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Background: Recruitment into psychiatry is correlated with the quality of undergraduate medical school teaching programmes and with a commitment of major resources to teaching students. There is an extensive literature related to attitudes towards psychiatry but less on the learning and teaching of psychiatry., Aims: To identify the current issues in undergraduate psychiatric education in the UK for lead teachers at UK medical schools., Method: Semi-structured telephone interviews with psychiatric leads at UK medical schools. A total of 26 participants were interviewed from 23 different medical schools., Results: Three key areas of problems were identified: issues related to teaching personnel (e.g. conflict of time), teaching resources and impact of teaching on recruitment (e.g. role models; stigma). Eight potential solutions to address the problems were identified and these included improving the quality of teaching, improving the perceived value of the discipline and recruiting teachers., Conclusion: There are several problems facing teachers in psychiatry but the teachers are also able to identify solutions which need support from both education and health if they are to be implemented.

Lichen scrofulosorum is a tuberculid that is usually seen in children or young adults. Although a rare occurrence, this tuberculid is an important marker of occult tuberculosis, which may not be detected otherwise. We report here a case of lichen scrofulosorum in a ten year-old boy with typical grouped lichenoid papules on the trunk associated with axillary tuberculous lymphadenitis.

Background: Current policy states that 'service users and carers should be involved in planning, providing and evaluating training for all health care professionals. We wished to explore service users' views regarding undergraduate psychiatry., Aims: We aimed to explore user perspectives on the specific role of service users in the delivery of teaching psychiatry., Method: The study design was qualitative and used focus groups. The study took place in a community context with one focus group in Leeds, Leicester, Lincoln and Nottingham. Four focus groups were run with a total of 28 participants (16 women and 12 men, all white). No exclusion criteria were applied. The lead of each group were contacted and they then recruited volunteers from their membership., Results: The key findings were that participants felt that service users could play important roles in contextualising the part mental health plays in people's lives; dispel myths and fantasies about mental health; offer positive aspects of mental health to counterbalance the media; illustrate diversity within mental health and hope and recovery. Participants also identified the potential challenges to their participation including vulnerabilities especially at critical points in people's illnesses; perceived credibility - lack of support from some involved in academic roles; lack of appropriate training and support and issues of power and lack of genuine partnership in the planning and delivery of teaching. They were favourable about the development of guidelines as long as they involved a range of perspectives., Conclusions: Service users present a range of ways in which they could be involved to enhance the educational experience of medical students in psychiatry.

Background: Despite being recognized by the World Health Organization as a significant social and health concern, information on suicidal behaviours in Nigerian adolescents is unknown., Aims: To establish the prevalence and associated psychosocial correlates of suicidal ideation and attempts in Nigerian youth., Methods: Stratified sampling was used to identify youth aged 10-17 years who completed the Nigeria version of the Global School Health Questionnaire (GSHQ) and the Diagnostic Predictive Scale (DPS) for youths (suicidal behaviour questions) in a classroom setting., Results: A total of 1429 youth completed the instruments. Over 20% reported suicidal ideation and approximately 12% reported that they had attempted suicide in the last year. Adolescents living in urban areas, from polygamous or disrupted families, had higher rates of suicidal behaviour. Multiple psychosocial factors such as sexual abuse, physical attack and involvement in physical fights were significant predictors of suicidal behaviour., Conclusion: Factors associated with suicidal ideation and behaviours are similar to those found in other studies but the rates of both suicidal ideation and attempts are towards the upper limit of rates for youth. This study suggests that there is an urgent need for Nigerian policymakers and health providers to review and address this issue.

