HSE's safety assessment principles for criticality safety.

The Health and Safety Executive (HSE) published its revised Safety Assessment Principles for Nuclear Facilities (SAPs) in December 2006. The SAPs are primarily intended for use by HSE's inspectors when judging the adequacy of safety cases for nuclear facilities. The revised SAPs relate to all aspects of safety in nuclear facilities including the technical discipline of criticality safety. The purpose of this paper is to set out for the benefit of a wider audience some of the thinking behind the final published words and to provide an insight into the development of UK regulatory guidance. The paper notes that it is HSE's intention that the Safety Assessment Principles should be viewed as a reflection of good practice in the context of interpreting primary legislation such as the requirements under site licence conditions for arrangements for producing an adequate safety case and for producing a suitable and sufficient risk assessment under the Ionising Radiations Regulations 1999 (SI1999/3232 www.opsi.gov.uk/si/si1999/uksi_19993232_en.pdf).

HSE's Safety Assessment Principles for radiation protection.

The Health and Safety Executive (HSE) published its revised Safety Assessment Principles for Nuclear Facilities (SAPs) in December 2006. The SAPs are primarily intended for use by HSE's inspectors when judging the adequacy of safety cases for nuclear facilities. The revised SAPs refer in part to HSE's expectations relating to the technical discipline of radiation protection. The purpose of this paper is to describe for the benefit of a wider audience HSE's reasoning behind the final published SAPs and to set out the purpose of each specific radiation protection (RP) principle. The paper also discusses principles in other sections of the SAPs which are relevant to radiation protection. The paper notes that the SAPs should be viewed as a reflection of good practice in relation to nuclear facilities in the context of interpreting relevant parts of primary legislation such as the Nuclear Installations Act 1965.

Protective aprons in imaging departments: manufacturer stated lead equivalence values require validation.

The composition of protective aprons worn by X-ray personnel to shield against secondary radiation is changing. Lead is being replaced by either lead-free or composite (lead with other high atomic numbered elements) materials. These newer aprons are categorised by manufacturers in terms of lead equivalent values, but it is unclear how these stated values compare with actual lead equivalent values. In this work, the actual lead equivalence of 41 protective aprons from four manufacturers, all specified as having 0.25 mm lead equivalence, were investigated with transmission experiments at 70 and 100 kVp. All aprons were in current use. The aprons were screened for defects, and age, weight and design was recorded along with details of associated quality assurance (QA). Out of the 41 protective aprons examined for actual lead equivalence, 73% were outside tolerance levels, with actual levels in some aprons demonstrating less than half of the nominal values. The lack of compatibility between actual and nominal lead equivalent values was demonstrated by aprons from three of the four manufacturers investigated. The area of the defects found on screening of the protective aprons were within recommendations. The results highlight the need for acceptancy and ongoing checks of protective aprons to ensure that radiation exposure of imaging personnel is kept to a minimum.

The relationship between hide cleanliness and bacterial numbers on beef carcasses at a commercial abattoir.

Cattle were visually inspected in the lairage of a commercial abattoir and assigned to a category ranging from 1 (very clean) to 5 (very dirty) depending on the observed cleanliness of the hide. Animals from categories 2, 3 and 5 were slaughtered and total viable counts (TVCs) enumerated at five sites (hock, brisket, cranial back, bung and inside round) on the subsequent carcasses. The TVCs at the hock were significantly higher on category 5 than on category 2 carcasses (P < 0.05). Similarly, TVCs at the brisket were significantly higher on categories 3 and 5 than on category 2 carcasses (P < 0.05). There were no differences in counts among the categories at any of the other sites. The TVCs averaged over the five carcass sites were higher for category 5 than for category 2 carcasses (P < 0.05). The TVCs at the brisket were significantly higher than all other sites (P < 0.01). In general, carcasses from category 2 animals slaughtered in a batch with dirtier animals (categories 3 and 5) did not have higher TVCs than carcasses of category 2 animals slaughtered at the beginning of the day in the absence of dirtier animals. The introduction of improved hygienic practices during the dehiding of category 4 animals resulted in reduced TVCs at the brisket (P < 0.001).

Reliability of the life chart schedule for assessment of the long-term course of schizophrenia.

