Subsequent Occasions Research Articles

Primary caregivers’ satisfaction with clinicians’ response to them as informal carers of young people with first‐episode psychosis: a qualitative study

To explore first-time primary caregivers' experience of the way mental health nurses and other mental health clinicians respond to them as carers of young people with first-episode psychosis. Caregivers have a key role in supporting family members/relatives with mental illness, but their contribution is undervalued frequently by mental health nurses and other mental health clinicians. Design. Qualitative interpretative phenomenological analysis. A qualitative interpretative design was undertaken, using semi-structured, audio-recorded interviews. Twenty primary caregivers were recruited through Orygen Youth Health, a first-episode psychosis centre in Melbourne. Interpretative phenomenological analysis was used to identify themes in the data. Two competing themes were identified in the data, highlighting caregivers' contrasting experience with mental health nurses and other mental health clinicians. First, most clinical staff were approachable and supportive. Second, several carers felt their contribution was undervalued by some clinical staff. This was as a consequence of being excluded from clinical deliberations because of clinical staffs' concerns and young people's requests about maintaining confidentiality regarding treatment, as well as carers feeling their role was not taken seriously by clinical staff. First-time primary carers have positive and negative experiences with first-episode psychosis mental health nurses and other clinicians, and these competing events are interrelated. Experiences are affected directly by the manner they are treated by clinical staff and this may, in turn, affect carers' commitment to caring, the way they engage with clinical staff on subsequent occasions and towards the first-episode psychosis service generally. Greater appreciation is needed of the contribution, experience and difficulties caregivers encounter in their role and in engaging with mental health nurses and other clinicians. Additional training is required for clinical staff in family interventions and to familiarise them with legislation and mental health policies relating to carers.

The value of using fractional flow reserve measurements in helping to diagnose acute left ventricular failure in the presence of normal left ventricular systolic function

1. Case history A 57-year-old female smoker with a longstanding history of hypertension and diabetes presented to hospital with sudden onset of severe breathlessness in the absence of chest pain. Examination revealed sinus tachycardia, hypertension (blood pressure 200/120) and pulmonary oedema. Routine blood investigations and 12-h troponin measurements were normal, and a diagnosis of acute decompensated heart failure secondary to hypertensive crisis was made. She was treated with diuretics and betablockers and made a good recovery. Transthoracic echocardiography demonstrated left ventricular hypertrophy with preserved left ventricular systolic function and Grade 2 diastolic dysfunction. Renal ultrasound confirmed structurally normal kidneys with no evidence of renal artery stenosis. The patient was able to exercise to Stage 3 of a standard Bruce protocol exercise test without symptoms or electrocardiographic changes and subsequent coronary angiography demonstrated a 50% tubular stenosis of the proximal left anterior descending (LAD) artery and 60% stenoses of the mid LAD and origin of the second diagonal (D2) (Fig. 1). Consequently, moderate non-flowlimiting coronary disease was diagnosed, and the patient was discharged with appropriate medical therapy. Unfortunately, the patient re-presented on three subsequent occasions with further episodes of acute pulmonary oedema. The haemodynamic significance of the LAD disease was therefore reassessed, with additional measurements of fractional flow reserve (FFR). This revealed an FFR of 0.71 distal to the mid LAD bifurcation. The D2 and LAD/ D2 bifurcation was therefore stented resulting in a post-stent FFR of 0.85 with a pressure “jump” of 0.08 over the proximal vessel on pull-back (Fig. 2). This led to an additional stent being deployed at the site of the proximal LAD stenosis with complete restoration of flow and perfusion in the distal LAD and a post-stent FFR of 0.9 in the distal LAD. Following discharge the patient has remained well and over 18 months, there have been no further episodes of acute pulmonary oedema.