The aim of this study was to explore what professionals working in a child and adolescent mental health service (CAMHS) thought of provision of mental health services to diverse groups and what their training needs might be. Semi-structured interviews were undertaken and audiotaped with 17 CAMHS professionals. The tapes were transcribed and the data analysed using thematic analysis. The findings show no discernible pattern between different professional groups within the sample, although this is limited by the sample size and is perhaps not surprising given the common professional context. Just over half the participants perceived cultural diversity as equating with ethnic diversity. Staff thought diversity influenced service provision through access; communication; perceptions that different communities hold about mental health; perceptions that different communities hold about mental health services; and service factors. Staff were not clear about their own training needs and identified that training to date had not been entirely satisfactory. Staff openness may present an ideal opportunity to start dialogues with staff and community groups about how best services can be provided for an increasing diverse population of children and families.

There is no organised training and service for CAMH in Nigeria. A 3-day course in child mental health aimed at multidisciplinary health professionals was developed and evaluated to inform future training. Developing the course involved multi-professional consultation. Course evaluation involved the completion of questionnaires by delegates (present from 5 of the 6 geopolitical zones of Nigeria) before and after the training. Training needs expressed include skills to manage CAMH problems in their own context, greater understanding of normal child development and strategies to train others. Most participants reported that their expectations were met and would affect their practice especially with regard to collaboration.

Infection with Leishmania major triggers several pathways in the host cell that are crucial to initial infection as well as those that are used by Leishmania to enhance its replication and virulence. To identify the molecular events of the host cell in response to Leishmania, the global gene expression of the human monocytic cell line THP-1 either infected with Leishmania major in the presence and absence of gamma interferon (IFN-gamma) or in the presence of IFN-gamma alone was analyzed using high-density human oligonucleotide microarrays, followed by statistical analysis. The persistence of the parasite despite an extensive response to IFN-gamma, added 24 h after infection with L. major, suggests that L. major can survive in an IFN-gamma-enriched environment in vitro. Results demonstrate that L. major counteracts the IFN-gamma response in macrophages on a large scale. Expression of genes involved in the innate immune response, cell adhesion, proteasomal degradation, Toll-like receptor expression, a variety of signaling molecules, and matrix metalloproteinases was significantly modulated.

The aim of this study was to explore Gujarati parents' and adolescents' perceptions of child and adolescent mental health services and how these should be improved to best meet their needs. Semi-structured qualitative interviews were carried out with 15 parents and 15 young people, recruited from a community centre. Overall, the quality of the service appeared more important than its responsiveness to culture or ethnicity for both young people and their parents. These findings indicate the need for further evidence and debate on whether Black and ethnic minority families should be treated as though they are a homogenous group.

Background: There is considerable ambiguity in the subjective dimensions that comprise much of the relational dynamic of the clinical encounter. Comfort with this ambiguity, and recognition of the potential uncertainty of particular domains of medicine (e.g.--cultural factors of illness expression, value bias in diagnoses, etc) is an important facet of medical education. This paper begins by defining ambiguity and uncertainty as relevant to clinical practice. Studies have shown differing patterns of students' tolerance for ambiguity and uncertainty that appear to reflect extant attitudinal predispositions toward technology, objectivity, culture, value- and theory-ladeness, and the need for self-examination. This paper reports on those findings specifically related to the theme of uncertainty as relevant to teaching about cultural diversity. Its focus is to identify how and where the theme of certainty arose in the teaching and learning of cultural diversity, what were the attitudes toward this theme and topic, and how these attitudes and responses reflect and inform this area of medical pedagogy., Methods: A semi-structured interview was undertaken with 61 stakeholders (including policymakers, diversity teachers, students and users). The data were analysed and themes identified., Results: There were diverse views about what the term cultural diversity means and what should constitute the cultural diversity curriculum. There was a need to provide certainty in teaching cultural diversity with diversity teachers feeling under considerable pressure to provide information. Students discomfort with uncertainty was felt to drive cultural diversity teaching towards factual emphasis rather than reflection or taking a patient centred approach., Conclusion: Students and faculty may feel that cultural diversity teaching is more about how to avoid professional, medico-legal pitfalls, rather than improving the patient experience or the patient-physician relationship. There may be pressure to imbue cultural diversity issues with levels of objectivity and certainty representative of other aspects of the medical curriculum (e.g.--biochemistry). This may reflect a particular selection bias for students with a technocentric orientation. Inadvertently, medical education may enhance this bias through training effects, and accommodate disregard for subjectivity, over-reliance upon technology and thereby foster incorrect assumptions of objective certainty. We opine that it is important to teach students that technology cannot guarantee certainty, and that dealing with subjectivity, diversity, ambiguity and uncertainty is inseparable from the personal dimension of medicine as moral enterprise. Uncertainty is inherent in cultural diversity so this part of the curriculum provides an opportunity to address the issue as it relates to patient care.

