"Connect Local": protocol for the evaluation of a codesigned whole of community approach to promote social connection in older adults.

Background: There is wide acknowledgement in the literature that social connection is protective against loneliness and depression. More robust research, however, is needed to evaluate interventions that promote social connection. This protocol paper outlines the evaluation of a community-wide social connection program, Connect Local, in metropolitan Melbourne, Australia to support people 65 years and older to increase access to local community services/activities; and to ascertain impact on social connection, loneliness, depressive symptoms, physical and mental wellbeing, and use of health services. Methods: A Type 1 Hybrid design, including program effectiveness, cost-effectiveness, and implementation evaluation of the Connect Local program, will be undertaken. Eighty-eight participants aged ≥65 years with one or more chronic health condition, who are also either experiencing or at risk of loneliness, social isolation and depressive symptoms will be invited to participate in the evaluation. Outcomes, measured at baseline, 3, 6 and 12 months, include loneliness, social isolation, depressive symptoms, social anxiety, goal attainment, wellbeing, quality of life and health care utilisation. A gender and age matched comparator group of 88 individuals will be recruited from outside the intervention local government area. Impact of the intervention on community service providers in the target region will be evaluated using mixed methods, where triangulation will be used to combine the qualitative and quantitative data using a deductive-simultaneous design. Changes in wellbeing and quality of life of community volunteers will also be measured. All groups will be interviewed to ascertain their experience and perceptions of the program. The economic evaluation will use a Social Return on Investment (SROI) approach, to include outcomes at the individual, community, and system levels. Implementation outcomes will consider Reach, Adoption, Feasibility, Acceptability, Appropriateness, Fidelity, and Sustainability of the intervention. Discussion: This study will provide a better understanding of the impacts of a community-wide social connection approach in older adults, the community and broader system. Clinical trial registration: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=385192; Identifier ACTRN12623000968673.

Macroprolactin screening in 464 patients with hyperprolactinaemia.

INTRODUCTION: Macroprolactinaemia is usually detected by polyethylene glycol (PEG) precipitation in clinical laboratories. Laboratory data on prolactin and macroprolactin screening by PEG precipitation in a tertiary hospital were reviewed in order to revise the local policy for reflex screening and reporting of macroprolactin in patients with hyperprolactinaemia. MATERIALS AND METHODS: Paired prolactin results from 464 patients before and after PEG precipitation, either requested by a clinician or performed as a reflex test, were retrieved and reviewed. RESULTS: Recovery of prolactin after PEG treatment was highly variable (3.7 to 97.7%). The distribution of prolactin recovery percentages after PEG precipitation in patients with true hyperprolactinaemia was markedly different from that in patients without true hyperprolactinaemia. The proportion of patients with true hyperprolactinaemia increased gradually with increasing pre-PEG prolactin concentrations; the reverse was true with macroprolactinaemia. Five patients (1.1%) were found to have co-existing macroprolactinaemia and true hyperprolactinaemia. CONCLUSION: Results from this retrospective study indicate that macroprolactinaemia is common and can be present even in patients with very high serum prolactin concentrations. There is no cut-off limit for pre-PEG serum prolactin concentration that can totally exclude macroprolactinaemia. Moreover, co-existence of true hyperprolactinaemia and macroprolactinaemia in the same patient is not a rare phenomenon. Post-PEG prolactin concentration and percentage recovery should be reported together to guide the interpretation and management of hyperprolactinaemia.

Is loneliness a feasible treatment target in psychosis?

PURPOSE: Loneliness is a challenge for individuals with psychosis; however, interventions rarely target loneliness in this group. METHOD: We developed a pilot positive psychology group intervention designed to reduce loneliness in psychosis and examined its feasibility and acceptability. RESULTS: Sixteen participants attended 5.38 (SD = 0.70) out of six sessions, with a dropout rate of 10%. Participants were significantly less lonely at post-treatment (p < 0.001, d = 1.51), and maintained their improvements from post-treatment to follow-up (p = 0.81, d = 0.07). CONCLUSIONS: Loneliness may be a feasible and acceptable treatment target within psychosocial treatments.

Enhancing social functioning in young people at Ultra High Risk (UHR) for psychosis: A pilot study of a novel strengths and mindfulness-based online social therapy.

