A systematic review of ethnic minority women's experiences of perinatal mental health conditions and services in Europe.

BACKGROUND: Women from ethnic minority groups are at greater risk of developing mental health problems. Poor perinatal mental health impacts on maternal morbidity and mortality and can have a devastating impact on child and family wellbeing. It is important to ensure that services are designed to meet the unique needs of women from diverse backgrounds. AIM: The aim of the review was to explore ethnic minority women's experiences of perinatal mental ill health, help-seeking and perinatal mental health services in Europe. DATA SOURCES: Searches included CINAHL, Maternity and Infant Care, MEDLINE and PsycINFO with no language or date restrictions. Additional literature was identified by searching reference lists of relevant studies. DESIGN: This was a mixed method systematic review. Study selection, appraisal and data extraction were conducted by two researchers independently. A convergent approach was adopted for the analysis and the data were synthesised thematically. RESULTS: The 15 eligible studies included women from a range of minority ethnic backgrounds and were all undertaken in the United Kingdom (UK). Seven overarching themes were identified; awareness and beliefs about mental health, isolation and seeking support, influence of culture, symptoms and coping strategies, accessing mental health services, experiences of mental health services and what women want. CONCLUSION: Lack of awareness about mental ill health, cultural expectations, ongoing stigma, culturally insensitive and fragmented health services and interactions with culturally incompetent and dismissive health providers all impact on ethnic minority women's ability to receive adequate perinatal mental health support in the UK. Future research should focus on in-depth exploration of the experiences of these women across multiple European settings and interventions to reduce health inequalities among vulnerable mothers and families affected by perinatal mental ill health.

SPECT-CT/VQ versus CTPA for diagnosing pulmonary embolus and other lung pathology: Pre-existing lung disease should not be a contraindication.

INTRODUCTION: Single Photon Emission Computed Tomography-Ventilation-Perfusion (SPECT-VQ) with low-dose CT (SPECT-CT/VQ) has equivalent diagnostic accuracy to CTPA for diagnosing pulmonary embolus (PE) while using lower radiation doses, but is underutilized owing to perceived inaccuracy of scintigraphy in the setting of pre-existing lung disease. This study assesses the accuracy of SPECT-CT/VQ compared with CTPA for the diagnosis of PE, including in patients with pre-existing lung disease. METHODS: Retrospective non-inferiority cohort study of all patients who underwent SPECT-CT/VQ scanning at St Vincent's Hospital, NSW, from June 2012 to November 2013, who also had a CTPA within the same admission and <72 h apart (n = 102). RESULTS: SPECT-CT/VQ had 100% sensitivity and 94.4% specificity when compared with CTPA. Of the 102 patients, 14 were lung transplant patients, and 27 had other pre-existing lung disease (41/102, 40.2%), with SPECT-CT/VQ having a sensitivity of 100% and specificity of 97.2% in this patient group. Non-inferiority of SPECT-CT/VQ was demonstrated at a significance level of 0.005. CONCLUSION: SPECT-CT/VQ has high sensitivity and specificity for diagnosing PE compared with CTPA, even among patients with pre-existing lung disease, with lower radiation doses.

Synemon ignita sp. nov., a new sun moth species from southern Australia (Lepidoptera, Castniidae).

Sun moths (Castniidae) constitute a family of day-flying moths that due to their slim bodies, broad and often richly coloured wings and clubbed antennae closely resemble butterflies. However, despite this superficial similarity, sun moths are not related to butterflies but belong to the diverse cossoid assemblage of lepidopterous families (Edwards et al. 1998). Until recently, Castniidae were assigned to the superfamily Sesioidea (Minet 1991). A molecular study by Mutanen et al. (2010), however, failed to find support for a close relationship of Sesiidae and Castniidae, resulting in the inclusion of both families in a larger concept of Cossoidea (Nieukerken et al. 2011). In contrast, Heikkil et al. (2015) who added considerable morphological data to DNA, recovered Sesioidea as monophyletic, with Sesiidae, Castniidae and Brachodidae as constituent families, yet with low support values. Thus, although the monophyly of Castniidae is well supported, the systematic position of this family is unresolved.

