Older people and legal advice – the need for joined up and creative approaches

This paper reports the findings from research conducted with older people in Northern
Ireland which investigated whether their needs for legal information and advice were
being met. One of the unique aspects of the research involved investigating the
potential of the internet as a possible source for advising older people in relation to
legal problems. The findings suggest that online legal information may frequently assist
older people in identifying potential answers to their legal questions, but may not be an
adequate substitute for personal communication and advice. The research also
highlights the need for professionals to work together to meet the needs of older
persons for legal advice and to safeguard their interests. Such ‘joined up’ approaches
are particularly important, for example at the point of dementia diagnosis, where
information sharing between health and social care professionals may significantly
promote the legal and welfare interests of older people at a vulnerable point in their
lives. This paper therefore turns to work by university-based legal clinics in the United
States, such as the Elder Law Clinic at Pennsylvania State University, where social
work or healthcare professionals, lawyers and law students collaborate to support older
people in their search for resolution of legal problems.

Developing a social work curriculum on political conflict – Findings from an IASSW funded project

This paper presents the findings from an innovative project funded by the
International Association of Schools of Social Work (IASSW) and undertaken by
an international team of academics investigating the development of a global
curriculum for social work in the context of political conflict. Coupled alongside
the emerging research and literature on the subject, our small-scale survey
findings indicate support for the need for social work educators to address
political conflict more systematically within social work curricula at both
undergraduate and post-qualifying levels of social work education. The paper
illuminates the opportunities for creative pedagogy whilst also examining the
threats and challenges permeating the realisation of such initiatives. In this way,
the implementation of a proposed curriculum for political conflict is given meaning within the context of IASSW’s Global Standards for social work education. Given the exploratory nature of this project, the authors do conclude that further research is warranted in regard to potential curriculum development and suggest using a comparative case study approach with more in-depth qualitative methods as a way to address this.

Effect of simvastatin on physiological and biological outcomes in patients undergoing esophagectomy: a randomised placebo controlled trial

OBJECTIVE: To test whether simvastatin improves physiological and biological outcomes in patients undergoing esophagectomy.

BACKGROUND: One-lung ventilation during esophagectomy is associated with inflammation, alveolar epithelial and systemic endothelial injury, and the development of acute lung injury (ALI). Statins that modify many of the underlying processes are a potential therapy to prevent ALI.

METHODS: We conducted a randomized double-blind placebo-controlled trial in patients undergoing esophagectomy. Patients received simvastatin 80 mg or placebo enterally for 4 days preoperatively and 7 days postoperatively. The primary end point was pulmonary dead space (Vd/Vt) at 6 hours after esophagectomy or before extubation. Inflammation was assessed by plasma cytokines and intraoperative exhaled breath condensate pH; alveolar type 1 epithelial injury was assessed by plasma receptor for advanced glycation end products and systemic endothelial injury by the urine albumin-creatinine ratio.

RESULTS: Thirty-nine patients were randomized; 8 patients did not undergo surgery and were excluded. Fifteen patients received simvastatin and 16 received placebo. There was no difference in Vd/Vt or other physiological outcomes. Simvastatin resulted in a significant decrease in plasma MCP-1 on day 3 and reduced exhaled breath condensate acidification. Plasma receptor for advanced glycation end products was significantly lower in the simvastatin-treated group, as was the urine albumin-creatinine ratio on day 7 postsurgery. ALI developed in 4 patients in the placebo group and no patients in the simvastatin group although this difference was not statistically significant (P = 0.1).

CONCLUSIONS: In this proof of concept study, pretreatment with simvastatin in esophagectomy decreased biomarkers of inflammation as well as pulmonary epithelial and systemic endothelial injury.