BACKGROUND: Psychological and pharmacological treatments have been shown to reduce rates of transition to psychosis in Ultra High Risk (UHR) young people. However, social functioning deficits have been unresponsive to current treatments. AIMS: The study aims were to: i) describe the theoretical basis and therapeutic targets of a novel intervention targeting social functioning in UHR young people; and ii) examine its acceptability, safety and preliminary effect on social functioning. METHODS: An international, multidisciplinary team developed a new intervention (MOMENTUM) to improve social functioning in UHR young people. MOMENTUM blends two novel approaches to social recovery: strengths and mindfulness-based intervention embedded within a social media environment, and application of the self-determination theory of motivation. The acceptability and safety of MOMENTUM were tested through a 2-month pilot study with 14 UHR participants. RESULTS: System usage was high, with over 70% of users being actively engaged over the trial. All participants reported a positive experience using MOMENTUM, considered it safe and would recommend it to others. 93% reported it to be helpful. There were large, reliable improvements in social functioning (d = 1.83, p < 0.001) and subjective wellbeing (d = 0.75, p = 0.03) at follow-up. There were significant increases in the mechanisms targeted by the intervention including strengths usage (d = 0.70, p = 0.03), mindfulness skills (d = 0.66, p = 0.04) and components of social support. Social functioning improvement was significantly correlated with indicators of system usage. CONCLUSION: MOMENTUM is engaging and safe. MOMENTUM appeared to engage the hypothesized mechanisms and showed promise as a new avenue to improve social functioning in UHR young people.

Relationship among attention-deficit hyperactivity disorder, dietary behaviours and obesity.

BACKGROUND: Attention-deficit hyperactivity disorder (ADHD) is one of the most common psychiatric disorders of childhood and can be associated with obesity. The aim of this study was to reveal the connection between ADHD symptoms, food habits and obesity. METHODS: We examined 12 350 children (6010 boys, 6340 girls) from 27 elementary schools in Cheonan, the Republic of Korea. The study subjects were 5- to 13-year-old children (9.4 ± 1.7 years). Parents completed the DuPaul ADHD Rating Scale. Food habits were measured by a questionnaire adapted from the Korea Youth Risk Behavior Web-based Survey and a validated mini-dietary assessment tool. The full set of hypothesized associations was tested using covariance structural modelling. RESULTS: The prevalence of ADHD was 7.6% and that of obesity was 4.5% in our study population. The data was well fit by the model. ADHD was associated with body mass index (BMI; standardized ß = 0.086, P < 0.001). Bulimic dietary behaviours was related to BMI (standardized ß = 0.548, P < 0.001). Socio-economic status was associated with BMI (standardized ß = -0.017, P = 0.027). CONCLUSION: Our analysis suggested that ADHD was a risk factor for obesity through dietary behavioural change and socio-economic status.

Renal dysfunction and barttin expression in Bartter syndrome Type IV associated with a G47R mutation in BSND in a family.

Bartter syndrome (BS) Type IV, associated with a G47R mutation in the BSND gene, is known to result in a mild renal phenotype. However, we report here on three brothers with varying degrees of renal dysfunction from mild to end-stage renal disease associated with renal barttin and ClC-K expression. The brothers had histories of polyhydramnios, prematurity, polyuria, deafness, and small body size. Laboratory findings showed hypokalemic metabolic alkalosis, normotensive hyperreninemic hyperaldosteronism, and an increased urinary excretion of sodium, potassium and chloride, consistent with BS Type IV. Microscopic examination of renal tissue showed hyperplasia of cells at the juxtaglomerular apparatus with dilated atrophic tubules and tubulointerstitial fibrosis. A weak barttin signal related to CIC-K expression in the cytoplasm of tubule cells, but not the basement membrane, was noted. A sequence analysis of the BSND gene showed that the affected males were homozygous for a missense G47R mutation in exon 1 of BSND. These findings suggest that the G47R mutation results in a dramatic decrease in barttin expression, which appears to be related to the location of CIC-K being changed from the basement membrane to the cytoplasm in the tubule and might have varying effects on renal function associated with factors other than this gene.

Cholesterol addition and removal in pacific oyster oocytes does not improve cryopreservation success.