Dose rates in nuclear medicine and the effectiveness of lead aprons: updating the department's knowledge on old and new procedures.

INTRODUCTION: Answers to common nuclear medicine radiation safety questions often involve the consideration of dose rates from injected patients and the inverse square law. For staff, lead aprons are available as an option, although they are not routinely used and their effectiveness varies depending on the isotope. New tests and procedures have been introduced at this hospital, including PET and Y microsphere implantation, which have required a review and investigation of their potential impact on staff doses. To answer these questions and to account for the recently introduced technologies and procedures, a study was conducted to measure and demonstrate the level of effectiveness of the department's lead aprons and to simulate patient dose rate measurements and estimations by obtaining measurements from water phantoms filled with these isotopes. MATERIALS AND METHODS: A calibrated survey meter was used to measure dose rates at varying distances from water phantoms filled with Tc, Ga, I, F and Y. Thermoluminescence dosimeters attached to an anthropomorphic phantom with a lead apron were used to assess the effectiveness of the lead aprons available within the department. An uncollimated detector from a gamma camera was used to observe the changes to the energy spectrum in the presence of the lead apron. RESULTS: The results from the dose rate measurements demonstrated an overestimation by the inverse square law at close distances. This overestimation can be in excess of four times the measurements made within this study. The use of a lead apron was shown to reduce doses by varying degrees depending on the isotope used. A 64.5% dose reduction was observed when shielding against Tc with diminishing effectiveness against the remaining isotopes. The results for Y suggest that using a lead apron could result in dose escalation at shallow depths. CONCLUSION: A table of conversion factors, independent of the isotope, was generated for the estimation of dose rates from injected patients at various distances. An isotope-specific conversion table was also generated. The effectiveness of the lead aprons within the department was also successfully measured and assessed and recommendations were passed on to staff regarding their use.

Social cognition, the male brain and the autism spectrum.

Behavioral studies have shown that, at a population level, women perform better on tests of social cognition and empathy than men. Furthermore Autism Spectrum Disorders (ASDs), which are characterized by impairments in social functioning and empathy, occur more commonly in males than females. These findings have led to the hypothesis that differences in the functioning of the social brain between males and females contribute to the greater vulnerability of males to ASD and the suggestion that ASD may represent an extreme form of the male brain. Here we sought to investigate this hypothesis by determining: (i) whether males and females differ in social brain function, and (ii) whether any sex differences in social brain function are exaggerated in individuals with ASD. Using fMRI we show that males and females differ markedly in social brain function when making social decisions from faces (compared to simple sex judgements) especially when making decisions of an affective nature, with the greatest sex differences in social brain activation being in the inferior frontal cortex (IFC). We also demonstrate that this difference is exaggerated in individuals with ASD, who show an extreme male pattern of IFC function. These results show that males and females differ significantly in social brain function and support the view that sex differences in the social brain contribute to the greater vulnerability of males to ASDs.

When family looks strange and strangers look normal: a case of impaired face perception and recognition after stroke.

We describe a patient (JS) with impaired recognition and distorted visual perception of faces after an ischemic stroke. Strikingly, JS reports that the faces of family members look distorted, while faces of other people look normal. After neurological and neuropsychological examination, we assessed response accuracy, response times, and skin conductance responses on a face recognition task in which photographs of close family members, celebrities and unfamiliar people were presented. JS' performance was compared to the performance of three healthy control participants. Results indicate that three aspects of face perception appear to be impaired in JS. First, she has impaired recognition of basic emotional expressions. Second, JS has poor recognition of familiar faces in general, but recognition of close family members is disproportionally impaired compared to faces of celebrities. Third, JS perceives faces of family members as distorted. In this paper we consider whether these impairments can be interpreted in terms of previously described disorders of face perception and recent models for face perception.

Dual-time-point (18)F-FDG-PET/CT imaging in the assessment of suspected malignancy.