Fragmentation of Neutral Amino Acids and Small Peptides by Intense, Femtosecond Laser Pulses

High power femtosecond laser pulses have unique properties that could lead to their application as ionization or activation sources in mass spectrometry. By concentrating many photons into pulse lengths approaching the timescales associated with atomic motion, very strong electric field strengths are generated, which can efficiently ionize and fragment molecules without the need for resonant absorption. However, the complex interaction between these pulses and biomolecular species is not well understood. To address this issue, we have studied the interaction of intense, femtosecond pulses with a number of amino acids and small peptides. Unlike previous studies, we have used neutral forms of these molecular targets, which allowed us to investigate dissociation of radical cations without the spectra being complicated by the action of mobile protons. We found fragmentation was dominated by fast, radical-initiated dissociation close to the charge site generated by the initial ionization or from subsequent ultrafast migration of this charge. Fragments with lower yields, which are useful for structural determinations, were also observed and attributed to radical migration caused by hydrogen atom transfer within the molecule.

How Do Trainees Rate the Impact of a Short Cognitive Behavioural Training Programme on their Knowledge and Skills?

Background: A strong evidence base for cognitive behavioural therapy has led to CBT models becoming available within mainstream mental health services. As the concept of stepped care develops, new less intensive mental health interventions such as guided self-help are emerging, delivered by staff not trained to the level of accredited Cognitive Behavioural Therapists. Aim: The aim of this study was to determine how mental health staff evaluated the usefulness of a short training programme in CBT concepts, models and techniques for routine clinical practice.
Method: A cohort of mental health staff (n = 102) completed pre- and posttraining self-report questionnaires measuring trainee perceptions of the impact of a short training programme on knowledge and skills. Mentors and managers were also asked to comment on perceived impact of the training.
Results: Trainees and mentors reported perceived gains in knowledge and skills posttraining and at 1-year follow-up. Managers and trainees reported perceived improvements in skills and practice. Conclusion: A short Cognitive Behavioural skills programme can enable mental health staff to integrate basic CB knowledge and skills into routine clinical practice.

A school based study of psychological disturbance in children following the Omagh bomb

Objective
To assess the extent and nature of psychiatric morbidity among children (aged 8 to 13 years) 15 months after a car bomb explosion in the town of Omagh, Northern Ireland.

Method
A survey was conducted of 1945 school children attending 13 schools in the Omagh district. Questionnaires included demographic details, measures of exposure, the Horowitz Impact of Events Scale, the Birleson Self-Rating Depression Scale, and the Spence Children’s Anxiety Scale.

Results
Children directly exposed to the bomb reported higher levels of probable PTSD (70%), and psychological distress than those not exposed. Direct exposure was more closely associated with an increase in PTSD symptoms than in general psychiatric distress. Significant predictors of increased IES scores included being male, witnessing people injured and reporting a perceived life threat but when co-morbid anxiety and depression are included as potential predictors anxiety remains the only significant predictor of PTSD scores.

Conclusions
School-based studies are a potentially valuable means of screening and assessing for PTSD in children after large-scale tragedies. Assessment should consider type of exposure, perceived life threat and other co-morbid anxiety as risk factors for PTSD.

The effects of the Omagh bomb on adolescent mental health: a school-based study

Background: The main objective of this study was to assess psychiatric morbidity among adolescentsfollowing the Omagh car bombing in Northern Ireland in 1998.

Methods: Data was collected within schools from adolescents aged between 14 and 18 years via a selfcompletionbooklet comprised of established predictors of PTSD; type of exposure, initialemotional response, long-term adverse physical problems, predictors derived from Ehlers andClark’s (2000) cognitive model, a PTSD symptoms measure (PDS) and the General HealthQuestionnaire (GHQ).

Results:Those with more direct physical exposure were significantly more likely to meet caseness onthe GHQ and the PDS. The combined pre and peri trauma risk factors highlighted in previousmeta-analyses accounted for 20% of the variance in PDS scores but the amount of varianceaccounted for increased to 56% when the variables highlighted in Ehlers and Clark’scognitive model for PTSD were added.

Conclusions: High rates of chronic PTSD were observed in adolescents exposed to the bombing. Whilstincreased exposure was associated with increased psychiatric morbidity, the best predictors ofPTSD were specific aspects of the trauma (‘seeing someone you think is dying’), what youare thinking during the event (‘think you are going to die’) and the cognitive mechanismsemployed after the trauma. As these variables are in principle amenable to treatment theresults have implications for teams planning treatment interventions after future traumas.