The optimal cholesterol content in cells could provide the benefit of lowering or eliminating the lipid phase transition temperature, while maintaining membrane fluidity and strength; thus, making cells less sensitive to chilling injury and more amenable to cryopreservation. Such effects were shown in some gametes and embryos of certain mammalian species, however, some other cell types, benefited from cholesterol removal. The experiments developed in this study aimed to determine the effect of incubating Pacific oyster (Crassostrea gigas) oocytes in cholesterol-addition or removal solutions prior to cryopreservation on their post-thaw fertilization ability. The results showed a positive association of cholesterol with the oocytes when assessed by fluorescent microscopy. However, this uptake was not reflected by an increase in cholesterol as determined by colorimetric analysis or in the post-thaw fertilization rate of treated oocytes. It is presumed either that oyster oocytes already contain a substantial amount of cholesterol or other lipids in their plasma membranes and do not benefit from any additional cholesterol or there is no lipid phase transition temperature in oyster oocytes.

Determination of the membrane permeability characteristics of Pacific oyster, Crassostrea gigas, oocytes and development of optimized methods to add and remove ethylene glycol.

In order for cryopreservation to become a practical tool for aquaculture, optimized protocols must be developed for each species and cell type. Knowledge of a cell's osmotic tolerance and membrane permeability characteristics can assist in optimized protocol development. In this study, these characteristics were determined for Pacific oyster oocytes and modified methods for loading and unloading ethylene glycol (EG) were tested. Oocytes were found to behave as ideal osmometers and their osmotically inactive fraction (V(b)) was calculated to be 0.48. Oocytes exposed to NaCl solutions of 0.6 to 2.3 Osm fertilized at rates equivalent to oocytes left in seawater. This corresponds to volume changes of +27.3 and -38.1+/-1.2%. The permeability of the oocytes to water (L(p)) was determined to be 3.8+/-0.4 x 10(-2), 5.7+/-0.8 x 10(-2), and 13.2+/-1.3 x 10(-2) microm min(-1)atm(-1), when measured at temperatures of 5, 10 and 20 degrees C. The respective EG permeability values (P(s)) were 9.5+/-0.1 x 10(-5), 14.6+/-1.2 x 10(-5), and 41.7+/-2.4 x 10(-5) cm min(-1). The activation energies for L(p) and P(s) were determined to be 14.5 and 17.5 kcal mol(-1), respectively. Different models for EG loading and unloading from oocytes were developed and tested. Post-thaw fertilization did not differ significantly between a published step addition method and single step addition at 20 degrees C. This represents a considerable reduction in handling. The results of this study demonstrate that the cryobiological characteristics of a given cell type should be taken into account when developing cryopreservation methods.

Survival of Pacific oyster, Crassostrea gigas, oocytes in relation to intracellular ice formation.

The effect of IIF in Pacific oyster oocytes was studied using cryo and transmission electron microscopy (TEM). The viability of oocytes at each step of a published cryopreservation protocol was assessed in an initial experiment. Two major viability losses were identified; one when oocytes were cooled to -35 degrees C and the other when oocytes were plunged in liquid nitrogen. Although the cryomicroscope showed no evidence of IIF in oocytes cooled with this protocol, TEM revealed that these oocytes contained ice crystals and were at two developmental stages when frozen, prophase and metaphase I. To reduce IIF, the effect of seven cooling programmes involving cooling to -35 or -60 degrees C at 0.1 or 0.3 degrees C min(-1) and holding for 0 or 30 min at -35 or -60 degrees C was evaluated on post-thaw fertilization rate of oocytes. Regardless of the cooling rate or holding time, the fertilization rate of oocytes cooled to -60 degrees C was significantly lower than that of oocytes cooled to -35 degrees C. The overall results indicated that observations of IIF obtained from cryomicroscopy are limited to detection of larger amounts of ice within the cells. Although the amount of cellular ice may have been reduced by one of the programmes, fertilization was reduced significantly; suggesting that there is no correlation between the presence of intracellular ice and post-thaw fertilization rate. Therefore, oyster oocytes may be more susceptible to the effect of high solute concentrations and cell shrinkage than intracellular ice under the studied conditions.

Outcome of open trigger digit release.

This study was undertaken to review the outcome of open trigger digit release of 483 digits in 373 consecutive patients over a 1 year period. Parameters were obtained from case records. The patients were followed up for a minimum of 6 months postoperatively. The most commonly affected digits were the ring (42%) and middle (26%) fingers. Based on the classification by Wolfe [Tenosynovitis. In: Green DP (Ed). Operative hand surgery, 5th Edn. New York, Churchill Livingstone, 2005: 2137-2159], Grade II (51%) and III (33%) trigger digits accounted for majority of affected digits. Non-operative treatment was the first line modality for 82% of the patients. Primary surgical release (18% of patients) was performed for patients who had refractory conditions, grade IV triggering and those who requested this treatment. The overall complication rate was 1%. These included superficial wound dehiscence, extension lag and postoperative residual stiffness. There were no recurrences of triggering. Steroid injection is recommended as the first line treatment. Surgical release is recommended for refractory and severe triggering.

