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This case study considers a complex presentation of anxiety with associated depression, and describes a stepped approach to care and treatment, as advocated by the National Institute for Health and Clinical Excellence. The classification of mental disorders is referred to in the case study. Mixed anxiety and depression is a common presentation in primary care, characterised by a mix of anxiety and depressive symptoms without clear prominence of any one type and the presence of one or more physical symptoms that are present for more than six months. Anxiolytic medication is often used as a first aid measure in anxiety, and is very useful and appropriate for this. However, it is quite difficult to assess the longer-term effectiveness of these drugs, as anxiety tends to vary for reasons other than drug treatment, such as external pressures. There is good evidence to support the efficacy of psychological interventions in anxiety spectrum disorders. Consequently, self help and cognitive behaviour therapy may be the first line of treatment for less severe cases and can be used in conjunction with medication.

Health professionals in primary care may be the first to notice or hear of patients who are experiencing obsessive compulsive disorder. While care from specfic professionals is likely to be needed, Andy Youngexplains how practice nurses can direct the care for these patientsObsessive compulsive disorder (OCD) is a mental health condition in the which the quality of the sufferer's life is adversely affected by intrusive or inappropriate thoughts and actions. People with OCD have repetitive thoughts that cause anxiety symptoms. In order to control these thoughts and their associated unpleasant effects, the person develops behaviours they feel might prevent the thought from becoming reality. OCD is found in 1% of the UK population, affecting men and women equally. There is evidence to suggest that OCD runs in families and has some genetic basis, and it appears to be partly caused by alterations to the balance of serotonin and/or dopamine in the brain. OCD often develops in childhood or young adulthood, and the presence of obsessive and compulsive phenomena may require referral and treatment from Child and Adolescent Mental Health Services. ‘Pathological doubting’ and the inability to distinguish between the memory of real or imagined actions is a central feature of OCD, especially compulsions associated with the disorder. The primary care team have an opportunity to recognise OCD symptoms and intervene before the condition worsens and the patient requires hospitalisation.

Health professionals in primary care may be the first to notice or hear of patients who are experiencing obsessive compulsive disorder. While care from specfic professionals is likely to be needed, Andy Youngexplains how practice nurses can direct the care for these patientsObsessive compulsive disorder (OCD) is a mental health condition in the which the quality of the sufferer's life is adversely affected by intrusive or inappropriate thoughts and actions. People with OCD have repetitive thoughts that cause anxiety symptoms. In order to control these thoughts and their associated unpleasant effects, the person develops behaviours they feel might prevent the thought from becoming reality. OCD is found in 1% of the UK population, affecting men and women equally. There is evidence to suggest that OCD runs in families and has some genetic basis, and it appears to be partly caused by alterations to the balance of serotonin and/or dopamine in the brain. OCD often develops in childhood or young adulthood, and the presence of obsessive and compulsive phenomena may require referral and treatment from Child and Adolescent Mental Health Services. ‘Pathological doubting’ and the inability to distinguish between the memory of real or imagined actions is a central feature of OCD, especially compulsions associated with the disorder. The primary care team have an opportunity to recognise OCD symptoms and intervene before the condition worsens and the patient requires hospitalisation.

The article deals with the development of obsessive compulsive disorder (OCD) in women during pregnancy or after birth. According to a 2016 study, at least 2 in every 100 women were affected by perinatal OCD. The main parts of perinatal OCD are obsessions, anxiety and compulsions. The signs and symptoms of perinatal OCD are identified, including intense fear for germs, dirt, or poison and worrying too much about doing things.

In this article, Andy Youngdiscusses the complicated legal structure of medical consent for minors. When patients are minors, it is important for the health professional to be aware of what the law requires to treat and manage these patientsPrimary care is fundamentally about first-contact healthcare accessible to all. It is undifferentiated by age, gender or disease modality, and it is about the continuity of a clinical relationship over time, coordinated across sectors, and interventions that focus on both the individual and the wider population and community. Conveying relevant information about treatment and risk can be problematic, particularly in relation to minors, but it is nevertheless vital that health professionals promote autonomy in decision-making. This requires effective and sensitive communication, with consideration as to how information is framed and presented to patients and their families, as the communication process has a strong influence on how people understand, remember and evaluate information (Brown, 2006).