First-time primary caregivers' experience accessing first-episode psychosis services

Easy access to first-episode psychosis (FEP) services is critical in reducing the duration of untreated illness. However, primary caregivers can encounter difficulties accessing services on behalf of young people with FEP. This qualitative study describes the lived experience of first time primary caregivers of young adults with FEP, with a focus on examining how they access specialist FEP services. A qualitative study was undertaken using semi-structured, in-depth interviews with 20 caregivers in Melbourne. Most carers were women (85%, n = 17) and parents (85%, n = 17). Nearly all lived in the same households as the young people with FEP (90%, n = 18). The mean duration of their involvement with the FEP service was 14.5 months (standard deviation = 8.9). Three competing themes were identified in the data, reflecting caregivers' polarized experiences accessing FEP services. First, general practitioners were regarded as either a resourceful or an unresourceful means of access to FEP services. Second, caregivers often encountered service-focused and carer-focused barriers when initially accessing services. Third, a combination of acquired knowledge, experience with services and caregiver assertiveness enhanced access on subsequent occasions. This study highlights the important contribution and experience of first-time primary caregivers and the difficulties they face accessing services. The findings suggest access should be influenced more by clinical need and less by caregivers'perseverance. The findings also underline the importance of providing clinical training that acknowledges the needs and contributions of caregivers, as well as interventions that meet the unique challenges faced by first-time caregivers accessing services after the onset of FEP.

Validating an indirect measure of clarity of feelings: Evidence from laboratory and naturalistic settings.

This study analyzed the reliability and validity of an indirect measure of clarity of feelings that is based on response latencies (RTs) of mood ratings. Fifty-two participants completed a laboratory session and an experience-sampling week with 6 measurement occasions per day. Shorter RT of mood ratings measured in the laboratory (but not self-reported dispositional clarity) predicted higher overall mood regulation success during the experience-sampling week. As a new indirect ambulatory measure of clarity, RTs of mood ratings were measured on handheld devices during the experience-sampling week. The new ambulatory RT measure of clarity demonstrated good psychometric properties. Within-occasions reliability (internal consistency) was satisfactory, and between-occasions reliability (consistency of aggregated scores) was high. Ambulatory RT of mood ratings demonstrated moderate to high convergence with RT of mood ratings measured in the laboratory session. Both RT measures were unrelated to self-reported dispositional clarity of feelings. However, momentary RT converged with a self-report measure of momentary clarity on the within-persons level: Participants were faster to rate those mood items that they were more certain about. Evidence for the predictive validity of the new ambulatory RT measure was provided by the finding that on the within-persons level, shorter RT (but not self-reported momentary clarity) predicted higher mood regulation success and better mood at subsequent measurement occasions. The results suggest that RT of mood ratings can be used as a reliable and valid indicator of an individual's clarity of feelings in laboratory and experience-sampling studies.

Origins of large crescent-shaped bedforms within the axial channel of Monterey Canyon, offshore California

Crescent-shaped bedforms with wavelengths from 20 to 80 m, amplitudes to 2.5 m, and concave down-canyon crests occur in the axial channel of Monterey Canyon (offshore California, USA) in water depths from 11 to more than 350 m. The existence of these features may be an important new clue as to how sediment moves through submarine canyons. Three complementary studies were initiated in 2007 to understand the origin and evolution of these bedforms. (1) Vibracoring. Three transects of closely spaced remotely operated vehicle–collected vibracores were obtained across these bedforms. The seafloor underneath these features is composed of gravity-flow deposits. (2) Acoustic array. Three boulder-sized concrete monuments containing acoustic beacons were buried just below the surface of the canyon floor in ∼290 m water depth and their locations were redetermined on 17 subsequent occasions. Although the beacons became more deeply buried >0.6 m below the seafloor, they still could be tracked acoustically. Over a 26-month period the position of 1 or more of the beacons moved down-canyon during at least 6 discrete transport events for a total displacement of 994–1676 m. The movement and burial of the monuments suggest that the seabed was mobilized to >1 m depth during gravity-flow events. (3) Autonomous underwater vehicle (AUV) repeat mapping. AUV-acquired high-resolution multibeam mapping, and CHIRP (compressed high-intensity radar pulse) subbottom profiling surveys of the seafloor in the active channel were repeated four times in the first half of 2007. In addition, the movement of large instrument frames deployed in 2001–2003 within the axis of Monterey Canyon in the area now known to be associated with the crescent-shaped bedforms is documented. The fate of the frames has helped elucidate the frequency, transport potential, and processes occurring within the axis of Monterey Canyon associated with these bedforms. The crescent-shaped bedforms appear to be produced during brief gravity-flow events that occur multiple times each year, commonly coincident with times of large significant wave heights. Whether the bedforms are generated by erosion associated with cyclic steps in turbidity flows or internal deformation associated with slumping during gravity-flow events remains unclear.

