Predictors of admission and readmission to hospital for major depression: A community cohort study of 52,990 individuals.

Background Our current knowledge about predictors of admission and re-admission to hospital as a result of major depressive disorder (MDD) is limited. Here we present a descriptive analysis of factors which are associated with MDD hospitalisations within a large population cohort. Methods We linked participants of the Scottish Health Survey (SHS) to historical and prospective hospital admission data. We combined information from the SHS baseline interview and historical hospitalisations to define a range of exposure variables. The main outcomes of interest were: (1) first time admission for MDD occurring after the SHS interview; and (2) readmission for MDD. We used Cox regression to determine the association between each predictor and each outcome, after adjusting for age, gender and deprivation quintile. Results 52,990 adult SHS participants were included. During a median follow-up of 4.5 years per participant, we observed 530 first-time admissions for MDD. A relatively wide range of factors – encompassing social, individual health status, and lifestyle-related exposures – were associated with this outcome (p&#60;0.05). Among the 530 participants exhibiting a de novo admission for MDD during follow-up, 118 were later re-admitted. Only older age (over 70) and a prior non-depression related psychiatric admission were associated with readmission for MDD. Limtations MDD was defined using records of International Classification of Disease hospital discharge codes rather than formal diagnostic assessments. Conclusion These findings have implications for mental health service organisation and delivery and should stimulate future research on predictive factors for admission and readmission in MDD.</p

Studies in malaria chemotherapy

This thesis is an account of the study of some aspects of experimental malaria therapy carried out in an Army Research Team during the period July 1944 to January 1946. -It covers investigations on the response to treatment of malaria cases seen under Field conditions in North Africa and Italy and deals with a continuation of similar work on anti -malarial compounds' conducted at a Military Hospital in England. Until the cessation of hostilities many of the findings in this work were restricted from publication owing to their bearing on military operations, a restriction for which there is now happily no need, so that expressions of opinion on the relative merits of different drugs may be freely given and supported by factual evidence hitherto not possible to disclose. A very great deal of research on the problem of malaria has been done in the last few years prompted e by the need for the United Nations to wage war in malarious countries at a time when the main World supply of Quinine was in enemy hands. This work, which received very high priority and official backing, was carefully directed and co- ordinated in Britain and America by combined Committees of civilian.and Service Authorities who arranged for an organised approach to the problems presenting and for á mutual sharing of facilities for study as well as results. For reasons of security, little mention of this work has appeared in recent medical literature, but there can be few diseases which have been the subject of more organised study than malaria and few organisms that can have proved more wily and resistant antagonists than the causal Plasmodia. Scientists in university laboratories, synthetic chemists in the great drug manufacturing concerns, therapeutic trial teams in far-flung theaters of war and field control teams draining swamps and spraying D.D.T. from aircraft over jungles; all have played a part and made their contribution to the story of the united front against malaria and to the successes that have been achieved. It is indeed a solemn thought.for reflection that nothing less than a world -wide conflict was .required for civilisation to support, with more than the customary financial pittance, medical research into the prevention and treatment of the disease which has been for long years the greatest single scourge of the human race

Reducing Undesirable Environmental Impacts in the Marine Environment: A Review of Market-Based Incentive Management Measures

Using the example of commercial fishing, this paper explores the potential of incentive based management measures as a means of reducing the undesirable impacts of industries operating within the marine environment. Despite having been successfully applied for similar purposes in the management of terrestrial environments, and their potential to achieve environmental gains in an economically efficient manner, examples of incentive based management mechanisms are still relatively limited in the marine context. We assess the potential of a number of alternative market based management measures by reviewing and considering the successes and limitations of previous applications and how these would translate in the case of commercial fishing. Several fishing methods and conservation values are considered and the circumstances in which incentive measures may be most applicable are identified. Where appropriate, and by either replacing or (more likely) complimenting existing management arrangements, incentive based measures have the potential to improve upon the performance of existing measures. This has a number of implications. From the environmental perspective they should allow the expected level of undesirable impact to be reduced. They can also reduce the costs imposed upon the industry by letting them develop the solutions. Further, in the increasingly relevant case of MPAs the potential costs to Government may also be significantly reduced if increasing environmental performance makes it possible for certain industry members to continue operating, reducing the necessity of often costly structural adjustment programs.Environmental Economics and Policy,

Fine resolution pollen analysis of late Flandrian II peat at north Gill, north York moors