Methoxy[meso-5,10,15,20-tetrakis-(2,6-difluorophenyl)porphyrinato]-iron(III), [Fe(TDFPP)(OCH3)].

The crystal structure of the title compound, [Fe(C(44)H(20)F(8)N(4))(CH(3)O)], has been determined. The Fe atom lies 0.485 (1) A out of the plane of the four N atoms to which it is coordinated and from the inversion centre at the origin of the unit cell. The methoxy group is axially coordinated to the Fe atom with O-Fe-N angles of 106.3 (2) and 102.4 (2) degrees, a C-O-Fe angle of 128.3 (5) degrees and an Fe-O distance of 1.788 (5) A. Difluorophenyl rings are tilted from the porphyrin (por) plane with torsion angles of -68.1 (6) and 77.7 (5) degrees across the two C(por)-C-C-C(ar) systems.

Effects of flavonoids of Ginkgo biloba on proliferation of human skin fibroblast.

Ginkgo biloba studies have focused on the anti-inflammatory effects of the major components, ginkgolide and bilobalide, whereas little is known about their effect on fibroblasts. This study demonstrated the enhancing effects of Ginkgo L. extracts, especially the flavonoid fractions: quercetin, kaempferol, sciadopitysin, ginkgetin, isoginkgetin, on the proliferation of normal human skin fibroblast in vitro measured by MTT (3-[4,5-dimethylthiazole-2-yl]-2,5-diphenyl-tetrazolium bromide) assay and direct hemocytometer cell count. Furthermore, increased production of collagen and extracellular fibronectin were documented by radioisotope (2,3-3H-proline) incorporated collagen assay, procollagen type I C-peptide assay and by immunoturbidimetric assay. These proliferative effects suggest another useful pharmacologic application of Ginkgo L. extracts in addition to their well-known anti-inflammatory effect.

Studies of reaction kinetics in relation to the Tg' of polymers in frozen model systems.

The rates of diffusion-controlled processes in a frozen system can be influenced by the presence of glassy states. One characteristic of cryostabilization by this mechanism is a change in the temperature dependence of reaction rates at the Tg' of the system. The cryostabilization behavior of solutes such as maltodextrin, carboxymethylcellulose (CMC), and sucrose was studied. Three different model reaction systems (enzyme hydrolysis, protein aggregation, and non-enzymatic oxidation) were used. Maltodextrin had a consistent pattern of cryostabilization behavior at temperatures ranging from -3 degrees C to -20 degrees C for all three model systems. Significant retardation effects were evident in the temperature range corresponding to its glassy states. Sucrose did not show a stabilizing effect in the non-proteinaceous model system (the non-enzymatic oxidation reaction). This could partly be due to the absence of the glassy state, since the storage temperatures were above its Tg'. However, in the protein aggregation model system, sucrose was an excellent stabilizer in protecting actomyosin from aggregation. This may be explained by a "solute exclusion" mechanism. CMC did not show any stabilizing effect in the protein aggregation and non-enzymatic oxidation model systems studied, even though it has a Tg' as high as that of maltodextrin. These results demonstrated that although the presence of a glassy state may well have a retarding effect on the rates of diffusion processes, just knowing the Tg' of a polymer is not sufficient for prediction of its stabilization effect in a frozen system.

A psychiatric emergency clinic: a study of attendances over six months.

Two thousand three hundred and ninety consecutive visits to a walk-in psychiatric emergency service were studied to examine issues relevant to service provision. Only a third of patients were from the catchment area. Psychotic patients and those admitted or kept overnight (guests) were more frequent after hours and among non-medical referrals, especially family and police referrals; but suicidal patients often came from other hospitals. At index visit a third of patients were offered follow-up, but attendance was poor. Factors influencing attendance were examined. Keeping overnight avoided unnecessary admissions. There was little evidence that patients abused the service. The findings suggest that a psychiatric emergency service should be available to all referrals 24 hours a day.