We report on the inter-rater reliability of the Life Chart Schedule (LCS). The LCS is designed to assess the long-term course of schizophrenia in four key domains (symptoms, treatment, residence, and work) over two time periods (past two years, entire period of illness). The subjects were 27 consecutive admissions to a schizophrenia research unit. The LCS was filled out by pairs of raters, blinded to each others' ratings, using the same data (interview with subject and chart). Reliability was examined for 45 LCS ratings selected from all four domains and both time periods. Selected ratings pertained to the duration of specified experiences, the quality of these experiences, and the long-term time trend. The kappa statistic and the intra-class correlation coefficient (ICC) were used to determine inter-rater reliability for continuous and categorical ratings, respectively. LCS ratings proved reliable in all four key domains and both time periods. The reliability was fair to excellent for ratings of duration of experience (ICC ranged from 0.53 to 0.99), quality of experience (kappa ranged from 0.46 to 0. 92) and long-term time trends (kappa ranged from 0.66 to 0.94). The LCS can be used to obtain reliable ratings of the long-term course of schizophrenia in multiple domains.

Practice patterns of international and U.S. medical graduate psychiatrists.

OBJECTIVE: The practice patterns of international medical graduate (IMG) and U.S. medical graduate (USMG) psychiatrists were compared. METHOD: Using data from the 1996 National Survey of Psychiatric Practice, the authors compared IMGs and USMGs in terms of demographic characteristics, practice settings, patients' clinical characteristics, and sources of reimbursement. RESULTS: The IMGs surveyed tended to be older than USMGs, included a higher proportion of women, and were more racially heterogeneous. They worked longer hours, worked more frequently in the public sector, and treated a higher proportion of patients with psychotic disorders. The IMGs also received a higher percentage of their income than USMGs from Medicaid and Medicare, whereas the reverse was true of self-payment. Most of these differences remained significant after psychiatrist's age, gender, race, board certification, and work setting were controlled for. CONCLUSIONS: IMG and USMG psychiatrists have different practice patterns. Policies that substantially decrease the number of IMG psychiatrists may adversely affect the availability of psychiatrists to treat minorities and other underserved populations.

Family planning knowledge, attitudes and practices in women with schizophrenic spectrum disorders.

This study set out to test three hypotheses about family planning in women with schizophrenic spectrum disorders, as compared to demographically comparable non-mentally ill control women: that they (1) report at least as much unprotected intercourse while not desiring pregnancy; (2) have less knowledge about contraception; and (3) perceive more, and different, obstacles to obtaining or using birth control. A semistructured Family Planning Interview was administered to subjects (n = 44) with Research Diagnostic Criteria diagnoses of schizophrenia and schizoaffective disorder, and to non-mentally ill control subjects (n = 50). The participants had high rates of unprotected intercourse, as did non-mentally ill controls. They had significantly less reproductive and contraceptive knowledge than the control subjects, and were more likely to perceive birth control as difficult to obtain. The most common reason women with schizophrenic spectrum disorders gave for failing to use birth control was that they did not expect to have sex, while that given by non-mentally ill subjects related to side-effects of birth control. Important obstacles to family planning in women with schizophrenic spectrum disorders include relative lack of knowledge and difficulty planning ahead. Although many women with schizophrenia could benefit from long-acting, reversible contraception, many may be unaware of those options and/or may find them difficult to obtain. Integrating family planning with mental health care might better address the unique needs of this population.

PIP: A semi-structured interview was used to gather data in testing the three hypotheses about family planning in women with schizophrenic spectrum disorders, as compared to demographically comparable non-mentally-ill control women: 1) that they report at least as much unprotected intercourse while not desiring pregnancy; 2) that they have less knowledge about contraception; and 3) that they perceive more, and different, obstacles in obtaining or using birth control. A total of 44 women with Research Diagnostic Criteria diagnosed of schizophrenia and schizoaffective disorder, and 50 non-mentally-ill control subjects were administered with the Family Planning Interview. The interview elicited detailed information about sexuality, pregnancy history, education and communication about family planning, and birth control knowledge, practices and attitudes. Results revealed that the participants had high rates of unprotected intercourse, as did non-mentally-ill controls. They had significantly less reproductive and contraceptive knowledge than the control subjects, and were more likely to perceive birth control as difficult to obtain. The reason most commonly endorsed by women with psychotic disorders had to do with not expecting to have sex, and not thinking about birth control while having sex. It also provides support for the hypothesis that difficulty planning ahead was a major obstacle to the use of birth control methods. These findings underscore the importance of gearing family planning programs to the particular needs of mentally ill women.