The role of the forensic odontologist in disaster victim identification: Lessons for management

Forensic odontologists are involved in all phases of disaster victim identification (DVI). The failure of DVI management to embed odontology teams within all phases of the investigation and to include them in management decisions throughout the operation may lead to delays in the reconciliation process and could possibly compromise the integrity of the DVI investigation. In the case study presented, trained and experienced teams of forensic odontologists were not utilised to full capacity in all phases of the investigation. The complexity of the initial scene investigation was not identified resulting in the incomplete recovery of all remains. The scene had to be re-examined on three subsequent occasions. The post-mortem examination of the remains had to be deferred until all subsequent material had been collected. The collection of all ante-mortem dental records was not undertaken, resulting in transcription information that was incomplete and compromised. As a result, the reconciliation (formal identification) of the deceased became problematic because of the compounded errors in all phases of this DVI investigation and the resulting odontological report of identification could have jeopardised the integrity of the entire DVI process. Following a review of this case and the recognition of possible areas of omission in the management of the investigation a strategy to address these problems is proposed.

An Enzyme-Linked Immunosorbent Assay to Study Bevacizumab Pharmacokinetics

Bevacizumab is an antivascular endothelial growth factor humanized monoclonal antibody used to inhibit angiogenesis in cancer. It displays an important interindividual pharmacokinetic variability, which could explain part of the interindividual differences in clinical response. Therefore, an assay to measure bevacizumab serum concentrations is needed. An enzyme-linked immunosorbent assay was developed using microtiter plates sensitised with vascular endothelial growth factor 165, a recombinant form of vascular endothelial growth factor. Lower and upper limits of quantitation as well as limit of detection were determined. Eight calibrators and three quality controls, with concentrations of 5 mg/L, 30 mg/L, and 75 mg/L, were tested on five occasions initially and on five subsequent occasions. Trough and peak serum concentrations of bevacizumab were measured in patients with metastatic colorectal cancer. Bevacizumab concentrations were described using a two-compartment population pharmacokinetic model with first-order constants. Imprecision and accuracy of calibrators and quality controls were 20% or less, except for the zero calibrator. The limit of detection was 0.033 mg/L. Lower and upper limits of quantitation were 5 and 75 mg/L, respectively. A total of 175 blood samples was available for analysis from 16 patients. Median (range) trough and peak concentrations during the treatment were 47.2 (9.6-106.9) mg/L and 159.3 (33.0-327.3) mg/L, respectively. This method is rapid, accurate, reproducible, and may be useful for pharmacokinetic and pharmacokinetic-pharmacodynamic studies as well as in therapeutic drug monitoring of bevacizumab.

High Prevalence of Normal Tests Assessing Hypercortisolism in Subjects with Mild and Episodic Cushing's Syndrome Suggests that the Paradigm for Diagnosis and Exclusion of Cushing's Syndrome Requires Multiple Testing

Many Endocrinologists believe that a single determination of eucortisolism or a single demonstration of appropriate suppression to dexamethasone excluded Cushing's syndrome, except in what was previously thought to be the rare patient with episodic or periodic Cushing's syndrome. We hypothesize that episodic Cushing's syndrome is relatively common and a single test assessing hypercortisolism may not be sufficient to accurately rule out or diagnose Cushing's syndrome and retrospectively examined the number of normal and abnormal tests assessing hypercortisolism performed on multiple occasions in 66 patients found to have mild and/or episodic Cushing's syndrome compared to a similar group of 54 patients evaluated for, but determined not to have Cushing's syndrome. We found that 65 of the 66 patients with Cushing's syndrome had at least one normal test of cortisol status and most patients had several normal tests. The probability of having Cushing's syndrome when one test was negative was 92% for 23:00 h salivary cortisol, 88% for 24-h UFC, 86% for 24-h 17OHS, and 54% for nighttime plasma cortisol. These results demonstrated that episodic hypercortisolism is highly prevalent in subjects with mild Cushing's syndrome and no single test was effective in conclusively diagnosing or excluding the condition. Rather, the paradigm for the diagnosis should be a careful history and physical examination and in those patients in whom mild Cushing's syndrome/disease is strongly suspected, multiple tests assessing hypercortisolism should be performed on subsequent occasions, especially when the patient is experiencing signs and symptoms of short-term hypercortisolism.

