Barriers and facilitators to targeted anxiety prevention programmes in families at risk: a qualitative interview study.

Anxiety disorders are the most common psychiatric disorder in children and young people. They can be prevented in those at risk, but families do not always take up opportunities to participate in prevention programmes. This qualitative study aimed to understand what families with children who were at prospective risk of anxiety disorders perceived to be the barriers to access to targeted anxiety prevention programmes, and to explore what would help facilitate access. We used Information Power to determine our sample size, and individually interviewed seven young people (14-17 years) who had anxiety disorders and their mothers, each of whom had pre-natal anxiety disorders. We transcribed all interviews and thematically analyzed them to identify perceived barriers and facilitators to targeted anxiety prevention programmes. Perceived potential barriers to access included possible negative consequences of anxiety prevention, difficulties in identifying anxiety as a problem and concerns about how professions would respond to raising concerns about anxiety. Possible facilitators included promoting awareness of anxiety prevention programmes and involvement of schools in promotion and delivery of prevention. Our findings illustrate that implementation of targeted anxiety prevention could be improved through (i) the provision of tools for parents to recognize anxiety in their children as a problem, (ii) promotion of awareness, as well as delivery, of anxiety prevention via schools and (iii) the involvement of parents and possibly adolescents in the intervention programme, but not younger children.

Societal decisions about climate mitigation will have dramatic impacts on eutrophication in the 21st century.

Excessive nitrogen runoff leads to degraded water quality, harming human and ecosystem health. We examine the impact of changes in land use and land management for six combinations of socioeconomic pathways and climate outcomes, and find that societal choices will substantially impact riverine total nitrogen loading (+54% to -7%) for the continental United States by the end of the century. Regional impacts will be even larger. Increased loading is possible for both high emission and low emission pathways, due to increased food and biofuel demand, respectively. Some pathways, however, suggest that limiting climate change and eutrophication can be achieved concurrently. Precipitation changes will further exacerbate loading, resulting in a net increase of 1 to 68%. Globally, increases in cropland area and agricultural intensification will likely impact vast portions of Asia. Societal and climate trends must therefore both be considered in designing strategies for managing inland and coastal water quality.

Computer modelling of human behaviour in aircraft fire accidents.

The mathematical simulation of the evacuation process has a wide and largely untapped scope of application within the aircraft industry. The function of the mathematical model is to provide insight into complex behaviour by allowing designers, legislators, and investigators to ask 'what if' questions. Such a model, EXODUS, is currently under development, and this paper describes its evolution and potential applications. EXODUS is an egress model designed to simulate the evacuation of large numbers of individuals from an enclosure, such as an aircraft. The model tracks the trajectory of each individual as they make their way out of the enclosure or are overcome by fire hazards, such as heat and toxic gases. The software is expert system-based, the progressive motion and behaviour of each individual being determined by a set of heuristics or rules. EXODUS comprises five core interacting components: (i) the Movement Submodel -- controls the physical movement of individual passengers from their current position to the most suitable neighbouring location; (ii) the Behaviour Submodel -- determines an individual's response to the current prevailing situation; (iii) the Passenger Submodel -- describes an individual as a collection of 22 defining attributes and variables; (iv) the Hazard Submodel -- controls the atmospheric and physical environment; and (v) the Toxicity Submodel -- determines the effects on an individual exposed to the fire products, heat, and narcotic gases through the Fractional Effective Dose calculations. These components are briefly described and their capabilities and limitations are demonstrated through comparison with experimental data and several hypothetical evacuation scenarios.

Immobilization hypercalcaemia due to low bone formation and responding to intravenous sodium sulphate.

A young man developed acute renal failure and hypercalcaemia following severe burns. The hypercalcaemia was initially controlled by haemodialysis, but it persisted after return of renal function. Plasma PTH was inappropriately elevated, but the nephrogenous cyclic adenosine monophosphate level was low; thus the PTH was probably not biologically active, and may have been artefactually elevated by the moderate renal impairment. Bone histology, showed a normal resorbing surface, but a zero forming surface, implying that the bone dissolution leading to hypercalcaemia resulted from a failure of bone formation. Because of widespread infection and impaired renal function, the hypercalcaemia could not be treated by corticosteroid drugs, mithramycin or phosphate, and there was no response to salmon calcitonin. He was therefore treated with intravenous sodium sulphate, which increased urinary calcium excretion and reduced the plasma calcium. Sodium sulphate still has a role in the treatment of patients with hypercalcaemia.

Ventilation during cardiopulmonary resuscitation: which method?

A questionnaire was circulated to assess the influence of the presence of vomitus, secretions and infection on the willingness of 70 hospital staff members to use methods of ventilation during cardiopulmonary resuscitation (CPR). The responses showed that only 13% would use mouth-to-mouth and 59% mouth-to-mask ventilation in the presence of these features. Thirty-five of these subjects were then tested for their ability to ventilate a manikin adequately (tidal volume, 800 mL). The best performance was seen with mouth-to-mouth ventilation. After instruction, their performance was satisfactory with mouth-to-mouth and mouth-to-mask resuscitation and with the Robertshaw resuscitator. Bag-valve-mask ventilation had a 97% failure rate before and after instruction and may be inappropriate for CPR. A resuscitation mask which allows effective ventilation without contamination and with oxygen supplementation is the most cost-effective and best accepted method of emergency ventilation.

Coronary ostial stenosis in Takayasu's arteritis.

A patient with Takayasu's arteritis with left coronary ostial narrowing is presented. The dramatic clinical and pathologic findings are discussed in detail. Emphasis is placed on making the diagnosis as soon as possible, in order to expedite bypass surgery to prolong life.