Long-term course of acute brief psychosis in a developing country setting.

BACKGROUND: This study in North India compared acute brief psychosis--defined by acute onset, brief duration and no early relapse--with other remitting psychoses, over a 12-year course and outcome. METHOD: In a cohort of incident psychoses, we identified 20 cases of acute brief psychosis and a comparison group of 43 other remitting psychoses based on two-year follow-up. Seventeen people (85%) in the acute brief psychosis group and 36 (84%) in the comparison group were reassessed at five, seven and 12 years after onset, and were rediagnosed using ICD-10 criteria. RESULTS: At 12-year follow-up, the proportion with remaining signs of illness was 6% (n = 1) for acute brief psychosis versus 50% (n = 18) for the comparison group (P = 0.002). Using ICD-10 criteria, the majority in both groups were diagnosed as having schizophrenia. CONCLUSIONS: Acute brief psychosis has a distinctive and benign long-term course when compared with other remitting psychoses. This finding supports the ICD-10 concept of a separable group of acute and transient psychotic disorders. To effectively separate this group, however, the ICD-10 criteria need modification.

Testosterone, LH and FSH episodic secretory patterns in GnRH-immunized bulls.

The objective was to determine: (i) the secretory patterns of LH, FSH and testosterone in bulls, and the temporal relationships between the pulses of these hormones; and (ii) the effect of GnRH immunization on these parameters. Friesian bulls (n = 72) were given a primary immunization on day 0 (10-week-old) and a booster immunization on either day 28 (n = 36) or day 56 (n = 36) against either a GnRH-human serum albumin (HSA) conjugate (n = 48) or HSA (n = 24; control). On the basis of GnRH antibody titres at a plasma dilution of 1:160, 1 week after booster immunization, 12 GnRH-immunized and six control bulls from each booster-immunized group were selected and allocated to one of three groups: control bulls and bulls with medium and high antibody titres (0.3, 32 and 51% binding, respectively; pooled SED 4.3%). Blood samples were taken from these animals (n = 36) every 15 min for 8 h on three occasions: (i) 2 weeks after booster immunization when bulls were 4-5 months of age (prepubertal); (ii) at 7 months of age (peripubertal); and (iii) at 11 months of age (post-pubertal). Data were analysed by PULSAR, ANOVA and chi-squared test. The mean antibody titre of the high antibody titre group was greater (P < 0.05) than that of the medium antibody titre group in prepubertal bulls only, but the mean antibody titres of both antibody titre groups were greater (P < 0.05) than that of the control bulls at all times. The frequency and amplitude of LH and FSH pulses in the control bulls were greater (P < 0.05) during prepuberty than after puberty. The frequency, amplitude and duration of LH pulses were greater (P < 0.05) in control bulls than those in medium and high antibody titre bulls at prepuberty. The mean and basal concentrations of FSH and the amplitude and duration of FSH pulses were greater (P < 0.05) in the control bulls than in the high antibody titre bulls at prepuberty. The frequency of testosterone pulses was greater (P < 0.05) in the control bulls than in the medium and high antibody titre bulls at peripuberty. The mean and basal concentrations and pulse amplitude of testosterone were greater (P < 0.05) in high antibody titre bulls than in control bulls after puberty. There was a close temporal relationship between LH and FSH (62.5% of LH pulses were followed by FSH pulses within 75 min) at prepuberty in the control bulls but there was no relationship after puberty. The opposite trend occurred in the high antibody titre bulls, that is, there was no relationship between LH and FSH at prepuberty but there was a close temporal relationship after puberty. The temporal relationship between LH and testosterone was closest at peripuberty (86.7%) in the control bulls, but increased in the high antibody titre bulls from 0% at prepuberty to 57.1% after puberty. In summary, there was an age-related decrease in LH and FSH pulse frequency and amplitude and also in the temporal relationships between these hormones in control bulls. Prepubertal GnRH immunization had a suppressing effect on the pulsatile release of LH, FSH and testosterone before but not after puberty. The presence of high amplitude testosterone pulses in the GnRH-immunized bulls after puberty indicates that the long-term tonic release of LH may be sufficient to initiate a late pubertal-type increase in testosterone concentrations.