Anxiety in patients undergoing percutaneous coronary interventions

Objective Many patients undergoing percutaneous coronary intervention (PCI) experience symptoms of anxiety; however, it is unclear whether anxiety is an issue in the early recovery period and the types of factors and patient concerns that are associated. This study set out to determine the patterns of anxiety and concerns experienced by patients undergoing PCI and the contributing factors in the time period surrounding PCI. Methods A convenience sample of patients undergoing PCI (n = 100) were recruited, and anxiety was measured using the Spielberger State Anxiety Inventory immediately before the PCI, the first day postprocedure, and 1 week postdischarge. Patients were also asked to identify their most important concern at each time. Independent predictors of anxiety at each time were determined by multiple regression analysis. Results Anxiety scores were highest pre-procedure (35.72, standard deviation [SD] 11.75), decreasing significantly by the postprocedure time (31.8, SD 10.20) and further still by the postdischarge time (28.79, SD 9.78) (repeated-measures analysis of variance: F = 39.72, P < .001). The concerns patients identified most frequently as most important were the outcome of the PCI and the possibility of surgery pre-procedure (37%) and postdischarge (31%), and the limitations and discomfort arising from the access site wound and immobility postprocedure (25%). The predictor of anxiety at the pre-procedure time was taking medication for anxiety and depression (b = 7.12). The predictors of anxiety at the postprocedure time were undergoing first-time PCI (b = 4.44), experiencing chest pain (b = 7.63), and experiencing pre-procedural anxiety (b = .49). The predictors of anxiety at the postdischarge time were reporting their most important concern as the future progression of CAD (b = 7.51) and pre-procedural anxiety (b = .37). Conclusion Symptoms of anxiety were common, particularly before PCI. These symptoms are important to detect and treat because pre-procedural anxiety is predictive of anxiety on subsequent occasions. Patients who have had chest pain or their first PCI should be targeted for intervention during the early recovery period after PCI, and information on CAD should be provided postdischarge.

How Positive and Negative Feedback Motivate Goal Pursuit

This article explores the feedback individuals give, seek, and respond to in the course of pursuing their goals. We propose that positive feedback motivates goal pursuit when it signals an increase in goal commitment, whereas negative feedback motivates goal pursuit when it signals insufficient goal progress. We review research suggesting that whether individuals are drawn to evaluate their level of commitment versus rate of progress determines the type of feedback (positive or negative) that best motivates them to pursue their goals. We then review research suggesting that these effects of feedback operate by inducing positive and negative general moods as well as specific emotions. Feedback is essential for goal pursuit. Information on successful and failed actions allows individuals to adjust and direct their efforts to match the challenge they are facing (Bandura, 1991; Dweck & Leggett, 1988; Festinger, 1954; Locke & Latham, 1990). Consequently, there are specific social roles associated with providing feedback on goal pursuit. For example, educators, coaches, and bosses all provide feedback that helps individuals monitor the level and direction of their actions to ensure they meet their goals. In addition, people seek feedback, including praise and criticism, from those surrounding them: friends, family members, colleagues, and neighbors. The feedback people seek can refer to their mastery goals, such as how well they perform a new skill, to their self-improvement goals, such as exercising or dieting, and to their relationship goals, such as how well they maintain their social connections. Across these various feedback agents and goals, we explore the circumstances under which positive feedback on accomplishments, strengths, and correct responses versus negative feedback on lack of accomplishments, weaknesses, and incorrect responses is more effective in motivating goal pursuit and hence is more frequently sought and given. A number of theories offer a universal answer to our question, attesting that either positive or negative feedback is generally more effective. Several motivation theories attest that positive feedback is more effective for motivating goal pursuit than negative feedback because it increases outcome expectancy of the goal and perceived self-efficacy of the pursuer (Atkinson, 1964; Bandura & Cervone, 1983; Lewin, 1935; Weiner, 1974; Zajonc & Brickman, 1969). According to this theoretical approach, positive feedback increases people’s confidence that they are able to pursue their goals, leading people to expect successful goal attainment. Negative feedback, in contrast, undermines people’s confidence in their ability to pursue their goals and their expectations of success. Because positive feedback is effective, various social agents use positive feedback to encourage individuals to internalize or integrate new goals to their self-concept, with the expectation that these individuals will then be more committed to pursue the goal on subsequent occasions (Ryan & Deci, 2000).