Background: The General Medical Council set out the framework within which it expects medical education to develop. Educational guidelines have been developed across the world but their development is less clear in the UK. There has been little work regarding views about educational guidelines., Aim: The research objective was to establish the views of medical education stakeholders towards specific guidelines for teaching in cultural diversity to medical students., Methods: Sixty-one individuals were interviewed using a semi-structured interview. Thematic analysis was undertaken after the interviews were transcribed verbatim., Results: In total, 51 respondents felt that guidelines would be useful; 17 of these explicitly stipulated that these would only be useful if they were not prescriptive and if they were applied flexibly and were practical. Four respondents, including two policy-makers holding senior positions with medical educational bodies, felt that new guidelines would not be useful, as they already existed in some form. Five respondents were unsure if guidelines would be helpful or not., Conclusions: Guidelines were considered to be potentially useful for several reasons including to: help clarify what should be taught regarding cultural diversity and how it should be taught, provide justification for teaching the subject, help those unfamiliar with the subject, support those assigned with responsibility for developing such teaching, provide course and curriculum designers with reassurance, increase the credibility of the subject, set standards that serve as a benchmark against which schools can compare themselves with one another and highlight good practice. The reservations expressed suggest that the guidelines need to be developed using a range of stakeholders and have some degree of consensus to ensure that they will be used. The literature relating to attitudes towards clinical practice guidelines has much to contribute to the development of educational guidelines.

Leishmania are protozoan parasites that cause a wide spectrum of clinical diseases in humans and are a major public health risk in several countries. Leishmania life cycle consists of an extracellular flagellated promastigote stage within the midgut of a sandfly vector, and a morphological distinct intracellular amastigote stage within macrophages of a mammalian host. This study reports the use of DNA oligonucleotide genome microarrays representing 8160 genes to analyze the mRNA expression profiles of L. major promastigotes and lesion derived amastigotes. Over 94% of the genes were expressed in both life stages. Advanced statistical analysis identified a surprisingly low degree of differential mRNA expression: 1.4% of the total genes in amastigotes and 1.5% in promastigotes. These microarray results demonstrate that the L. major genome is essentially constitutively expressed in both life stages and suggest that Leishmania is constitutively adapted for survival and replication in either the sandfly vector or macrophage host utilizing an appropriate set of genes for each vastly different environment. Quantitative proteomics, using the isotope coded affinity tag (ICAT) technology and mass spectrometry, was used to identify L. infantum promastigote and axenic amastigote differentially expressed proteins. Of the 91 distinct proteins identified, 8% were differentially expressed in the amastigote stage, 20% were differentially expressed in the promastigote stage, and the remaining 72% were considered constitutively expressed. The differential expression was validated by the identification of previously reported stage specific proteins and identified several amastigote and promastigote novel stage specific proteins.

In this article, the authors present one of the key ethical features of research: confidentiality as maintained by nondis-closure of participants' identities. In light of (a) the contingency that certain participants might vest interest in research studies through their identity and (b) the concept of respect for participants' autonomy, the authors consider the possibilities of offering research participants the choice of nonconfidentiality, afforded as an autonomous (negative) right of refusal of nondisclosure of identity. They address the issue that this possibility generates within the context(s) of current codes of ethics related to health research and the manifest responsibilities of the institutional review process. In this way, they attempt to elucidate potential benefits and consequences that arise from confidentiality and nonconfidentiality.

