The In-Hospital Suicide: A Psychological Autopsy of a System Involving Borderline Dynamics

This manuscript reviews principles of hospital management in the care of severe borderline patients with concomitant affective syndromes. The case presented highlights a process of experiential learning in a novice clinician (a beginning psychiatric resident) and illustrates several critical areas of concern with these patients. The following four facets of clinical management are discussed: 1) Failed attempts to understand borderline dynamics and subsequent countertransference reactions; 2) Staff resistance to consistent, honest and open acknowledgement of suicide potential; 3) Special risks when borderline dynamics are combined with affective syndromes; and 4) Possible suicide preventive measures and their relative effectiveness

Hydrothermal hydrolysis of starch with CO2 and detoxification of the hydrolysates with activated carbon for bio-hydrogen fermentation.

The imminent use of hydrogen as an energy vector establishes the need for sustainable production technologies based on renewable resources. Starch is an abundant renewable resource suitable for bio-hydrogen generation. It was hypothesised that starch hydrolysates from a large (250 mL) hydrothermal reactor could support bioH2 fermentation without inhibition by toxic byproducts.\ud \ud Starch was hydrolysed at high concentrations (40 200 g.L-1) in hot compressed water (HCW) with CO2 at 30 bar in a 250 mL reactor, the largest so far for polysaccharide hydrolysis, at 180 235 °C, 15 min. Hydrolysates were detoxified with activated carbon (AC) and tested in biohydrogen fermentations. The maximum yield of glucose was 548 g.kg starch 1 carbon at 200 °C. 5 hydroxymethyl furfural, the main fermentation inhibitor, was removed by AC to support 70% more hydrogen production than the untreated hydrolysates. The potential utilization of starch hydrolysates from HCW treatment for upscaled fermentations is promising

Integration of Assertive Community Treatment into a Residency Curriculum: The Resident\u27s Perspective

Assertive Community Treatment (ACT) is a service delivery system designed to provide long-term quality care to patients with chronic mental illnesses. A brief description of these programs is presented. These programs can provide valuable training experiences for psychiatric residents. The authors report the results of their survey of residents whose training included a rotation through these services

Quality Improvement of Diabetic Care at a Resident Clinic

Our objective was to develop a quality improvement project on diabetes mellitus at our internal medicine residency clinic. Residents developed projects aimed at improving an aspect of diabetic care. Continuity of care, achievement of clinical targets, no-show rates, patient knowledge of diabetes, and preventive care were evaluated. Our data was obtained with a questionnaire and a retrospective review of medical records. A different provider was scheduled about every 1.78 visit. The no-show rate was 25.4%. About half of patients identified goal hgbA1c and BPs, and 35% and 60% achieved their hgbA1c and SBP goals respectively. Nearly all of the charts planned for screening exams. We concluded that our clinic needs to improve diabetes education, reaching clinical targets, continuity of care and no-shows. Incorporating a QI project into the clinic with one disease such as diabetes is an efficient way to include practice based learning into an internal medicine residency’s curriculum

Current and Future Salinity Intrusion in the South-Western Coastal Region of Bangladesh

The southwestern coastal regions of Bangladesh (SWCRB) are highly exposed to saltwater intrusions brought about through cyclones and storm surges. These salinity intrusions are contributing to soil and water salinity in the coastal areas. This study aimed to determine the impact of these salinity intrusions on the quality of water and soil in three vulnerable coastal areas. In this investigation, water and soil samples were collected and analysed for pH, electrical conductivity (EC) and other trace elements. The analysis found many of the parameters to be higher than the recommended values. The study found that in soil samples there was a significant correlation between OM and ECe dS/m, as well as K and TN; and a highly significant correlation between TN and OM. This study further examined the historical salinity data at low and high tides to determine any patterns occurring alongside storm surges and cyclones. Water salinity statistics were obtained from the three locations of the Bangladesh Water Development Board (BWDB), which neighbours the study area. A Digital Evaluation Model (DEM) predicts the salinity induced by storm gushes in the corresponding impacted zones. Lastly, the study compared projections for future storm surges at current and predicted sea levels. Potential storm gushes circumstances from 1 to 9 m can impact up to 33% of the nation and 97% of the Shyamnagar Upazila. The occurrence of cyclone-related storms will increase and make cultivation and settlement in the region difficult. The predicted sea-level rises and saltwater contamination will intensify the adverse effects of salinity.info:eu-repo/semantics/publishedVersio

Functionalisation of terpenoids at C-4 via organopalladium dimers: cyclopropane formation during oxidation of homoallylic sigma-organopalladium intermediates with lead tetraacetate