Children With Cochlear Implants Recognize Their Mother's Voice

The available research indicates that cochlear implant (CI) users have difficulty in differentiating talkers, especially those of the same gender. The goal of this study was to determine whether child CI users could differentiate talkers under favorable stimulus and task conditions. We predicted that the use of a highly familiar voice, full sentences, and a game-like task with feedback would lead to higher performance levels than those achieved in previous studies of talker identification in CI users. In experiment 1, 21 CI users aged 4.8 to 14.3 yrs and 16 normal-hearing (NH) 5-yr-old children were required to differentiate their mother's scripted utterances from those of an unfamiliar man, woman, and girl in a four-alternative forced-choice task with feedback. In one condition, the utterances incorporated natural prosodic variations. In another condition, nonmaternal talkers imitated the prosody of each maternal utterance. In experiment 2, 19 of the child CI users and 11 of the NH children from experiment 1 returned on a subsequent occasion to participate in a task that required them to differentiate their mother's utterances from those of unfamiliar women in a two-alternative forced-choice task with feedback. Again, one condition had natural prosodic variations and another had maternal imitations. Child CI users in experiment 1 succeeded in differentiating their mother's utterances from those of a man, woman, and girl. Their performance was poorer than the performance of younger NH children, which was at ceiling. Child CI users' performance was better in the context of natural prosodic variations than in the context of imitations of maternal prosody. Child CI users in experiment 2 differentiated their mother's utterances from that of other women, and they also performed better on naturally varying samples than on imitations. We attribute child CI users' success on talker differentiation, even on same-gender differentiation, to their use of two types of temporal cues: variations in consonant and vowel articulation and variations in speaking rate. Moreover, we contend that child CI users' differentiation of speakers was facilitated by long-term familiarity with their mother's voice.

Amaurosis, ophthalmoplegia, ptosis, mydriasis and periorbital blanching following inferior alveolar nerve anaesthesia

Ophthalmic complications following inferior alveolar nerve anaesthesia are rare. They include transient blindness (amaurosis), ophthalmoplegia, ptosis, mydriasis and diplopia. These events may occur following the intravascular administration of anaesthetic solution and are distressing to both patient and operator alike. We report the unusual case of a young patient who experienced amaurosis, total ophthalmoplegia, complete upper eyelid ptosis, mydriasis and periorbital blanching following inferior alveolar nerve anaesthesia. Similar but less profound signs were observed in the same patient on a subsequent occasion. This was following general anaesthesia, during which she had received local anaesthetic prior to mandibular wisdom tooth removal. Ophthalmic complications following inferior alveolar nerve anaesthesia are rare but distressing events. In particular, amaurosis is an extremely rare event and usually heralds a more sinister pathology such as stroke. Clinicians should be aware of these complications to minimise anxiety and reassure their patients appropriately.

Electronic data capture using the Womac® NRS 3.1 Index (m-Womac®): a pilot study of repeated independent remote data capture in OA

A preliminary evaluation of mobile phone technology for repeated independent remote data capture using the mobile phone-based m-WOMAC NRS 3.1 Index. Following orientation to the m-WOMAC Index, and initial completion in the office, patients took the phones home and independently completed the Index on four subsequent occasions over 12 days, sending their data each time to a server in USA. Three men and nine women with hip (n = 2) and knee (n = 10) OA successfully completed the m-WOMAC Index on each occasion. Average time to completing the Index at termination was 4.8 min. The majority of patients rated logging on/opening the application, completing the m-WOMAC Index on the phone, and sending data as very easy (10-11/12), and were very confident (11/12) in continuing to use the phone to report their symptoms. These data support the feasibility of repeated independent remote data capture using the m-WOMAC NRS3.1 Index.