We are supportive of the desire to ensure that CAMHS staff provide appropriate care that is tailor made for each child and family they encounter, and would argue that this is a benchmark for quality. It is important to qualify that this is not just a case of giving the consumer what they want, but rather helping families think about the issues they present with, and then arriving collaboratively at a management plan that is coherent to all parties. However, we would be more cautious about what can be achieved through individual strategies such as cultural competence or diversity training, that are not linked to other strategies. There is a need to reflect on what we are doing rather than responding in a knee jerk fashion. We also need to consider the evidence we use to frame our interventions. Sometimes there is no evidence available and action is needed. In these situations we need to be transparent about our approaches and be prepared to change them in light of emerging evidence. Delivering appropriate services to diverse populations is so much more than having a checklist and sending the workforce to be superficially trained. Before we embark on training, we should ask what we anticipate the training to achieve. This has to be set within an educational rather than political -framework, if educational objectives are to be met. It is also inexcusable to fund or support any kind of intervention without building in evaluation processes. Finally, we need to find out what kind of training improves the patient experience and health care outcomes. Unless we take all these factors into account, paying attention to diverse populations may end up being nothing more than a passing fad.

Context: Personal attitudes of doctors towards cultural diversity may influence the delivery of clinical care. Yet whether medical schools should assess a student's cultural awareness and if so, how, has not been specifically debated., Objective: To establish the views of key stakeholders in medical education on the assessment of awareness of cultural diversity within the undergraduate curriculum., Methods: Semi-structured interviews were undertaken, using sampling and snowballing, with 61 stakeholders, including policymakers, teachers of diversity, students, service users and carers. The data were analysed qualitatively using quasi-statistical and template approaches and themes identified., Results: Three main themes emerged. The first was ambivalence over the need to assess students. Most felt students should be assessed to ensure the subject was taken seriously. Some were concerned that assessment might encourage false attitudes. The second theme was uncertainty over the best methodology. Objective structured clinical examinations (OSCEs) were the most favoured method. Significant concern was expressed that this alone was sufficient. The third theme was concern that current assessment methods do not identify students with inappropriate attitudes that are potentially detrimental to patient care., Conclusions: Assessment of cultural awareness should be attempted but it needs to be multifaceted. The OSCE alone is inadequate. Other tools, such as reflective portfolios, need evaluation.

Background: Cultural diversity teaching is increasingly present in both undergraduate and postgraduate training programmes. This study explored the views of stakeholders in medical education about the potential outcomes of cultural diversity teaching and how they thought cultural diversity programmes might be effectively evaluated., Methods: A semi-structured interview was undertaken with 61 stakeholders (including policymakers, diversity teachers, students and users). The data were analysed and themes identified., Results: Many participants felt that clinical practice was improved through 'cultural diversity teaching' and this was mostly as a result of improved doctor-patient communication. There was a strong view that service users need to participate in the evaluation of outcomes of cultural diversity teaching., Conclusion: There is a general perception, rather than clear evidence, that cultural diversity teaching can have a positive effect on clinical practice. Cultural diversity teaching needs to be reviewed in undergraduate and postgraduate medicine and better evaluation tools need to be established.

Purpose of Review: The purpose of this paper is to review the literature reporting on children and young people's views on child and adolescent mental health services., Recent Findings: The review demonstrates that there is limited research exploring the views of children and young people regarding mental health services. Despite its limitations, the research available shows that young people, their parents and healthcare providers often have different expectations of services. Young people want accessible services staffed by those they are able to trust and who demonstrate an ability to listen; above all, young people want to be involved in the decisions made about them., Summary: To date, children and young people have not been actively engaged or involved in service development. This is an evolving field and we need to ensure that existing evidence is taken into account as well as investigating further the views of young people. Child and adolescent mental health services need to consider how we serve young people, particularly children, whose perspectives may differ from those of their parents.