Pollen and charcoal percentage and concentration analyses have been conducted upon several upland peat profiles of late Flandrian II and early Flandrian III age at North Gill, North York Moors, where earlier research had proven recurrent major pre Elm Decline woodland disturbance, supported in one profile by radiocarbon dating. Fine temporal resolution pollen analysis (FRPA) involving the use of contiguous millimetre sampling was applied to Flandrian II disturbance phases at five of the North Gill profiles. At North Gill 1A a further phase of disturbance near the end of Flandrian II was examined using FRPA to study evidence of pre Elm Decline agricultural activity, and at this profile both the horizontal and vertical resolution limits of the technique were tested by progressively finer sub-sampling. The millimetre level FRPA analyses showed that each of the examined pre Elm Decline disturbance phases was an aggregate feature, composed of a number of smaller sub-phases, the ecological effects of which in terms of spatially-precise woodland successions and community structures were assessed and contrasted. Inter-profile spatial comparison of the ecology of woodland disturbances has been made at both FRPA and conventional scales of temporal resolution. FRPA study of the late Flandrian II disturbance phase at North Gill 1A showed that cereal cultivation had occurred prior to the Elm Decline as part of a multi-phase period of agricultural land-use activity. The high resolution spatial and temporal data from North Gill have shown FRPA to be a most sensitive palaeoecological technique, and are discussed in relation to the effects of disturbance upon mire and woodland ecosystems, Mesolithic land-use, pre Elm Decline cereal cultivation and early Neolithic land-use

Environmental alteration by mesolithic communities in the north York moors

Palynological and stratigraphic analyses have been conducted at eight sites in two areas of the North York Moors upland, supported in one case by radiocarbon analysis. Attention has been concentrated upon peat deposits of pre-Flandrian III age, in order to elucidate environmental alteration associated with Mesolithic communities in the region. Phases of forest recession apparently caused by fire clearance of the vegetation have been identified at each of these sites, and these have been attributed to the activities of Mesolithic man. The ecological changes associated with these forest clearance events have been illustrated using relative and concentration pollen diagrams, many of which have been drawn using the computer program NEWPLOT devised by Dr. I. Shennan and have involved the use of statistical confidence limits to assist in interpretation of the pollen data. The results of these analyses have been assessed, together with examples of pre-ulmus decline forest recession in the region collated from previously published data. The landscape of the North York Moors during Flandrian I and II has been discussed in terras of its resource potential for human communities, and a number of palaeoenvironmental zones have been identified on this basis. The origin, character and distribution of Menolithic clearance activity in relation to these zones has been discussed, together with its ecological consequences. Finally the role of environmental alteration in Mesolithic economy and land-use in the region and its long-term effects upon the landscape have been considered

Analysis of glioma cell heterogeneity by lineage-tracing in murine and human model systems

Intra-tumour heterogeneity and plasticity are key factors in treatment resistance and the recurrence of Glioblastoma (GBM), which is invariably fatal. Genetics, epigenetics, cell metabolism and plastic cancer stem cell (CSC) hierarchies interact with volatile micro-environmental forces to promote and shape cell identity. Improved understanding of these factors will inform more precise and effective GBM therapies. Here, we aim to develop a fluorescent tracking approach for patient derived GBM cells to investigate the relationship between clones, environment and CSC marker expression. Using a murine GBM model combined with Rosa26-confetti fluorescent labelling, we trialled suitable techniques for detection of labelled tumour clones and concluded fluorescent imaging and flow cytometry were the most effective. For patient-derived cells, we modified LeGO-vector fluorescent labelling with the aim of tracking a greater number of clones. We further optimised this technique for simultaneous flow cytometry detection of clones and their CSC marker expression. In the final chapter, we address the hypothesis that whole population CSC surface marker plasticity is a result of emergent clonal predominance. In two patient derived GBM lines, under steady-state environmental conditions, serial passaging and assessment of clonal marker expression detected distinct marker expression patterns between clones in the same culture dish. For both cell lines, transfer and culture of clonal mixtures to Matrigel® spheroids produced an expected plastic transition in population marker expression but also considerable predominance of certain clones. While the clonalsurface marker dynamics of the two cell lines were markedly distinct, divergent surface marker plasticity between clones of the same cell line was a consistent observation. Taken together these results supported our hypothesis that population marker plasticity is in part a result of emergent clonal predominance. We propose our developed techniques are suitable for rapid and economic characterisation of patient specific gene disruption, therapeutic vulnerabilities and resistance mechanisms