Parental Feeding in Ring Doves (Streptopelia roseogrisea): Innate or Learned?

Summary Some observations on parental feeding in ring doves (Streptopelia roseogrisea) are reported. Lehrman (1955) advances an explanation of the development of parental feeding in ring doves by three experiments, in which the hormone prolactin was injected into ring doves. These birds, and appropriate control groups injected with distilled water, were then presented with seven day old squabs in a test situation. In experiment 1 Lehrman found that prolactin-injected birds fed young, and control birds did not. In experiment 2 he found that inexperienced birds, whether injected with prolactin or distilled water, did not feed seven day old squabs. In experiment 3, in which the crops of 12 birds were anesthetized with efocaine injected into the crop walls, and 12 birds were anesthetized elsewhere in the body, Lehrman found that 8 out of 12 birds whose crops were anesthetized did not feed young, while 2 out of 12 control birds injected elsewhere in the body did not feed the squabs. From these results the conclusion is drawn that the engorged crop of ring doves serves as a drive stimulus for approach behavior to the squabs, and that the squabs, having by trial and error inserted their bills into the parents' mouth elicit vomiting (regurgitation). In this way the parent becomes conditioned to the squab as a tension-reducing stimulus, and will on subsequent occasions voluntarily approach the young to feed them. Incidental observations collected during the course of another study demonstrate that Lehrman's explanation is not tenable. When mourning doves were hatched under ring dove foster parents, squabs were fed with crop milk or a clear watery liquid, irrespective of whether the foster parents had previous breeding experience, or at what stage of the parents' own incubation period these squabs hatched. If no cropmilk is in the foster parents' crops no increased sensitivity due to distension can be assumed; hence, the tension-reducing hypothesis becomes untenable. That regurgitation feeding is not the same as vomiting induced by the irritating bill of the squabs is shown by the observation that mechanical feeding devices used in hand-raising doves never elicit vomiting. The use of seven day old partially feathered squabs as test objects rather than one or two day old down young, which alone may be the appropriate releaser for the feeding response, most likely accounts for the different results in Lehrman's study and the present one. The conclusion is then that parental feeding in inexperienced ring doves is innate, and that an explanation in terms of trial and error learning is not acceptable.

Pelvic fracture‐related injuries of the bladder neck and prostate: their nature, cause and management

To report our experience of bladder neck injuries, which are a well recognized but rare consequence of pelvic fracture-related trauma to the lower urinary tract, as we have been unable to find any reference in the English literature to their specific nature, cause and management in adults. In the last 10 years we have treated 15 men with bladder neck injuries after pelvic fracture. Two were treated at our centre by delayed primary repair. Thirteen were initially treated elsewhere and presented to us 3 months to 5 years after their injury with intractable incontinence and various other symptoms most notably recurrent urinary infection and gross haematuria. Twelve of the injuries were at or close to the anterior midline and associated with lateral compression fractures or 'open-book' injuries. Five of them were confined to the bladder neck and prostatic urethra; the other seven extended into the subprostatic urethra. Four of these were associated with a coincidental typical rupture of the posterior urethra. All had an associated cavity involving the anterior disruption of the pelvic ring. Two of the injuries, following particularly severe trauma, were a simultaneous complete transection of the bladder neck and of the bulbo-membranous urethra with a sequestered prostate between. We have seen this in children before but not in adults. Another injury, also after particularly severe trauma, was an avulsion of the anterior aspect of the prostate. We have not seen this described before. Fourteen patients underwent lower urinary tract reconstruction and one underwent a Mitrofanoff procedure. All of the 14 had a layered reconstruction of the prostate and bladder neck and in 13, this was supplemented with an omental wrap. In all patients with an anterior midline rupture, the primary injury appeared to be to the prostate and prostatic urethra with secondary involvement of the bladder neck and the subprostatic urethra. The Mitrofanoff procedure was successful. Of the 14 patients with a layered reconstruction one, without an omental wrap, broke down but was successfully repaired on a subsequent occasion. The four patients who also had a ruptured urethra had a simultaneous bulbo-prostatic anastomotic urethroplasty, two of which required further attention. Eight of the 14 reconstructed patients underwent implantation of an artificial urinary sphincter (AUS) for sphincter weakness incontinence, in seven of whom this was successful. Two of these had previously undergone implantation of an AUS with an unsatisfactory outcome and were made continent by bladder neck reconstruction. The other six patients had acceptable urinary incontinence by reconstruction of the bladder neck and urethra alone. The primary injury is to the prostate and prostatic urethra. The bladder neck and subprostatic urethra are involved secondarily by extension. These injuries have a particular cause and a particular location with a predictable outcome. They need to be identified and treated promptly as they do not heal spontaneously and otherwise cause considerable morbidity. We also describe two particular types of bladder neck injury that we have not seen described before in adults.