The synthesis of new potential adjuvant saponin aglycons was investigated by selective palladium mediated C-H functionalisation of appropriately functionalised derivatives of lanosterol, cholesterol, and friedelin. The desired equatorial aldehyde functionality was successfully introduced into the lanosterol skeleton as expected. Cyclopalladation of a cholesterol derivative proceeded as expected, but during oxidation of the organopalladium intermediate, participation of the adjacent alkene functionality led to stereoselective formation of a cyclopropane and introduction of an acetate group into the steroid backbone at C-6. Further investigation of this unusual cyclopropane formation on a model decalin system confirmed the result, but C-H activation on a related open chain system was prevented by complexation of the alkene functionality to the palladium. (c) 2007 Elsevier Ltd. All rights reserved

Screening for Autism Spectrum Disorders-Validation of the Portuguese Version of the Social Communication Questionnaire

There are no assessment and screening tools for Autism Spectrum Disorders (ASD) validated for the Portuguese population. The Social Communication Questionnaire (SCQ) is an useful screening tool of ASD diagnosis. The main objectives of our study were to produce a Portuguese version of the SCQ (SCQ-PF), study its internal consistency, sensitivity and specificity in order to evaluate its validity as a screening instrument for ASD. We also wanted to study the impact of intellectual disability and verbal impairment and other mental disorders on SCQ-PF psychometric properties. The study included 211 children and adolescents, aged 4-17, divided in three groups: ASD Group (n = 96), Other Mental Disorders Group (OMD) (n = 63) and No Mental Disorders (NMD) Group (n = 52). Parents or other primary caregiver provided information on the SCQ items. The SCQ-PF score was significantly higher in the ASD group than in the other groups (p < 0.001). As to internal consistency, Cronbach's alpha was 87%. ASD subjects were distinguished from subjects without ASD (OMD and NMD Groups) and the area under the curve (AUC) was 0.897 (95% Confidence Interval: 0.852-0.943), for a cutoff of 14, which yielded the highest AUC, with values of sensitivity and specificity 0.76 and 0.93, respectively. These findings show that SCQ- PF with a cutoff of 14 is an acceptable and useful screening tool for ASD in the Portuguese population

Dietary administration of a commercial mixed-species probiotic improves growth performance and modulates the intestinal immunity of tilapia, Oreochromis niloticus.

The growth performance, immunological status, intestinal morphology and microbiology of tilapia, Oreochromis niloticus, were investigated after dietary administration of the commercial probiotic AquaStar(®) Growout. Tilapia (29.02 ± 0.33 g) were split into five treatments; control (CON), 1.5 g kg(-1) probiotic (PRO-1.5), 3 g kg(-1) probiotic (PRO-3), pulsed probiotic feeding (PRO-PULSE) or an initial probiotic feed followed by control feeding (PRO-INI). After six weeks of experimental feeding, fish fed PRO-3 displayed significantly higher final weight, weight gain and SGR compared to the CON or PRO-INI treatments. Supplementation of the probiotic at this dose induced an up-regulation of intestinal caspase-3, PCNA and HSP70 mRNA levels compared to the CON fed fish. Immuno-modulatory pathways were also affected; significantly higher expression of TLR2, pro-inflammatory genes TNFα and IL-1β, and anti-inflammatory genes IL-10 and TGFβ suggest that the probiotic may potentiate a higher state of mucosal tolerance and immuno-readiness. Histological appraisal revealed significantly higher numbers of intraepithelial leucocytes in the intestine of PRO-3 fed fish compared with treatments CON, PRO-PULSE and PRO-INI but not PRO-1.5. Additionally, fish receiving PRO-3 had a significantly higher abundance of goblet cells in their mid-intestine when compared with fish from all other treatments. Together, these data suggest that continuous provision of AquaStar(®) Growout at 3 g kg(-1) can improve tilapia growth and elevate the intestinal immunological status of the host

Primates do not spontaneously use shape properties for object individuation: a competence or a performance problem?

Several recent studies have documented that non-human primates can individuate objects according to property and/or kind information in much the same way as human infants do from around one year of age when they begin to acquire language. Some studies suggest, however, that only some properties are used for the individuation of food items: color, but not shape. The present study investigated whether these findings reveal a true competence problem with shape properties in the food domain or whether they merely reveal a performance problem (e.g., lack of attention to shapes). We tested 25 great apes (chimpanzees, bonobos and gorillas) in two food individuation tasks. We manipulated subjects’ experience with differences in color and shape properties of food items. Results indicated (i) that all subjects, regardless of their prior experience, solved the color-based object individuation task and (ii) that only the group with previous experience with different shape properties succeeded in the shape-based individuation task. Great apes can thus be primed to take shape into account for individuating food objects, and this results clearly speaks in favor of a performance (rather than a competence) problem in using shape for object individuation of food items