Effect of cephapirin on formation of D-alanine carboxypeptidase in growing Bacillus subtilis cells.

Cephapirin was utilized to examine the interaction of beta-lactam antibiotics with growing Bacillus subtilis cells and the biological effects simultaneously produced. Saturation binding and quantitative cell death were observed at the cephapirin concentration of 0.1 mug/ml. Cephapirin bound to all penicillin-binding proteins except the d-alanine carboxypeptidase. A specific [(14)C]benzylpenicillin-binding assay was developed for the d-alanine carboxypeptidase. At the lowest saturating concentration of antibiotic (0.1 mug/ml), cephapirin inhibited formation of the d-alanine carboxypeptidase. Upon incubation with cephapirin, 18% of the membranous d-alanine carboxypeptidase was released into the media. The data suggest that beta-lactam antibiotics may affect the formation of bacterial cytoplasmic membranes in addition to their effect on cell wall synthesis.

The formation of functional penicillin-binding proteins.

A method was developed which permitted determination of the [14C]benzylpenicillin and [14C]Cephapirin binding capacity of rapidly growing Bacillus subtilis cells in liquid culture. Over the concentration range of the binding plateau (0.1 to 0.8 mug/ml), [14C]benzylpenicillin significantly inhibited formation of functional penicillin-binding proteins, but had comparatively little effect on total bacterial protein synthesis. The data suggest that penicillin covalently bound to the cells in a chemically stable manner alone is not sufficient to inhibit formation of functional binding proteins and that unbound penicillin in the growth medium is necessary. The concentration of unbound antibiotic in the culture medium, in turn, is a function of the cell-bound penicillinase activity whose significance increases with cell density. [14C]Cephapirin, a cephalosporin resistant to this cell-bound penicillinase almost completely inhibited the formation of functional Cephapirin-binding proteins, but had relatively little effect on total protein synthesis. At concentrations 250-fold higher than that required to inhibit formation of functional binding proteins. Cephapirin did not inhibit particulate D-alanine carboxypeptidase activity and presumably did not bind covalently to this penicillin-binding protein.

Accessibility of the (14C)benzylpenicillin binding proteins in membranes of sporulating bacilli.

Triton X-100 treatment or freeze-thawing damages the membranes of sporulating or vegetative cells as seen by protein leakage from cells. A 40% increase in the specific [(14)C]benzylpenicillin-binding capacity of detergent-treated or frozen sporulating cells was observed. Neither freezing nor Triton X-100 treatment of vegetative cells produced a detectable effect on their [(14)C]benzylpenicillin-binding capacity. These data indicate the presence of penicillin-binding sites in intact sporulating bacilli not accessible to penicillin in routine binding assays. The chemical specificity of [(14)C]benzylpenicillin binding to detergent-treated sporulating cells is similar to that observed with untreated vegetative or sporulating cells.

Penicillin: reversible inhibition of forespore septum development in Bacillus megaterium cells.

Benzylpenicillin inhibits the development of the forespore septum in sporulating Bacillus megaterium cells. The inhibitory effect is a function of the duration of exposure to the antibiotic and is completely reversible by penicillinase. Under the incubation conditions employed, less than 20% of the covalently bound antibiotic is released from the cells. The penicillin which remains bound to the cells after treatment with penicillinase may be necessary but is not sufficient for the effect; unbound antibiotic in the sporulation medium is also required.

Binding of radioactive benzylpenicillin to asporogenous mutants of Bacillus subtilis during postexponential growth.

The specific penicillin binding capacity of a postexponential culture of Staphylococcus aureus remains constant, but that of a sporulating Bacillus subtilis culture fluctuates dramatically. An initial decrease in binding capacity during presporulation events is followed by two distinct intervals of enhanced specific binding capacity during the postlogarithmic growth of a sporulating B. subtilis culture. The first peak of enhanced binding occurs during septation, when enzymes for germ cell wall formation are present; and the second peak coincides with cortical biosynthesis. The specific postlogarithmic binding capacities of a number of Spo(-) mutants of B. subtilis were examined to ascertain if specific asporogenous mutations altered the binding pattern observed with the wild-type organism. Four distinct postexponential binding patterns were recognized: (i) a low, constant binding capacity resembling the binding pattern of S. aureus, (ii) a decrease in binding capacity with no subsequent significant peaks, (iii) a decrease in binding capacity followed by a single peak corresponding to the first peak seen with the wild type, (iv) a pattern similar to the wild type. The fourth pattern was observed in a mutant blocked during stage III of sporogenesis which produced forespores that never became refractile. Mutations blocking either one or both periods of enhanced postlogarithmic binding were interspersed throughout a linkage group of spore genes next to lys-2 on the B. subtilis chomosome.

Binding of radioactive benzylpenicillin to sporulating Bacillus cultures: chemistry and fluctuations in specific binding capacity.

The chemistry of the binding of (14)C-benzylpenicillin to sporulating cultures of Bacillus megaterium and B. subtilis is similar to that in a 4-hr vegetative culture of Staphylococcus aureus. Unlabeled penicillins prevent the binding of (14)C-benzylpenicillin, but benzylpenicilloic acid and benzylpenilloic acid do not. Bound antibiotic can be removed from cells with neutral hydroxylamine at 25 C. Sporulating cultures display two intervals of enhanced binding, whereas binding to stationaryphase S. aureus cells remains constant. The first period of increased binding activity occurs during formation of the spore septum or cell wall primordium development, and the second coincides with cortex biosynthesis.