Effects of a depositional flood event on the hyporheos of a New Zealand stream

Abstract: We investigated the effects of a rare depositional fl ood (return period about 5 years) on the hyporheos of a fl ood-prone river in southern New Zealand. The fl ood deposited 15–40 cm of new sediment across most of the 42-m study site. On four occasions after the fl ood (4 d, 17 d, 35 d, 49 d), pump samples (1 L volume) were col-lected for physicochemical and invertebrate analysis from three depths in the sediment (10, 30, 50 cm). The study site was dominated by downwelling water, therefore, temporal variations in interstitial physicochemistry probably refl ected surface water conditions. Composition of the hyporheos immediately after the fl ood differed from that on subsequent occasions. Densities of most invertebrate taxa were similar across sampling occasions. Nevertheless, the depth distributions of leptophlebiid nymphs (Ephemeroptera), Podonominae larvae (Chironomidae) and the water mite Planaturus setipalpis all changed with time, consistent with post-fl ood recolonisation of recently depos-ited sediments from underlying undisturbed sediments. Invertebrate distributions were not signifi cantly related to measured physicochemical parameters, possibly because any such relationships were obscured by recolonisation patterns. Our results indicate that buried sediments may be an important source of colonists of surface sediments for some epigean (surface-dwelling) taxa during recovery from disturbance associated with sediment deposition.

The neural architecture of discourse compression

Re-telling a story is thought to produce a progressive refinement in the mental representation of the discourse. A neuroanatomical substrate for this compression effect, however, has yet to be identified. We used a discourse re-listening task and functional magnetic resonance imaging (fMRI) to identify brain regions responsive to repeated discourse in twenty healthy volunteers. We found a striking difference in the pattern of activation associated with the first and subsequent presentations of the same story relative to rest. The first presentation was associated with a highly significant increase in blood oxygen level dependent (BOLD) signal in a bilateral perisylvian distribution, including auditory cortex. Listening to the same story on subsequent occasions revealed a wider network with activation extending into frontal, parietal, and subcortical structures. When the first and final presentations of the same story were directly compared, significant increments in activation were found in the middle frontal gyrus bilaterally, and the right inferior parietal lobule, suggesting that the spread of activation with re-listening reflected an active neural process over and above that required for comprehension of the text. Within the right inferior parietal region the change in BOLD signal was highly correlated with a behavioural index of discourse compression based in re-telling, providing converging evidence for the role of the right inferior parietal region in the representation of discourse. Our findings demonstrate, for the first time, the existence of a neural network underlying discourse compression, showing that parts of this network are common to re-telling and re-listening effects.

“WHAT SAY YOU TO [THIS] BOOK? […] IS IT YOURS?”: ORAL AND COLLABORATIVE NARRATIVE TRAJECTORIES IN THE MEDIATED WRITINGS OF ANNA TRAPNEL

This article argues that, when a printed page is initially orally generated and then transcribed, either at the time or on a subsequent occasion by a listener or an interlocutor, there are important critical implications for the “I” of the account. It takes as a case study Anna Trapnel's first published works. Appearing within a few weeks of each other in 1654, The Cry of a Stone and Strange and Wonderful News are both mediated texts, large parts of which depend on the agency of a relater. The article begins by examining the textual traces of the relater, arguing for the centrality of his role and other agencies in the shaping of the works which bear Trapnel's name. Situating itself in relation to a current orientation in feminist autobiographical theory that places emphasis on the external requirement to narrate one's life, rather than on the spontaneous production of autobiography by an inner self, the article emphasizes notions of coaxing, witnessing and intersubjectivity to point up an appreciation of women's life writing as a species of cultural production in which various historical actors—male and female—participate. This dialogic process, which persists into the afterlife of transcription, owes part of its genesis to the political vagaries of 1654 and precipitates two contrasting—but equally “authentic”—versions of Trapnel's life and self. Mapping this movement, discussion concentrates on the ways in which a critical confrontation with women's oral narrative is as much an activity of disentangling as it is of reconstructing, an activity which is revealing of the extent to which a spectrum of social and cultural networks participates in and facilitates the female writing act.