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 90Y 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.

Parts one and two of this series focused on the process and principles of violence risk assessments in forensic mental health practice. Building on these substantive issues, part three considers the difficult issue of sourcing information, putting the pieces of the risk jigsaw together and evaluating risk. It also considers confidentiality and disclosure, as they are important aspects of the clinical duty of care and are directly related to the risk assessment and the management process.

In the last 20 years, risk assessment has expanded to mean much more than a simple determination of how dangerous an individual is. Risk formulations now encapsulate the assessment process more generally, and provide the basis for the identification of treatment needs, the development of supervision and risk reduction plans. In the first part of this series, the fluid nature of violence risk was emphasized. Further to this, it was pointed out that violence risk often changes over time and is heavily dependent on context. Part 2 expands on some of these ideas by considering some basic principles of forensic risk assessment and identifying some key issues which touch on the risk assessment and management processes.

In the last 20 years, risk assessment has expanded to mean much more than a simple determination of how dangerous an individual is. In 2009, the concept extends well beyond establishing level of risk. Risk formulations now encapsulate the assessment process more generally, and provide the basis for the identification of treatment needs and the development of supervision and risk reduction plans. Recent legislation in the UK, for example, the Sex Offenders Act (1997), the Crime and Disorder Act (1998) and the Mental Health Act (2007) all emphasize the importance of effective community management of violence risk. Reviewing the recent growth in multi-agency approaches to meet this challenge, the authors consider how health, social care and criminal justice agencies can share information and collaborate effectively. This paper offers some practical guidance on improving techniques designed to minimize forensic risk.

Professionalism in the context of advanced nursing practice is a complex topic, and must include a consideration of both individual and collective nurses', societal and patient rights and obligations. While attempting to propose a definition to capture the many aspects of this issue, this article also examines conflict of interest between prescribers and the pharmaceutical industry, and the controversial subject of conscientious objection and opting out of the clinical encounter. These may be overlooked by advanced practitioners or dealt with on a systemic level by the nursing collective, but they also have a real and lasting impact at the level of the individual clinician. Conversely, while much of the attention in nurse professionalism is paid to the individual practitioner, there is also an important role to be played in policy development and national and international advocacy efforts by organizations such as the Association of Advanced Practice Educators (AAPE) and the International Council for Nurses (ICN).

This article presents comments on the statement by Gore Vidal regarding reading amongst the youth. James Nolan observed that style of young writers favor the unorthodox. Frank Wilson disagrees with Vidal's presumption that young people read less. Anis Shivani used the popularity of the Harry Potter books as part of her analysis of Vidal's statement.

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 luteuswere 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−3h−1. M. luteuswas 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.

From over forty independently isolated potato lines transformed with wild-type and promoter-mutated T-cyt genes [12], a number of lines were selected for examination of phenotypic changes in growth and development for plants grown in soil in a controlled environment. The three lines chosen for most detailed examination showed a wide spectrum of phenotypic changes. In comparisons with control potato cv. Désirée, the plants of one line had a two- to three-fold increase in biomass production during early vegetative growth, advanced senescence and a shortened plant life-span. Another line showed abnormal cellulytic senescence. In two lines there were increases in tuber numbers and more skewed tuber size distributions which correlated with reduced shoot apical dominance and shortened dormancy of the stored tubers. None of the lines showed altered timing of onset of tuberization or flowering, although tuberization was consistently delayed when expressed as a function of increasing total plant weight. A hypothesis is proposed to explain the diverse phenotypes which postulates that (1) T-cyt transformation causes enhanced sensitivity to cytokinins in specific types of shoot cells which are already targets for regulation by normal root-derived cytokinins; (2) two distinct types of shoot target cells are present, one in shoot meristems and one in leaves; (3) the two types can acquire enhanced sensitivity, either separately or in combination depending on the particular T-cyt transformation event. The scope for using the transformed plants in subsequent physiological, biochemical and molecular studies, aimed at examining the molecular basis of the model or selected consequences of T-cyt transformation in altering regulation of potato plant growth and development, is discussed. The attention is drawn to the possible involvement at the subcellular level of sucrose phosphate synthase in mediating the phenotypic effects caused by T-cyt transformation.