This paper presents a rationale for the education of CAMHS staff and service development as a partnership between the UK and developing countries. The local context and background of child and adolescent mental health services in India are described, and the rationale for the teaching principles is outlined. The planning and delivery of the teaching, following these principles, is illustrated through a case study of work in India. The discussion focuses on what worked well, problems and difficulties faced, how these were managed, and how visitors can influence change whilst respecting the local perspective. Suggestions are made for improving future programmes so as to maximise the outcomes of such links.

The views that students hold about cultural diversity and its teaching have been investigated to a limited extent in the UK and North America. The objective of this study was to establish whether there is a difference in attitudes between UK and US medical students with regard to this issue. A questionnaire survey was carried out on 191 year one medical students at the University of Illinois (Chicago and Urbana campuses) and University of Leicester. Differences of attitudes between students from the two countries and also between the same ethnic groups across the two countries were compared. There were statistically significant differences between UK and US students in each of the key areas of the balance between different cultures, attitudes of doctors and their practice relating to cultural diversity, culture and its associations with race/skin colour, perspectives on specific cultures and attitudes towards diversity teaching. There were some similarities in how students define culture but differences in how they understand multiculturalism. These findings suggest that programmes need to be tailored to particular circumstances, and that complex models of diversity need to be utilized in order for students to engage with them in a substantive way.

Ophiostoma piceae is a sap-staining fungus that colonizes and discolours wood. It has been established that the mycelium form but not the yeast form becomes pigmented in vitro. Suppressive subtractive hybridization PCR was used to isolate transcripts specifically upregulated in either the yeast or mycelial forms of O. piceae. Subtracted cDNAs were cloned and transformed into Escherichia coli. The yeast and mycelium specific clones were then screened by differential screening to reduce the possibility of isolating false positive clones and the differential expression of the two sets of cDNAs was confirmed by reverse Northern hybridization. Numerous genes appear to be specifically expressed in either the yeast or mycelial forms. Sequence analysis identified several cDNAs similar to known genes. However, a few cDNAs showed no similarity to sequences in the public databases.

Two sisters, aged 2 and 3 years, having generalized cutis laxa, presenting with progressive loose pendulous skin since birth are reported.

Introduction: Students entering medical school today will encounter an ageing population and a higher incidence of diseases affecting the elderly-for example, chronic respiratory and cardiac disease and malignancy., Purpose: This study was carried out to determine the attitudes of preclinical medical students towards the care of patients for whom a cure is not possible., Methods: All students were invited to complete a 23 item questionnaire prior to initial teaching and again following the second teaching session in palliative care., Results: Overall, 149 of the 186 students (80%) completed the pre-teaching questionnaire (59 males and 90 females; median age 20 years, range 19-27 years), and 66 students (35%) completed the post-teaching questionnaire. Attitudes towards chronically ill and dying patients were generally positive. It was found that increasing age was associated with a more positive view of caring for patients with chronic or terminal illness, a more positive view of listening to patients reminisce, and a more positive view of patients dying at home (p = 0.014). The only notable result was that after palliative care teaching students had a significantly more positive view of hospices., Conclusion: Caring for patients at the end of life can be one of the most rewarding aspects of being a doctor. This study suggests that the majority of medical students have a positive attitude towards patients with chronic incurable illness, and the trend for encouraging older students to enter medicine may be an influencing factor.

Students entering medical school today will encounter an ageing population and a higher incidence of patients with terminal and life threatening illness. This study was carried out to determine the attitudes of pre-clinical medical students towards the care of patients for whom a cure is not possible. All students were invited to complete a 23-item questionnaire prior to any teaching in palliative care. Of the 186 students who participated in the study, 151 (79%) completed the pre-teaching questionnaire (males=59; females 90; median age 20 years; range 19-27]. Attitudes towards chronically ill and dying patients were generally positive. When comparing age with attitudes it was found that increasing age was associated with a more positive view of caring for patients with chronic or terminal illness, a more positive view of listening to patients reminisce and a more positive view of patients dying at home. Caring for patients at the end of life can be one of the most rewarding aspects of being a doctor. This study suggests that the majority of medical students have a positive attitude towards patients with chronic and terminal illness-the trend for encouraging older students to enter medicine may be an influencing factor.