Black Rhinoceros (Diceros bicornis) Calf Succumbs After Lion Predation Attempt: Implications for Conservation Management

Actual observations of black rhinoceros predation are rarely reported and are limited to two incidences involving subadults. Nevertheless, some authors attribute tail and ear deformities in up to 7.1% of some populations to predation attempts. In August 2008 we observed a mother with dependent c. 8-month-old female black rhinoceros calf in Hluhluwe-iMfolozi Park, South Africa. The calf had a recently amputated tail, wounds to the anogenital region, right posterior flank and right side of the neck resembling a lion attack. Thirteen days later and on three subsequent occasions, the mother was sighted alone, suggesting that the calf had succumbed to its injuries. This incident provides evidence to suggest a link between attempted lion predation and tail amputation in black rhinoceros. Significantly, it implies that amputated tails and ears throughout Africa may represent failed depredation attempts and that calf predation may be more prevalent than previously appreciated. Predation is seldom considered in the management of black rhinoceros but should be when attributing cause to poor population performance of this critically endangered species.

Buried Glandular Mucosa After Radiofrequency Ablation of Dysplasia in Barrett's Esophagus

Background: Radiofrequency ablation (RFA) is an accepted modality for endoscopic treatment of dysplastic Barrett's esophagus. Neosquamous mucosal ingrowth overlying persistent intestinal metaplasia, known as buried glandular mucosa, or “buried Barrett's,” has been observed after other endoscopic ablative techniques. However, there have been no reports of this finding in surveillance biopsies after RFA. Methods: We identified all patients treated at our center for Barrett's esophagus using the HALO ablation system. Patients were excluded if they had been treated with other ablation modalities, or if no follow-up biopsies were available. Seattle protocol biopsies were obtained of the length of treated esophagus between 6 and 12 weeks after the most recent RFA. Biopsies were interpreted by expert pathologists at our institution. Buried glandular mucosa was defined as specialized columnar epithelium beneath a layer of squamous epithelium with no communication with the surface. Follow-up was defined as the time from first RFA treatment to most recent biopsy. All patients were treated with twice daily PPI for at least 6 weeks after RFA. Results: A total of 41 patients were identified and 27 were included in the study. Fourteen patients were excluded due to a history of treatment with other ablation modalities (8) and lack of follow-up pathology (6). The median age was 61 years (interquartile range (IQR); 55, 74) and 70% were male. The median Barrett's segment length was 2 cm (IQR 0.5, 6). The cohort included 3 patients with non-dysplastic Barrett's, 5 with low-grade dysplasia (LGD), and 19 with high-grade dysplasia (HGD), 6 of whom also had intramucosal adenocarcinoma. Thirteen of these had undergone EMR prior to RFA. Three underwent circumferential ablation only, 18 underwent focal ablation only, and 6 underwent step-wise circumferential and focal RFA. The median number of treatment sessions was 2 (IQR 1, 2) and median follow-up was 6 months (IQR 5, 11). Buried glandular mucosa was reported in 4 patients (14.8%); 3 of these patients initially had HGD and one had LGD. RFA was repeated in all 4 patients. In one, buried glandular mucosa was not observed on Seattle protocol biopsies on three subsequent occasions. In the others, repeat surveillance biopsies have not yet been obtained. Conclusions: Buried glandular mucosa can be seen in surveillance biopsies after treatment with RFA for dysplastic Barrett's esophagus. As RFA is well tolerated, patients with this finding can be retreated. The clinical importance of this entity remains to be determined and further follow-up will be necessary to determine clearance rates of these changes.