PH has been completely unable to recognise faces since sustaining a closed head injury some four years ago, but can recognise familiar people from their names. His performance on face processing tasks is, however, comparable to that of normal subjects if explicit recognition is not required. Thus he can make same/different identity judgements more quickly for familiar than unfamiliar face photographs, and faster matching of familiar faces is only found for identity matches involving the face's internal features. When making semantic categorisation decisions to printed names he shows interference from distractor faces belonging to an incorrect category, even when the faces in each category are matched on physical appearance. When learning to associate the occupation or the name with photographs of faces, his performance is better with true (face and person's actual name or occupation) than untrue (face and another person's name or occupation) pairings. Covert recognition can also be demonstrated for faces of people PH has only met since his accident. These findings show that in prosopagnosia, much of the processing of familiar faces can remain intact despite absence of awareness that recognition has occurred.

A commentary on Le Visage et l'Expression Faciale: Approche Neuropsychologique, by R. Bruyer. Bruxelles; Pierre Mardaga, 1983, 120Ff. ISBN 2-87009-175-3

Holding, D. H. The psychology of ches skill. Hillsdale, N. J.: Lawrence Erlbaum Associates. 1985. Pp. 271. ISBN 0-89859-575-4. £28.95.Brown, Fredick M. and Greaber, . Curtis (Eds.). Rhythmic aspects of behaviour. Hillsdale, N. J.: Lawence Erlbaum Associates. 1982. Pp. xvii + 483. ISBN 0-89859-168-6 £30.00.Harris, J. E. and Morris, P. E. (Eds.). Everyday memory, actins and absent-mindedness. London: Academic Press. 1984. Pp. 253. ISBN 0-12-32764-3. £27.50.Graesser, A. C. and Black, J. B. (Eds.). The psychology of questins. Hillsdale, N. J.: Lawrence Erlbaum associates. 1985. Pp. 383. ISBN 0-89859-444-8 $45.00, £36.00.Donchin, E. (Ed.). Congnitive psychophysiology : Event-related potentials and the study of cognition. Hillside, N. J.: Lawrence Erlbaum Associates. 1984. Pp. 428. ISBN 0-89859-150-3 £44.00.Oyama, S. The ontogeny of information : Development systems and evolution. Cambridge: Cambridge University Press. Pp. 206. Hardback : ISBN 0-521-32098-4. £22.50. Paperback: ISBN 0-521-31257-4. £8.95.Benser, D., Waller, T. G. and MacKinnon, G. E. (Eds.). Reading research: Advances in theory and practice, Vl. 5. Orlando, Fla.: Academic Press Inc. 1985. Pp. 356. ISBN 0-12-572305-9.Barr, A. and Feigenbaum, E. A. (Eds., Vols. 1 and 2). Cohen, P. R. and figenbaum, E. A. (Eds., Vol. 3). The handbook of atificial intelligence. Los Altos, Calif.: William Kaufmann, Inc. 1986. Paperback set: ISBN 0-86576-088-8. Pp. xiv + 409, xiii + 428, xviii+ 640. £69.00.Arnheim, R. New essays on the psychology of art. Berkeley: University of California Press, 1986. Pp. 331. ISBN 0-530-05553-5. £21.25.Ottoson, D. and Zeki, S. (Eds.). Central and perpheral mechanisms of colour vision. London: Macmillan. 1985. Pp. x +239. ISBN 0-333-39321-X. £60.00.Totman, R. Social and biological roles of language : The psychology of justification. London: Academic Press. 1985. Pp. 190. £39.50.Lynch, G., McGaugh, J. L. and Weinberger, N. M. (Eds.). Neurobiology of learining and memoryNew York: guilford. 1984. Pp. xiii + 528. ISBN 0-89862-645-5. £70.85.Weinberger, N. M., McGaugh, J. L. and Lynch, G. (Eds.). Memory systems of the brain. New York: Guilfrd. 1985. Pp. xiii + 514 ISBN 0-89862-666-8. £57.00.King, M. (Ed.). Parsing natural language. London: Academic Press. 1983. Pp. 308. ISBN 0-12-408280-7. $21.00.Cracco, R. Q. and Bodis-Wollner, I. (Eds.). Evoked potentials (Frontiers of clinical neuroscience, Vol, 3). New York: Alan R. Liss. 1986. Pp. xiv +551. ISBN 0-8451-4502-9. £98.05.Freeman, N. H. and Cox, M. V. Visual order : The nature and development of pictorial representation. Cambridge: Cambridge Unversity Press. 1985. Pp. 395. ISBN 0-521-26668-8. £27.50.Sndgrass, J. G., Levy-Berger, G. and Matin Haydon. Human experimental psychology. New York: Oxford University Press. 1985. Pp. 484. ISBN 0-19-503574-7. £30.00.Bradshaw, J. Basic experiments in neuropsychology. Amsterdam: Elsevier Science Publishers. 1986. Pp. 206. ISBN 0-444-80803-5. $42.25.Halpern, J. Y. (Ed.). Theoretical aspects of reasoning about knowledge: Proceedings of the 1986 Conference. Los Altos, CA: Morgan Kaufman. 1986. Pp. vii + 407. ISBN 0-934613-04-4. Paperback £ 18.95.Moore, B. C. J. (Ed.). Frequency selectivity in hearing. London: Academic Press. 1986. Pp. xv + 492. ISBN 0-12-505625-7. £49.50.Kandel, E. R. and Schwatz, J. H. (Eds.). Principles of neural science(Second Edition). New York: Elsevier. 1985. Pp. 979. ISBN 0-444-00944-2. £39.00.D. Frank Bensn and Eran Zaidel (Eds). The dual brain : Hemispheric specialization in humans. New York: Guilford Press. 1985. Pp. xviii +430. ISBN 0-89862-643-9. $49.95. £34.00.Posner, M. I. Chronometric explorations of mind: The third Paul M. Fitts lectures. Oxford: Oxford University Press. 1986. Pp. 271. ISBN 0-19-503999-8. £16.00.

