression (61% of cases of PTSD) and generalized anxiety disorder (39%) was common, but less so with social phobia (17%) and panic disorder (6%). Substance use disorder comorbidity (22%) was also fairly common. Patients with PTSD reported significantly more functional impairment than patients without mental disorders. Patients with PTSD also made greater use of healthcare resources than not mentally ill patients. PTSD frequently is encountered in primary care, and is associated with considerable functional impairment and healthcare utilization. Comorbidity with other mood and anxiety disorders is extensive. It remains to be seen if greater awareness and more aggressive treatment of PTSD in primary care will lead to improved functioning and reduced (or more appropriate) healthcare utilization. These are topics for further study.

Dimensionality of posttraumatic stress symptoms: a confirmatory factor analysis of DSM-IV symptom clusters and other symptom models.

Recent exploratory [Taylor, S., Kuch, K., Koch, W. J., Crockett, D. J., & Passey, G. (1998). The structure of posttraumatic stress symptoms. Journal of Abnormal Psychology, 107, 154-160.] and confirmatory [Buckley, T. C., Blanchard, E. B., & Hickling, E. J. (1998). A confirmatory factor analysis of posttraumatic stress symptoms. Behaviour Research and Therapy, 36, 1091-1099; King, D. W., Leskin, G. A., King, L. A., & Weathers, F. W. (1998). Confirmatory factor analysis of the clinician-administered PTSD scale: evidence for the dimensionality of posttraumatic stress disorder. Psychological Assessment, 10, 90-96.] factor analytic investigations suggest that the three symptom clusters of posttraumatic stress disorder (PTSD) as defined in the Diagnostic and Statistical Manual [4th ed.; DSM-IV; American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.] may not provide the best conceptualization of symptom dimensionality. However, the alternative models have not been in agreement, nor have they been compared against each other or models based on the DSM-IV. The purpose of the present investigation was to test a series of dimensional models suggested by these recent factor analytic investigations and the DSM-IV. Using data collected with the PTSD Checklist--Civilian Version [Weathers, F. W., Litz, B. T., Huska, J. A., & Keane, T. M. (1994). PCL-C for DSM-IV. Boston: National Center for PTSD--Behavioral Science Division.] from 349 referrals to a primary care medical clinic, we used confirmatory factor analysis to evaluate a: (1) hierarchical four-factor model, (2) four-factor intercorrelated model, (3) hierarchical three-factor model, (4) three-factor intercorrelated model, and (5) hierarchical two-factor model. The hierarchical four-factor model (comprising four first-order factors corresponding to reexperiencing, avoidance, numbing, and hyperarousal all subsumed by a higher-order general factor) provided the best overall fit to the data; although, all models met some standards specified for good model fit. More research is needed to establish the dimensional nature of PTSD symptoms and to assess whether identified dimensions differ as a function of the trauma experience. Implications for assessment, diagnosis, and treatment are also discussed.

Correlates of life stress in an alcohol treatment sample.

Men in alcohol dependence treatment commonly report elevated levels of stressful life experiences prior to entering treatment. Clinical researchers have argued that training patients to cope with stress is an important aspect of therapy for alcohol dependence. Current age and age of onset of alcohol dependence are two patient characteristics that may relate to stress and allow mental health care providers to anticipate patient needs more readily. This study examines whether current age and age of onset of alcohol dependence are related to the type of stress experienced preceding treatment. Participants were 350 male veterans receiving inpatient treatment for alcohol dependence who completed a semistructured interview-based life stress assessment. The likelihood of life events related to achievement, relationship, and legal problems decreased with age; the likelihood of health difficulties increased with age; and age and age of onset of alcohol dependence interacted to predict health difficulties. These results indicate that the nature of some stress experiences prior to treatment for alcohol dependence may be related to current age and the course of alcohol dependence.

Pentazocine suppositories for post-operative pain: intramuscular pentazocine injections versus suppositories in a controlled trial in 588 patients.

