Issues in the development of advance directives in mental health care

<i>Background</i>: Interest in advance directives in mental health care is growing internationally. There is no clear universal agreement as to what such an advance directive is or how it should function. <i>Aim</i>: To describe the range of issues embodied in the development of advance directives in mental health care. <i>Method</i>: The literature on advance directives is examined to highlight the pros and cons of different versions of advance directive. <i>Results</i>: Themes emerged around issues of terminology, competency and consent, the legal status of advance directives independent or collaborative directives and their content. Opinions vary between a unilateral legally enforceable instrument to a care plan agreed between patient and clinician. <i>Conclusion</i>: There is immediate appeal in a liberal democracy that values individual freedom and autonomy in giving weight to advance directives in mental health care. They do not, however, solve all the problems of enforced treatment and early access to treatment. They also raise new issues and highlight persistent problems. <i>Declaration</i> <i>of</i> <i>interest</i>: The research was funded by the Nuffield Foundation grant number MNH/00015G

Revealing design complexity: Lessons from the Open University

Design is an inherently complex activity. Design thinking is cognitively complex and design practice is contextually complex. This has implications for university-level design education which has traditionally displayed clear distinctions between the full-time and part-time undergraduate sectors, particularly in their teaching and learning strategies. However, a number of pressures and trends are evident which suggest that these two sectors are moving closer together. One of the drivers in this phenomenon is the need for students to be exposed to realistic levels of design complexity. This paper examines complexity in design and draws some significant parallels between modern design practice in general and the production of a new undergraduate course at the Open University. Both are used to illuminate design complexity. The paper suggests that some of the tools, techniques and approaches of part-time, undergraduate, distance design education might usefully be exploited in more traditional, full-time course models

Convergent variational calculation of positronium-hydrogen-atom scattering lengths

We present a convergent variational basis-set calculational scheme for elastic scattering of positronium atom by hydrogen atom in S wave. Highly correlated trial functions with appropriate symmetry are needed for achieving convergence. We report convergent results for scattering lengths in atomic units for both singlet ($=3.49\pm 0.20$) and triplet ($=2.46\pm 0.10$) states.Comment: 11 pages, 1 postscript figure, Accepted in J. Phys. B (Letter

Conductivity in Jurkat cell suspension after ultrashort electric pulsing

Ultrashort electric pulses applied to similar cell lines such as Jurkat and HL-60 cells can produce markedly different results , which have been documented extensively over the last few years. We now report changes in electrical conductivity of Jurkat cells subjected to traditional electroporation pulses (50 ms pulse length) and ultrashort pulses (10 ns pulse length) using time domain dielectric spectroscopy (TDS). A single 10 ns, 150 kV/cm pulse did not noticeably alter suspension conductivity while a 50 ms, 2.12 kV/cm pulse with the same energy caused an appreciable conductivity rise. These results support the hypothesis that electroporation pulses primarily interact with the cell membrane and cause conductivity rises due to ion transport from the cell to the external media, while pulses with nanosecond duration primarily interact with the membranes of intracellular organelles. However, multiple ultrashort pulses have a cumulative effect on the plasma membrane, with five pulses causing a gradual rise in conductivity up to ten minutes post-pulsing

S-, P- and D-wave resonances in positronium-sodium and positronium-potassium scattering

Scattering of positronium (Ps) by sodium and potassium atoms has been investigated employing a three-Ps-state coupled-channel model with Ps(1s,2s,2p) states using a time-reversal-symmetric regularized electron-exchange model potential fitted to reproduce accurate theoretical results for PsNa and PsK binding energies. We find a narrow S-wave singlet resonance at 4.58 eV of width 0.002 eV in the Ps-Na system and at 4.77 eV of width 0.003 eV in the Ps-K system. Singlet P-wave resonances in both systems are found at 5.07 eV of width 0.3 eV. Singlet D-wave structures are found at 5.3 eV in both systems. We also report results for elastic and Ps-excitation cross sections for Ps scattering by Na and K.Comment: 9 pages, 5 figures, Accepted in Journal of Physics

Nanosecond electric pulses penetrate the nucleus and enhance speckle formation

Nanosecond electric pulses generate nanopores in the interior membranes of cells and modulate cellular functions. Here, we used confocal microscopy and flow cytometry to observe Smith antigen antibody (Y12) binding to nuclear speckles, known as small nuclear ribonucleoprotein particles (snRNPs) or intrachromatin granule clusters (IGCs), in Jurkat cells following one or five 10 ns, 150 kV/cm pulses. Using confocal microscopy and flow cytometry, we observed changes in nuclear speckle labeling that suggested a disruption of pre-messenger RNA splicing mechanisms. Pulse exposure increased the nuclear speckled substructures by 2.5-fold above basal levels while the propidium iodide (PI) uptake in pulsed cells was unchanged. The resulting nuclear speckle changes were also cell cycle dependent. These findings suggest that 10 ns pulses directly influenced nuclear processes, such as the changes in the nuclear RNA–protein complexes