Normal or induced secretory patterns of luteinising hormone and follicle-stimulating hormone in anoestrous gonadotrophin-releasing hormone-immunised and cyclic control heifers.

The objective was to determine the effect of gonadotrophin-releasing hormone (GnRH), GnRH analogue (GnRH-A) or oestradiol administration on luteinising hormone (LH) and follicle-stimulating hormone (FSH) release in GnRH-immunised anoestrous and control cyclic heifers. Thirty-two heifers (477 +/- 7.1 kg) were immunised against either human serum albumin (HSA; controls; n = 8), or a HSA-GnRH conjugate. On day 70 after primary immunisation, control heifers (n = 4 per treatment; day 3 of cycle) received either (a) 2.5 micrograms GnRH or (b) 2.5 micrograms of GnRH-A (Buserelin) and GnRH-immunised heifers (blocked by GnRH antibody titre; n = 6 per treatment) received either (c) saline, (d) 2.5 micrograms GnRH, (e) 25 micrograms GnRH or (f) 2.5 micrograms GnRH-A, intravenously. On day 105, 1 mg oestradiol was injected (intramuscularly) into control (n = 6) and GnRH-immunised anoestrous heifers with either low (13.4 +/- 1.9% binding at 1:640; n = 6) or high GnRH antibody titres (33.4 +/- 4.8% binding; n = 6). Data were analysed by ANOVA. Mean plasma LH and FSH concentrations on day 69 were higher (P < 0.05) in control than in GnRH-immunised heifers (3.1 +/- 0.16 vs. 2.5 +/- 0.12 ng LH ml-1 and 22.5 +/- 0.73 vs. 17.1 +/- 0.64 ng FSH ml-1, respectively). The number of LH pulses was higher (P < 0.05) in control than in GnRH-immunised heifers on day 69 (3.4 +/- 0.45 and 1.0 +/- 0.26 pulses per 6 h, respectively). On day 70, 2.5 micrograms GnRH increased (P < 0.05) LH concentrations in control but not in GnRH-immunised heifers, while both 25 micrograms GnRH and 2.5 micrograms GnRH-A increased (P < 0.05) LH concentrations in GnRH-immunised heifers, and 2.5 micrograms GnRH-A increased LH in controls. FSH was increased (P < 0.05) in GnRH-immunised heifers following 25 micrograms GnRH and 2.5 micrograms GnRH-A. Oestradiol challenge increased (P < 0.05) LH concentrations during the 13-24 h period after challenge with a greater (P < 0.05) increase in control than in GnRH-immunised heifers. FSH concentrations were decreased (P < 0.05) for at least 30 h after oestradiol challenge. In conclusion, GnRH immunisation decreased LH pulsatility and mean LH and FSH concentrations. GnRH antibodies neutralised low doses of GnRH (2.5 micrograms), but not high doses of GnRH (25 micrograms) and GnRH-A (2.5 micrograms). GnRH immunisation decreased the rise in LH concentrations following oestradiol challenge.

Sexuality, pregnancy, and childrearing among women with schizophrenia-spectrum disorders.

OBJECTIVE: This study compared sexuality, reproduction, and childrearing characteristics of women with schizophrenia-spectrum disorders with those of women without serious mental illness. METHODS: A semistructured interview was given to 46 women meeting Research Diagnostic Criteria for schizophrenia or schizoaffective disorder and to 50 control subjects without major mental illness who were matched for age, race, education, employment status, and religion. RESULTS: Compared with the control subjects, the women with schizophrenic disorders had more lifetime sexual partners, were less likely to have a current partner, and were more likely to have been raped and to have engaged in prostitution. Despite being at high risk for HIV infection, as a group they were less likely to have been tested for HIV. They reported wanting sex less often than did control subjects and rated their physical and emotional satisfaction with sex lower. They had fewer planned pregnancies, more unwanted pregnancies, and more abortions and were more often victims of violence during pregnancy. They were more likely to have lost custody of children and to report that they were unable to meet their children's basic needs and less likely to have another caregiver helping them raise their children. Both groups reported high rates of substance abuse during pregnancy. CONCLUSIONS: Health care delivery systems could better meet the needs of women with severe mental illness by providing social skills training, family planning, and more consistent screening for pregnancy, HIV, and battering. In addition, barriers to care for pregnant women with severe mental illness and substance abuse should be reduced, and parenting training should be incorporated into psychosocial rehabilitation programs for mentally ill parents.