Purpose: To investigate whether medical students conceptualize culture and cultural diversity best within "categorical" or "cultural sensibility" teaching models., Method: In spring 2002, first-year medical students at the University of Illinois Colleges of Medicine at Chicago and Urbana-Champaign completed a previously developed questionnaire. A self-selected subset participated in focus groups. The questionnaire collected data on attitudes toward race, culture, and diversity education and how these concepts relate to medical practice; responses to a case scenario; attitudes toward cultural tolerance; definitions of key terms and sense of cultural belonging; and feedback on the questionnaire. The focus groups discussed the two models for teaching diversity., Results: Questionnaires were returned by 111 of 153 students (72.5%). Generally, the students displayed open attitudes about the balance between cultures of origin and the culture of the wider community in which immigrants may live. However, with very personal issues there was a tendency to stay with the familiar. These students had an impression of ethnic groups as very discrete and well defined. Skin color and issues of race remained a significant barrier to dialogue regarding diversity. Students were overwhelmingly in favor of the cultural sensibility teaching model that emphasizes the fluidity and malleability of culture., Conclusions: The students in this study were not familiar with key terms on culture and race, and struggled with the issues that diversity raises in medical practice. Although students held open attitudes toward equal opportunities and multiculturalism, differences among and within groups indicated that all students would benefit from a curriculum that emphasizes self-reflection and diversity teaching.

This paper describes consultation provided by the University of Leicester to the Medical University of Southern Africa (Medunsa) funded through British Council and the Department for International Development to develop a course addressing issues of diversity at Medunsa. The aims of the link were essentially for Leicester to provide support and guidance on the development of aspecific module. This inevitably included the provision of training in key areas such as teaching skills and evaluation of teaching. This paper focuses on the potential difficulties of such a link, which included cultural differences, issues of hierarchy and student influence. The project outcomes have been the development of a coherent module on human diversity which is assessed in such a way as to support the development of student writing skills, increased staff teaching skills and a joint conference to disseminate the learning that has taken place from the project.

All medical schools in the U.K. now include teaching in palliative care in the undergraduate curriculum, and this is mirrored in Europe and the U.S.A. In South Africa, however, palliative care education and provision are not widely available. An increasing number of medical and nursing staff are invited to teach palliative care in other countries. Such teaching should, however, take into account the cultural attitudes the students have towards the care of patients with a chronic or terminal illness. Nineteen statements on attitudes were constructed, and medical students in Leicester, U.K., and in Medunsa, South Africa, were invited to respond to them using a 10-point Likert scale. The questionnaire was distributed before either cohort of students had received any teaching in this area. Students in South Africa were significantly more likely to want to work in a speciality where most patients were likely to be cured (p < 0.001) and significantly less likely to believe that caring for dying patients could be rewarding (p < 0.001). South African medical students had significantly fewer positive attitudes than had their U.K. counterparts toward patients being informed of a terminal prognosis (p < 0.001). This study indicates that cultural differences between medical students may have an effect on the teaching of care for patients with life-limiting illness. This has relevance for curriculum delivery, especially when professionals are invited to teach or develop material on palliative care for other countries.

The effects of cAMP-elevating agents, N6-2'-O-dibutyryl cAMP (Bu2cAMP), and glucocorticoid (dexamethasone) on the production of inflammatory mediators--nitric oxide and interleukin-12 (IL-12) and anti-inflammatory mediator interleukin-10 (IL-10) were demonstrated in murine peritoneal macrophages. Inducible nitric oxide synthase (iNOS) and iNOS mRNA were detected by northern blot and western blot, respectively. The cAMP elevating agents Bu2cAMP and prostaglandin E2 each alone did not show any effect on NO production but along with IFN-gamma and lipolysaccharide (LPS) they slightly enhanced NO production. Dexamethasone inhibited NO production in IFN-gamma- and LPS-treated cells; cAMP elevating agents interfered with the NO production inhibited by dexamethasone. Inhibition was revealed at the mRNA level as well as at protein level. Bu2cAMP or dexamethasone either alone or synergistically inhibited IL-12 production; Bu2cAMP interfered with dexamethasone-mediated inhibition of IL-10 production in IFN-gamma- and LPS-treated macrophages. The use of glucocorticoids along with cAMP elevating agents was beneficial in lowering the level of inflammatory mediator IL-12 and producing high levels of the anti-inflammatory mediator IL-10 active in cell protection. On the other hand, interference of Bu2cAMP with dexamethasone-mediated NO inhibition may have adverse effect. Therefore, adverse effects due to cAMP-mediated interference (inhibition) with NO synthesis may occur in many inflammatory diseases during combined drug therapy by glucocorticoids and cAMP elevating agents.