UNLABELLED: INTRODUCTION (PURPOSE OF THE STUDY): The objective of this study was to assess whether dual-time-point (18)F-fluoro-2-deoxyglucose ((18)F-FDG)-PET/CT imaging improved the evaluation of suspected malignancy and if there was any resulting change in management. METHODS: A total of 53 patients with suspected malignancy were investigated by performing two static acquisitions started at mean times t = 64 and t = 155 min after the tracer injection. The total number of malignant lesions was 133 and the total number of benign lesions was 61. Visual and semiquantitative analysis was performed on both the early and delayed images. RESULTS: Overall, there was a significant improvement (P < 0.001) in the sensitivity of delayed imaging (94%) compared with early imaging (77%) in detecting malignant lesions, without a reduction in specificity. In 10 patients, 13 malignant lesions were undetected on early imaging alone but detected on delayed imaging. In seven patients, 10 malignant lesions were incorrectly classified as 'likely benign' on early imaging but correctly reported as 'likely malignant' on delayed imaging. Management was altered in 2 out of 17 patients. Overall, delayed imaging altered management in 2 out of 53 studied patients. Dual-time-point (18)FDG-PET/CT imaging was useful in differentiating malignant from benign intra-abdominal lesions but did not improve the evaluation of pulmonary lesions. CONCLUSIONS: (18)F-FDG-PET/CT imaging should be performed as late as reasonably possible after tracer administration in order to increase tumour-to-background contrast and thereby improve the sensitivity of demonstrating additional sites of disease. Dual-time-point (18)FDG-PET/CT may be of benefit in the evaluation of intra-abdominal lesions but does not improve the overall evaluation of pulmonary lesions.

Review: the legal duty of care for nurses and other health professionals.

AIMS AND OBJECTIVES: To explore the nature and extent of the legal duty of care in relation to contemporary healthcare practice. BACKGROUND: The paper seeks to re-frame and update the legal duty of care for clinical nursing practice in the 21st century, taking into account collaborative and partnership working in healthcare practice. DESIGN: Doctrinal legal 'approach'. METHOD: 'Black letter' legal research methodology used for data collection and analysis. Literature search using Westlaw and LexisNexis database(s) to identify recent common law decisions. RESULTS: There has been a perceptible doctrinal shift away from paternalism and toward patient empowerment and autonomy in the last decade. This has implications for nurses and other healthcare professionals in terms of consenting patients and acting reasonably to ensure quality patient care. CONCLUSIONS: A number of experienced nurses are currently assuming extended roles and some are completing medical tasks, traditionally allocated to doctors. These specialist practitioners must remember that additional responsibility invariably means increased professional risk and accountability. Therefore, it is essential that those engaging in advanced nursing practice, fully understand the nature and reach of their professional duty of care and the significance of statutory and common law developments. RELEVANCE TO CLINICAL PRACTICE: Nurses and other healthcare professionals must update their clinical skills and practice within a legal framework and to certain standards. The cases cited and discussed are relevant to all branches of nursing and indeed to all health professions.

Effect of ozone and open air factor against aerosolized Micrococcus luteus.

Because of increased concerns over failures in cleaning, the role of bioaerosols, and the environmental and clinical persistence of pathogens, the evaluation of novel decontaminants is increasingly important. The bactericidal properties of open air factor (OAF; a collection of highly reactive chemical species) were identified in the 1970s; however, the potential practical applications of artificially generated OAF have been considered only recently. In this study, the effects of OAF against Micrococcus luteus were investigated. OAF was generated and distributed in a bioaerosol test chamber by delivery of monoterpenes into ozonated air (0.1 ppm) at concentrations of 2.0 (high), 0.75 (medium), or 0.3 (low) mgm(-3) h(-1). M. luteus was aerosolized, and the number of culturable survivors was determined after 2, 5, 10, 20, and 60 min. Culturable bacteria were enumerated by aerobic plate counts in all-glass impinger fluid. Data were analyzed for statistical significance using one- or two-way analyses of variance. When aerosolized bacteria were exposed to ozone alone (0.05, 0.1, and 2 ppm), a significant (up to 3-log) reduction was observed at all concentrations, and the effect was time dependent. When exposed to the cyclic monoterpene alone, there were no significant differences between test samples and controls. When exposed to OAF (high and medium concentrations in 0.1 ppm ozone) there were significant differences after 20 min. These reductions were significantly greater than those achieved with ozone alone at 0.1 ppm. OAF is potentially an effective antibacterial agent that can reduce the microbial load in air. Because the technology uses reaction compounds naturally found in the environment, risks to health may be lower than those associated with ozone or other gaseous treatments. However, this hypothesis needs further investigation.