Acute manic episodes in pregnancy.

A 33-year-old pregnant woman at 26 weeks gestation, who had a history of bipolar mood disorder, type I, was admitted to the hospital for hypomania and poorly controlled diabetes mellitus. The patient had had her first episode of affective illness at age 28, after the birth of her second child. After an initial postpartum depression, she had cycled into a manic state. She had subsequently been hospitalized seven times for acute mania. A combination of valproate and chlorpromazine had proven effective in managing most of her manic episodes, while her two most severe episodes had been successfully managed with bilateral ECT.

Acute psychoses: a proposed diagnosis for ICD-11 and DSM-V.

This paper concerns the diagnostic classification of nonaffective acute remitting psychosis (NARP), which we also term acute brief psychosis. We argue that NARP can be delineated from both schizophrenia and the affective psychoses and considered as a single diagnosis. As indicated by the term NARP, four criteria would be central to the diagnosis: 1. nonaffective, 2. acute onset (over less than two weeks), 3. recovery within a brief duration (less than six months), and 4. psychosis broadly defined. We review the rationale and the empirical evidence for this proposed classification.

Course and outcome of acute non-organic psychotic states in India.

This paper presents an overview of the diagnoses and short-term course of acute psychotic illnesses--affective as well as nonaffective--in a developing country setting. In the Chandigarh Acute Psychosis Study (CAPS) in Northern India, a cohort of 91 cases of acute psychotic illness were assessed for symptoms, diagnosis, and course ratings at multiple intervals over a 12 month period; cases were drawn from a rural and an urban clinic, permitting comparison of patients in these two settings. Non-affective (mainly schizophrenic) patients were found to be the predominant group (51%), followed by manic (26%), and depressive (19%) patients. Overall the acute psychoses had an excellent short-term course and outcome, a result which held across all diagnostic groups and both the rural and urban setting. Rural and urban patients were similar in diagnostic distribution and course of illness. Investigations of such cases can expand our view of the possible manifestations and course of psychotic disorders, and may have implications for diagnosis.

Immunization of heifers against gonadotropin-releasing hormone: antibody titers, ovarian function, body growth, and carcass characteristics.

To investigate the effects of active immunization of cyclic beef heifers with different doses of a human serum albumin-Cys-Gly-GnRH (HSA-GnRH) conjugate on antibody titers, ovarian function, body growth, and carcass characteristics, 32 heifers (BW = 477 +/- 7.1 kg; mean +/- SE) were assigned to one of four immunization treatments: .1 mg of HSA or .01, .1, or 1.0 mg of HSA-GnRH, respectively. All heifers received a primary (d 0) and booster (d 28) immunization using DEAE-dextran as adjuvant. The duration of the experiment was 158 d. Overall antibody titers against GnRH were greater (P < .05) for heifers immunized against GnRH (13 +/- 3.3, 22 +/- 3.8, and 19 +/- 2.8% binding at a plasma dilution of 1: 640 for Treatments 2 to 4, respectively) than for controls (1 +/- .1%). The numbers of heifers that became anestrous (plasma progesterone < .5 ng/mL for > 21 d) were 1/8, 8/8, 7/8, and 8/8, respectively. The interval from primary immunization to anestrus (40.7 +/- 6 d) and the duration of anestrus (78 +/- 7 d) were not affected by dose of HSA-GnRH conjugate. The number of ovulations detected was reduced (P < .05) in GnRH-immunized (4.6 +/- .64, 4.0 +/- .70, and 3.6 +/- .60 for Treatments 2 to 4, respectively) compared with control heifers (9.4 +/- .20). During induced anestrus, follicular growth was generally arrested (< 5 mm in diameter) and plasma estradiol decreased.(ABSTRACT TRUNCATED AT 250 WORDS)

Immunization of bull calves with a GnRH analogue-human serum albumin conjugate: effect of conjugate dose, type of adjuvant and booster interval on immune, endocrine, testicular and growth responses.