Indirect and direct energy gaps in the Kondo semiconductor YbB12

Optical conductivity [$\sigma(\omega)$] of the Kondo semiconductor YbB$_{12}$ has been measured over wide ranges of temperature ($T$=8$-$690 K) and photon energy ($\hbar \omega \geq$ 1.3 meV). The $\sigma(\omega)$ data reveal the entire crossover of YbB$_{12}$ from a metallic electronic structure at high $T$ into a semiconducting one at low $T$. Associated with the gap development in $\sigma(\omega)$, a clear onset is newly found at $\hbar\omega$=15 meV for $T \leq$ 20 K. The onset energy is identified as the gap width of YbB$_{12}$ appearing in $\sigma(\omega)$. This gap in \sigma(\omega)$is interpreted as the indirect gap, which has been predicted in the band model of Kondo semiconductor. On the other hand, the strong mid-infrared (mIR) peak observed in$\sigma(\omega)$ is interpreted as arising from the direct gap. The absorption coefficient around the onset and the mIR peak indeed show characteristic energy dependences expected for indirect and direct optical transitions in conventional semiconductors.Comment: 4 pages, 3 figures, submitted to J. Phys. Soc. Jp

A γ-β frequency transition generated by inter-areal communication in the hippocampus in vitro

Gamma oscillations are generated in area CA3 of the hippocampus both in vitro and in vivo (Fisahn et al., 1998; Csicsvari et al., 2003). Here we present experimental and network simulation data to elucidate the mechanism of the generation of CA3-driven gamma and beta oscillations in area CA1. (1) The frequency of area CA1 output generated by gamma input from area CA3 was dependent on the degree of recruitment of CA1 principal cells. Passive involvement of area CA1 principal cells resulted in a gamma frequency oscillation. Active involvement of CA1 principal cells transformed this gamma oscillation into one at beta frequencies. (2) This beta oscillation in area CA1 was dependent on CA1 recurrent excitation. (3) It was also dependent on the temporal relationship between feedforward excitation of CA1 interneurons (by CA3 output) and feedback excitation of CA1 interneurons (by CA1 output). That is, the network beta oscillation in area CA1 depended on doublet firing of certain interneurons driven by area CA3. (4) The interneuron doublet rate during beta corresponded to whether or not dendrites are oriented horizontally or vertically: Interneurons with vertically oriented dendrites (eg. basket cells and - to a lesser extent - bistratified cells, all receiving input from CA3) fired considerably more doublets than interneurons with horizontally oriented dendrites (horizontal alveus cells or olm cells) which are not contacted by area CA3 and hardly ever fired doublets during beta. Taken together the findings demonstrate that different interneurons can serve different purposes during a given network oscillation, that single interneuron subtypes can mediate multiple network frequencies, and that the frequency of output from a cortical region serves to signal the degree of principal cell recruitment

A γ-β frequency transition generated by inter-areal communication in the hippocampus in vitro

Gamma oscillations are generated in area CA3 of the hippocampus both in vitro and in vivo (Fisahn et al., 1998; Csicsvari et al., 2003). Here we present experimental and network simulation data to elucidate the mechanism of the generation of CA3-driven gamma and beta oscillations in area CA1. (1) The frequency of area CA1 output generated by gamma input from area CA3 was dependent on the degree of recruitment of CA1 principal cells. Passive involvement of area CA1 principal cells resulted in a gamma frequency oscillation. Active involvement of CA1 principal cells transformed this gamma oscillation into one at beta frequencies. (2) This beta oscillation in area CA1 was dependent on CA1 recurrent excitation. (3) It was also dependent on the temporal relationship between feedforward excitation of CA1 interneurons (by CA3 output) and feedback excitation of CA1 interneurons (by CA1 output). That is, the network beta oscillation in area CA1 depended on doublet firing of certain interneurons driven by area CA3. (4) The interneuron doublet rate during beta corresponded to whether or not dendrites are oriented horizontally or vertically: Interneurons with vertically oriented dendrites (eg. basket cells and - to a lesser extent - bistratified cells, all receiving input from CA3) fired considerably more doublets than interneurons with horizontally oriented dendrites (horizontal alveus cells or olm cells) which are not contacted by area CA3 and hardly ever fired doublets during beta. Taken together the findings demonstrate that different interneurons can serve different purposes during a given network oscillation, that single interneuron subtypes can mediate multiple network frequencies, and that the frequency of output from a cortical region serves to signal the degree of principal cell recruitment

On the boundary conditions in multi-phase flow through the piston ring-cylinder liner conjunction

Prediction of load capacity and friction depends on the assumed boundary conditions. The inlet comprises swirl and counter flows, admitting only a portion of the inward flow into the conjunctional gap. At the contact exit, the lubricant film ruptures with multi-phase flow through a cavitation region. Therefore, the boundary conditions affect the load carrying capacity and friction. A Navier–Stokes solution of multi-phase flow, including vapour transport is presented, with determined realistic boundary conditions. The evaluated boundaries agree with potential flow analysis satisfying compatibility conditions, not hitherto reported in literature. The investigation is extended to the determination of optimum compression ring contacting geometry