Obestatin reduces food intake and suppresses body weight gain in rodents.

Obestatin was recently described as a bioactive peptide encoded for by the same gene as ghrelin but with opposite actions on food intake. Although some groups have confirmed these findings others find no effect. We investigated the effect of obestatin on feeding in rodents over a wide range of doses. Acute administration of obestatin inhibited feeding at doses of 10-100 nmol/kg i.p. in mice and 100-300 nmol/kg i.p. in lean and Zucker fatty rats. Interestingly, the dose-response relationship was U-shaped such that both low and high doses were without effect in either species. Treatment of mice with obestatin over a 7-day period decreased body weight gain and food consumption. Overall, obestatin suppressed food intake and body weight gain in rodent and an unusual dose-response relationship was found. These findings may explain the difficulties in reproducing the effects of obestatin on feeding reported by some groups.

Mapping the time course of nonconscious and conscious perception of fear: an integration of central and peripheral measures.

Neuroimaging studies using backward masking suggest that conscious and nonconscious responses to complex signals of fear (facial expressions) occur via parallel cortical and subcortical circuits. Little is known, however, about the temporal differentiation of these responses. Psychophysics procedures were first used to determine objective thresholds for both nonconscious detection (face vs. blank screen) and discrimination (fear vs. neutral face) in a backward masking paradigm. Event-related potentials (ERPs) were then recorded (n = 20) using these thresholds. Ten blocks of masked fear and neutral faces were presented under each threshold condition. Simultaneously recorded skin conductance responses (SCRs) provided an independent index of stimulus perception. It was found that Fear stimuli evoked faster SCR rise times than did neutral stimuli across all conditions, indicating that emotional content influenced responses, regardless of awareness. In the first 400 msec of processing, ERPs dissociated the time course of conscious (enhanced N4 component) from nonconscious (enhanced N2 component) perception of fear, relative to neutral. Nonconscious detection of fear also elicited relatively faster P1 responses within 100 msec post-stimulus. The N2 may provide a temporal correlate of the initial sensory processing of salient facial configurations, which is enhanced when top-down cortical feedback is precluded. By contrast, the N4 may index the conscious integration of emotion stimuli in working memory, subserved by greater cortical engagement. Hum. Brain Mapping 21:64-74, 2004.

The impact of a convectional summer rainfall event on river flow and fine sediment transport in a highly urbanised catchment: Bradford, West Yorkshire.

Urban watercourses are important assets to cities, but they often have extremely 'flashy' hydraulic regimes and poor water quality, making them potential hazards. Current knowledge of the impact of intense rainfall events on urban river water discharge and, in particular, fine sediment transport is limited. Continuous monitoring of flow and turbidity (subsequently calibrated to suspended sediment concentration) was undertaken at a network of four sites throughout the highly urbanised Bradford catchment in West Yorkshire, NE England. An intense convectional rainfall event, which occurred over central Bradford in June 2001, generated extreme flow and fine sediment transport responses at the most downstream site, Shipley Weir. In just 15 min, discharge increased from 0.45 to 34.6 m(3) s(-1) (median annual peak instantaneous discharge of 27.5 m(3) s(-1), 1983-2001) and suspended sediment concentration increased from 14 to 1,360 mg l(-1). A peak sediment flux of 47.2 kg s(-1) was recorded. It is demonstrated that this extremely large and urban flux of fine sediment is likely to have a major downstream impact on water quality in the River Aire.