Bull calves were immunized with GnRH analogue-human serum albumin (HSA-Cys-Gly-GnRH) conjugate to determine the effects of dose, adjuvant type and interval between primary and booster injections on plasma testosterone and LH concentrations, and testes and body growth. Friesian bull calves aged between 8 and 10 weeks (n = 72) were blocked according to age and weight and, within block, randomly assigned to 12 treatment combinations (n = 6 per treatment combination) in a 3 x 2 x 2 factorial plan. Main effects were (i) conjugate dose (0.0, 0.1 or 1.0 mg HSA-Cys-Gly-GnRH), (ii) adjuvant (diethylaminoethyl-dextran or non-ulcerative Freund's adjuvant), and (iii) interval between primary (day 0) injection and booster injection (day 28 or 56). Plasma testosterone and LH concentrations and antibody titres were determined in blood samples collected at 14 day intervals during the experiment (140 days). Testicular measurements were taken in situ every 28 days. Antibody titres (% binding at 1:160 dilution) were > or = 10% 28 days after booster injection and remained high for 140 days in 47 of 48 GnRH-immunized bulls. The mean titre was higher (P < 0.05) in response to the 1.0 mg dose compared with the 0.1 mg dose (37.7% versus 29.6% binding, respectively; pooled SED 2.55%). Mean LH and testosterone concentrations were reduced (P < 0.05) in immunized animals compared with controls. However, the 1.0 mg dose decreased mean testosterone concentrations by a greater extent (P < 0.001) than either the 0.1 mg or 0.0 mg doses. Testes length and depth, and scrotal circumference were decreased (P < 0.001) in immunized animals compared with controls; however, the 1.0 mg dose decreased (P < 0.001) testes parameters to the greatest extent. There was no effect of conjugate dose on average daily gain in body mass. It is concluded that (i) dose of conjugate, type of adjuvant and interval between primary and booster injections affected antibody titres, (ii) the use of 0.1 or 1.0 mg of HSA-Cys-Gly-GnRH decreased LH and testosterone concentrations, and testicular development throughout the experiment, without adversely affecting body growth, and (iii) an effective protocol is 1.0 mg GnRH-HSA conjugate, given in the adjuvant diethylaminoethyl dextran, with a primary-booster interval of 56 days.

Benzodiazepines inhibit neutrophil chemotaxis and superoxide production in a stimulus dependent manner; PK-11195 antagonizes these effects.

Diazepam, which binds both central (neuronal) and peripheral (non-neuronal) benzodiazepine binding sites, and Ro5-4864, a ligand selective for benzodiazepine peripheral binding sites (PBS), both inhibited the FMLP induced chemotaxis in human neutrophils at concentrations as low as 10(-8) M. A selective peripheral benzodiazepine antagonist, PK-11195 (10(-5) M), partially reversed the benzodiazepine inhibition of chemotaxis. Diazepam also inhibited the superoxide production induced by FMLP, NaF, and A23187, but not that induced by PMA whose stimulant action was insensitive even to 10(-4) M diazepam. The FMLP-induced superoxide production was most sensitive to diazepam inhibition (ID50 = 2.25 x 10(-6) M diazepam); the effect of NaF was slightly less sensitive (ID50 = 1.34 x 10(-5) M diazepam); and the effect of A23187 was least sensitive as it was suppressed only at 10(-4) M diazepam concentrations. Like diazepam, Ro5-4864 inhibited the FMLP-induced superoxide production, and PK-11195 (10(-5) M) significantly antagonized both diazepam and Ro5-4864 inhibition. Binding studies showed the presence of a saturable benzodiazepine 'peripheral' type binding site (PBS) on human neutrophils with a Kd of 1.2 +/- 0.06 x 10(-8) M (+/- SEM), and a Bmax of 1028 +/- 86.2 fmol/10(6) cells (+/- SEM) for [3H]Ro5-4864; the binding was displaceable by PK-11195, Ro5-4864 and diazepam but not by clonazepam.