Unlabelled: This paper describes the design (of process and content), implementation and evaluation of a component of the Human Diversity Module developed to teach cultural diversity to undergraduate medical students. The objectives of the teaching were to enable students to gain factual and practical information about other cultures and also for them to examine their own attitudes., Method: Students completed a questionnaire, designed in a previous study, at two stages; the first before the component on cultural diversity had been delivered and the second after the sessions on cultural diversity. The time interval between stages 1 and 2 was 1 week. The cultural diversity component was developed using a range of sources., Results: Out of 181 students, 140 (77.3%) completed the questionnaire at both stages. There were a number of statistically significant findings, which indicate that the teaching enabled the session objectives to be successfully met. The findings include statistically significant changes that reflect more "positive" attitudes about cultures coming together and about specific cultures., Conclusion: The study indicates that attitudes changed over the period of teaching. There is, however, scope for further development of measures to enable attitudinal shifts to be evaluated.

A strain of Micrococcus sp. was isolated for its capability of side chain degradation of cholesterol. This strain was characterized and identified as Micrococcus roseus. It was found to be the best strain for the production of androsta-1,4-diene-3,17-dione and androst-4-ene-3,17-dione compared with other Micrococcus strains.

This study aimed to establish whether students had an awareness of the requirement to consider cultural issues in caring for patients and to identify those issues which are most difficult for students, in order to aid course development. Data was collected using previously developed questionnaires which were modified and added to for the study undertaken at the University of Leicester Medical School in February and June 1998. Thirty fourth year and 75 second year medical students completed the questionnaires. Students accepted that they as doctors have a responsibility to be aware of the different cultures within their practice. Their responses supported the introduction of sessions on cultural and racial awareness as part of the Human Diversity Module. The sessions have been designed to facilitate students to explore their own perception and understanding of culture in a challenging, relevant and enjoyable way. The questionnaire developed in this study will be used to compare student attitudes pre- and post-teaching sessions to assess any change.

Mycobacterium microti-infected mouse peritoneal macrophages produced high amounts of prostaglandin E2 (PGE2) and nitric oxide (NO) when activated with interferon-gamma (IFN-gamma). In order to understand the relation between PGE2 and NO production and the expression of interleukin-12 (IL-12), interleukin-10 (IL-10) and MHC class-II (Ia) molecules by M. microti-infected and IFN-gamma-stimulated macrophages, we analyzed the level of these molecules in the presence or absence of PGE2 and NO inhibitors. Addition of NG-methyl-L-arginine (L-NMA) and indomethacin (IM) caused a significant increase in IL-12 level (2.6- and 1.9-fold, respectively) whereas IL-10 level decreased by 88 and 56%, respectively, relative to M. microti-infected and IFN-gamma-treated control macrophages. Enhanced PGE2 and NO upregulated IL-10 expression and down-regulated IL-12 and MHC class-II (Ia) expression in M. microti-infected and IFN-gamma-treated mouse peritoneal macrophages.