The background and predisposing causes of leprosy in Poona district, British India

The subject of leprosy is a large one, and it is not proposed to carry this study of it further at this time. On return to India, the author hopes to continue the study of leprosy in Poona District, and to make an effort to place the control of the disease on a better footing. From study of the land and the people, their habits, their diseases, their mental equipment, their means of subsistence, and the public resources available, some more satisfactory method of control of leprosy may emerge. The present position is in the highest degree unsatisfactory. For thousands of lepers in the District there exists one Leper Asylum and a few clinics, and only some 300 lepers at most are under control.ROGERS, 1931, animadverts against compulsory segregation as failing to stamp out or materially to reduce the prevalence of leprosy among backward races within a reasonable time. MUIR, 1932,(160), believes that segregation in India could not possibly be carried our for frightening patients "underground," and because of lack of finance. On the other hand, we have seen the success which has attended strict measures of isolation and control in Norway, (40) Withoug going further into the matter, it is enough to emphasise that in Poona District segregation of lepers has never been tried, strictly and efficiently, nor probably in any part of India, .and one would be better convinced of the truth of the opinions of ROGERS and of MUIR in this respect, if segregation or isolation had been tried. There is at least enough evidence, of its value to expect that one should "move heaven and earth," at least to give it a proper trial. Further, the problem of leprosy looks staggering when considered for the whole of India, but if one adopts a District as the unit of campaign, it does not look so hopeless. If one imagines the position of a state in India, small, independent, caring for no man, which determines to essay the proper control of leprosy within its borders, one cam visualise even success. Some degree of ruthlessness in the control of the liberty of the subject, and in the control of frontiers, and in the enforcement of anti- leprosy laws, and in the expenditure of money, would be demanded, but Norway has taught us that it can be done. Of course there are many difficulties:, but in India it has never been tried.In Poona District we have not even enough accommodation for the ordinary cure of the lepers who come to us. We are forced to treat 70 lepers in a clinic, because there is no room for them in a proper leper hospital. This position at least should be remedied, and if a modern leper hospital to contain 1,000 persons were built in Poona District, one is convinced that it would find occupants.Finally, one would like to suggest the anti-leprosy measures which need to be developed in Poona Districts: (a) All measures to spread general education and literacy. (b) Specific education about leprosy, among the people and among the existing medical personnel. (c) Increase in medical anti- leprosy staff. (d) Visiting every town and village in the District, and enumeration of lepers by careful and even bacteriological methods of diagnosis; at the same time carrying out propaganda and instituting treatment centres. (e) Building adequate leper hospitals: lepers require a great deal of ordinary medical care which at present is not possible, and there is a vast field in leper sugery alone. (f) Concerting of measures which aim at the 'bonification' of the people, as improvement of agriculture, housing, water supply, control of diseases, spread of knowledge of dietary and the like. (g) If enough courage and enough money be obtainable, securing in the end strict control and isolation of all known lepers

Theory of transition: latency and adolescence from an object-relations viewpoint

In this study, the uniqueness of reflective man expressed in a variety of separate persons, each with his own expanding system of relationships the separate elements of which overlap and form parts of the systems of others provides our definition of personality which is that specially human quality by which a person manifests his individuality in relationships with objects. The person who forms the unit is the product of processes of biological evolution and the force which is activating these processes is taken to be ultimately the same as that which energises systems of physical matter. The study of interchange of energy between physical structures and the psychic apparatus of individuals is within the field of metapsychology in which the unit is a mental process. Metapsychologically, persons are themselves systems. Recent developments in ego psychology indicate that the time has now come to attempt a synthesis of Freudian and later theoretical contributions to personality study, clinical findings in both adult and child analysis, philosophical considerations of the nature of reality and consciousness and some recent advances in the natural sciences. Such a large aim is beyond the scope of this work which is confined to an attempt to reformulate the Freudian theory of latency and adolescence within a comprehensive theory of transition

A study of "swayback": a demyelination disease of lambs with affinities to Schilder's disease, (encephalitis periaxialis diffusa) in man