An account of the author's experience is presented regarding hearing jazz music from a cymbalon.

The author describes a scale-based approach that would be more characteristic of jazz violinists to achieve chromaticity within standard hammered dulcimer tuning. The author presents two exercises to enhance one's playing on the dulcimer, including finding the G on the marked course on the right side of the treble bridge, and playing the G major scale adding a Bb and C#. He also explores three musical phrases that would be used to improvise over a G major chord and can be inverted, altered and spliced in any number of ways.

The author offers tips for dulcimer players on improving their skill to be able to join in a session in the U.S. He states his effort to make his music sound similar to fiddle, flute and box players when playing. He adds that learning ornamentation from other instruments create a challenge for players and increase their chances of being allowed to join in music sessions. Musicians are also advised to bring a recorder at a session and try to learn the tune they heard later at home.

Presents the poem "Lower Nine," by Andy Young. First Line: the moon a smudge above the wreckage; Last Line: the canal and its ships drift on.

Presents the poem "Nothing Cries Out," by Andy Young. First Line: not the blind-folded horse; Last Line: and kneels as if he is in prayer.

A new approach to regionalization of conceptual rainfall‐runoff models is presented on the basis of ensemble modeling and model averaging. It is argued that in principle, this approach represents an improvement on the established procedure of regressing parameter values against numeric catchment descriptors. Using daily data from 127 catchments in the United Kingdom, alternative schemes for defining prior and posterior likelihoods of candidate models are tested in terms of accuracy of ungauged catchment predictions. A probability distributed model structure is used, and alternative parameter sets are identified using data from each of a number of gauged catchments. Using the models of the 10 gauged catchments most similar to the ungauged catchment provides generally the best results and performs significantly better than the regression method, especially for predicting low flows. The ensemble of candidate models provides an indication of uncertainty in ungauged catchment predictions, although this is not a robust estimate of possible flow ranges, and frequently fails to encompass flow peaks. Options for developing the new method to resolve these problems are discussed.

Presents the poem "La Mezquita, Cordoba," by Andy Young.

The article reports that growth of cans has helped open up several beer occasions. It is said that outdoor informal occasions are increasing, driven by the popularity of craft beer and also mid-strength beer. An improvement in the quality of cans has let consumers to understand that canning is good for beer.