Objectives: The aim of this study was to provide a description of the characteristics of children and adolescents presenting to the accident and emergency (A&E) department with deliberate self harm., Methods: Descriptive analysis of data collected by reviewing the notes of all children and adolescents aged 16 years and under, presenting during the period of study (1 January to 31 December) with a history of deliberate self harm., Results: A total of 100 children (18 boys, 82 girls) were responsible for 117 episodes of deliberate self harm. Nine repeaters were responsible for 22% of the attendances; 38% had made use of emergency ambulance service and 6% were referred by their general practitioner (GP). Sixty nine per cent were accompanied by immediate family and 21% children presented alone. Seventy four per cent presented within three hours of the attempt and 37% presented between 6 pm and midnight; 77% presented during weekdays and 30% of attempts had occurred during spring. Ninety two per cent had used a pharmaceutical drug. Sixty five per cent had made the attempt at home and 12% in a public place. Twenty five per cent had prior or current contact with the child psychiatric services and a similar proportion had prior or current contact with social services., Conclusions: Few of the children and adolescents presenting with deliberate self harm to the A&E department have been referred by their GP. They frequently present alone or are accompanied by people who are not family members making assessment and treatment difficult. Many already have other services involved in their care and thus the gathering and dissemination of information can become quite lengthy. The time of presentation is usually out of hours, further complicating this process. A small number of young people present with repeated self harm, who are known to be most vulnerable for completing suicide.

A comparative study was done using J774A.1 and J774A.1-derived transfected cells (J774A.1 C.1) containing antisense tumor necrosis factor alpha (TNF-alpha) plasmid to determine the role of endogenous TNF-alpha on nitric oxide production as well as on the growth of Mycobacterium microti in interferon gamma (IFN-gamma)- and lipopolysaccharide (LPS)-treated cells. On stimulation with IFN-gamma and LPS a higher level of NO was observed in J774A.1 cells compared to J774A.1 C.1 which indicated that endogenous TNF-alpha is required for the production of NO. Comparing the effect of IFN-gamma and LPS on the intracellular growth of M. microti, the growth-reducing activity was higher in J774A.1 cells than in J774A.1 C.1 cells and was not completely abrogated in the presence of the nitric oxide inhibitor NG-methyl-L-arginine (L-NMA). J774A.1 C.1 cells infected with M. microti produced a significant amount of NO when exogenous TNF-alpha was added along with IFN-gamma and LPS and the concentration of intracellular bacteria decreased almost to that in IFN-gamma and LPS treated parental J774A.1 cells. Addition of exogenous TNF-alpha even in the presence of L-NMA in J774A.1 C.1 cells could also partially restore intracellular growth inhibition of M. microti caused by IFN-gamma and LPS. TNF-alpha is probably required for the production of NO in J774A.1 cells by IFN-gamma and LPS but TNF-alpha and NO are independently involved in the killing of intracellular M. microti with IFN-gamma and LPS.

This paper begins with a brief review of child psychiatry teaching to undergraduate medical students.Teaching methods are also considered.The development of the current child psychiatry course at the University of Leicester is then described. This falls naturally into three stages from the beginning of the project to improve on the previous course. For clarity, the results are presented separately for each stage. The changes from one stage to the next and the rationale for these changes are presented in the overall discussion. The final section considers the present position and how we can further develop the clinical child psychiatry teaching programme.

The growth of Mycobacterium microti was inhibited within J774A.1 macrophage cells activated with either interferon-gamma or tumor necrosis factor-alpha. Activation with interferon-gamma or tumor necrosis factor-alpha alone did not stimulate the production of nitrite in J774A.1 cells. Interferon-gamma but not tumor necrosis factor-alpha increased the production of hydrogen peroxide in a concentration dependent manner but scavengers of reactive oxygen species did not influence the growth inhibiting effect of interferon-gamma within J774A.1 cells. Both interferon-gamma and tumor necrosis factor-alpha enhanced the fusion of M. microti containing phagosomes with lysosomes and the ultimate degradation of bacteria. Our results showed that growth inhibition of M. microti within interferon-gamma or tumor necrosis factor-alpha stimulated J774A.1 cells was independent of reactive oxygen intermediate and reactive nitrogen intermediate production.