A between-patient comparison of the analgesic effect of pentazocine 50 mg by suppository and 30--45 mg by intramuscular injection was made in 558 postoperative patients, 54% within 24 hours of operation. The suppositories proved acceptable overall, even though effectiveness was less at half an hour after administration (particularly in those patients with severe initial pain) and there was greater need for further analgesia at one hour. The cost of treatment with suppositories is less than with injections. After the suppositories there were half as many patients asleep at one hour than after injections, and fewer possible side-effects (7 compared to 24).

Pentazocine suppositories versus pethidine injections in 500 patients with post-operative pain.

Pentazocine (Fortral) suppositories (50 mg) were compared with pethidine (100 mg) by injection in 500 patients after general and gynaecological surgery. Pain was assessed by patients using a pain thermometer, (a modification of a visual analogue scale), and by observers using an adjectival scale. There was a good relationship between these methods. Good pain relief was obtained with both drugs and there was little difference between the treatments in moderate pain. Pethidine was faster and more effective, particularly in severe pain. There were fewer side-effects with pentazocine suppositories. They are a useful alternative to injections, especially in moderate pain.

Social phobia in the primary care medical setting.

BACKGROUND: Social phobia (social anxiety disorder) is a common disorder that is receiving more attention as new treatments become available. Little is known about social phobia as it appears in the primary care setting. The purpose of our study was to determine the prevalence of social phobia in a primary care clinic, the rates of comorbidity with other anxiety and mood disorders, the extent of disability, and patterns of healthcare utilization. METHODS: A total of 511 English-speaking adults presenting for routine medical care participated in a 2-stage screening consisting of the administration of a self-report measure for social phobia followed by a structured diagnostic interview. We determined current (1-month) prevalence of social phobia, current comorbid disorders, and we ascertained use of health care in the previous 6 months. We also administered brief functional impairment and disability indices. RESULTS: A lower-bound estimate of 7.0% of primary care attendees suffered from social phobia as defined in the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition. Comorbidity with major depression (58.3% of cases of social phobia) was extensive, somewhat less so with panic disorder (27.8%) and generalized anxiety disorder (30.6%). Social phobics reported significantly more impairment in all functional domains than primary care patients without mental disorders; this was most pronounced in patients with the generalized subtype of social phobia. Social phobics made greater use of health care resources than patients who were not mentally ill, yet few (<20%) were receiving appropriate psychotropic medications. CONCLUSIONS: Patients with social phobia frequently present to primary care medical settings, and manifest impairment in multiple functional domains. But, on the basis of the low rate of psychotropic prescription, it seems that social phobia is either undiagnosed or felt by physicians to be unlikely to benefit from such treatments. Social phobia is highly comorbid with major depression and with other anxiety disorders in the primary care setting. Attention by family physicians to the presence of depression or panic attacks should signal the need to query patients about possible social phobia.

The atmospheric chemistry of trace gases and particulate matter emitted by different land uses in Borneo.

We report measurements of atmospheric composition over a tropical rainforest and over a nearby oil palm plantation in Sabah, Borneo. The primary vegetation in each of the two landscapes emits very different amounts and kinds of volatile organic compounds (VOCs), resulting in distinctive VOC fingerprints in the atmospheric boundary layer for both landscapes. VOCs over the Borneo rainforest are dominated by isoprene and its oxidation products, with a significant additional contribution from monoterpenes. Rather than consuming the main atmospheric oxidant, OH, these high concentrations of VOCs appear to maintain OH, as has been observed previously over Amazonia. The boundary-layer characteristics and mixing ratios of VOCs observed over the Borneo rainforest are different to those measured previously over Amazonia. Compared with the Bornean rainforest, air over the oil palm plantation contains much more isoprene, monoterpenes are relatively less important, and the flower scent, estragole, is prominent. Concentrations of nitrogen oxides are greater above the agro-industrial oil palm landscape than over the rainforest, and this leads to changes in some secondary pollutant mixing ratios (but not, currently, differences in ozone). Secondary organic aerosol over both landscapes shows a significant contribution from isoprene. Primary biological aerosol dominates the super-micrometre aerosol over the rainforest and is likely to be sensitive to land-use change, since the fungal source of the bioaerosol is closely linked to above-ground biodiversity.