1. When this investigation was begun in 1935, relatively little was known about the Swayback other than it was a form of lamb 'paralysis". These studies established the pathological nature of the disease for the first time and as a result caused it to be viewed in an entirely-new light, and thus placed it on sounder basis for further important work. • 2. Swayback is a nervous disorder of new-born and young lambs of different breeds occurring in many parts of England, Scotland and Wales. The same disease occurs in Australia and New Zealand and probably corresponds to conditions which have occurred in South America, Sweden, South Africa and India. The incidence in Britain varies annually and may be as high as 90 per cent. of the lambs born on any one affected farm. In some areas (e.g. Derbyshire) the disease is enzootic. • 3. The symptoms are those of a spastic paralysis of the limbs with resultant inco- ordination and occasionally blindness; the disease is progressive in most cases with a fatal termination. • 4. The pathology is characterised by a diffuse symmetrical demyelination of the cerebrum varying in extent in different cases from small foci in the centrum ovale to gross demyelination of the whole hemispheres. Liquefaction and cavitation is a common end stage of the lesion. Secondary degeneration of the motor tracts in the cord is always present. The disease is a degenerative disorder bearing some resemblance to Schilder's disease in man and is of ante-natal origin. • 5. Bacteria and /or viruses are not concerned in the aetiology; "Swayback" is analagous in this respect to the demyelinating disorders in man, monkey and the dog. • 6. The causal agent causes no obvious disturbance in the health of the ewe but exerts a pathogenic effect on the foetus or young lamb. In the latter this agent has a specific affinity for the cerebral myelin and/or for the mechanism or cells responsible for the laying down of myelin which it destroys with singular rapidity. • 7. The suggestion that a disturbance of copper metabolism in the pregnant ewes was concerned in this way with the aetioloty was subsequently investigated. Chemical analyses of the blood and body tissues of "Swayback" lambs and their mothers show lower Cu values compared with suitable controls. The remarkable prophylactic value of Cu is clearly proved as a result of a large scale field experiment carried out in Derbyshire. The exact role which the trace element plays in the aetiology is not, however, understood as it is apparent from the Cu analyses of the pastures that the disease is not a Cu deficiency per se. Until more is known about function of copper and its relation to myelin metabolism, the pathogenesis may not be easily explained. specific anaemic complication in the mother is not part of the syndrome and swayback is not thus a blood-brain complex parallel with pernicious anaemia and subacute combined degeneration in man

Disturbance and succession in early to mid-holocene northern english forests:Palaeoecological evidence for disturbance of woodland ecosystems by mesolithic hunter-gatherers

Forest succession can be monitored in the present, modelled for the future, but also reconstructed in the past on the records of forest history, including through the use of palaeo-ecological techniques. Longer-term records from pollen data can show changes over centennial and millennial timescales that are impacted by climate, migration or soil development. Having knowledge of previous phases of post-disturbance seral stages of woodland regeneration however, as after fire, can provide insights regarding successional process and function over short-term decadal timescales. The aim of this paper is to test the high-resolution pollen record as a source of new insights into processes of succession, assisted by the supplementary data of microscopic charcoal analyses. On short-term timescales, multiple phases of forest disturbance and then recovery have been identified in early to mid-Holocene peat records in northern England, many from the uplands but also from lowland areas. We identify and describe a typology of recovery patterns, including the composition and rate of recovery, and then test the processes and factors that impacted on different seral trajectories, concentrating on fire disturbance which might have had a natural origin, or might have been caused by pre-agricultural Mesolithic hunter-gatherers. Factors considered include the spatial location and intensity of the fire event, the duration of the disturbance phase, the structure and dynamics of the successional regeneration vegetation communities and the pre-disturbance tree cover. Data from examples of fire disturbance of woodland have been examined from both upland and lowland sites in northern England and indicate that they had different successional pathways after disturbance. Fire disturbances in the denser lowland forests were mostly single burn events followed by natural successions and regeneration to forest, whereas fire disturbances in the upland woods usually showed continued or repetitive fire pressure after the initial burning, arresting succession so that vegetation was maintained in a shrub phase, often dominated by Corylus, for an extended period of time until disturbance ceased. This creation of a kind of prolonged, almost plagioclimax, ‘fire-coppice’ hazel stage suggests controlled rather than natural successional pathways, and strongly suggests that Mesolithic foragers were the fire starters in the upland English woodlands where hazel was naturally common and could be maintained in abundance in later-stage successions, along with other edible plants, for human use. All post-fire seral stages would have been attractive to game animals, providing a reliable food source that would have been of great benefit to hunter-gatherer populations