Comprehensive Investigation of the Caveolin 2 Gene: Resequencing and Association for Kidney Transplant Outcomes

Caveolae are plasma membrane structures formed from a complex of the proteins caveolin-1 and caveolin-2. Caveolae interact with pro-inflammatory cytokines and are dysregulated in fibrotic disease. Although caveolae are present infrequently in healthy kidneys, they are abundant during kidney injury. An association has been identified between a CAV1 gene variant and long term kidney transplant survival. Chronic, gradual decline in transplant function is a persistent problem in kidney transplantation. The aetiology of this is diverse but fibrosis within the transplanted organ is the common end point. This study is the first to investigate the association of CAV2 gene variants with kidney transplant outcomes. Genomic DNA from donors and recipients of 575 kidney transplants performed in Belfast was investigated for common variation in CAV2 using a tag SNP approach. The CAV2 SNP rs13221869 was nominally significant for kidney transplant failure. Validation was sought in an independent group of kidney transplant donors and recipients from Dublin, Ireland using a second genotyping technology. Due to the unexpected absence of rs13221869 from this cohort, the CAV2 gene was resequenced. One novel SNP and a novel insertion/deletion in CAV2 were identified; rs13221869 is located in a repetitive region and was not a true variant in resequenced populations. CAV2 is a plausible candidate gene for association with kidney transplant outcomes given its proximity to CAV1 and its role in attenuating fibrosis. This study does not support an association between CAV2 variation and kidney transplant survival. Further analysis of CAV2 should be undertaken with an awareness of the sequence complexities and genetic variants highlighted by this study. 

A current-driven instability in parallel, relativistic shocks

Recently, Bell ( 2004 Mon. Not. R. Astron. Soc. 353 550) has reanalysed the problem of wave excitation by cosmic rays propagating in the pre-cursor region of a supernova remnant shock front. He pointed out a strong, non-resonant, current-driven instability that had been overlooked in the kinetic treatments by Achterberg ( 1983 Astron. Astrophys. 119 274) and McKenzie and Volk ( 1982 Astron. Astrophys. 116 191), and suggested that it is responsible for substantial amplification of the ambient magnetic field. Magnetic field amplification is also an important issue in the problem of the formation and structure of relativistic shock fronts, particularly in relation to models of gamma-ray bursts. We have therefore generalized the linear analysis to apply to this case, assuming a relativistic background plasma and a monoenergetic, unidirectional incoming proton beam. We find essentially the same non-resonant instability observed by Bell and show that also, under GRB conditions, it grows much faster than the resonant waves. We quantify the extent to which thermal effects in the background plasma limit the maximum growth rate.

The transport of cosmic rays in self-excited magnetic turbulence

The process of diffusive shock acceleration relies on the efficacy with which hydromagnetic waves can scatter charged particles in the precursor of a shock. The growth of self-generated waves is driven by both resonant and non-resonant processes. We perform high-resolution magnetohydrodynamic simulations of the non-resonant cosmic ray driven instability, in which the unstable waves are excited beyond the linear regime. In a snapshot of the resultant field, particle transport simulations are carried out. The use of a static snapshot of the field is reasonable given that the Larmor period for particles is typically very short relative to the instability growth time. The diffusion rate is found to be close to, or below, the Bohm limit for a range of energies. This provides the first explicit demonstration that self-excited turbulence reduces the diffusion coefficient and has important implications for cosmic-ray transport and acceleration in supernova remnants.

A cosmic ray current-driven instability in partially ionised media

Context. We investigate the growth of hydromagnetic waves driven by streaming cosmic rays in the precursor environment of a supernova remnant shock.

Aims. It is known that transverse waves propagating parallel to the mean magnetic field are unstable to anisotropies in the cosmic ray distribution, and may provide a mechanism to substantially amplify the ambient magnetic field. We quantify the extent to which temperature and ionisation fractions modify this picture.

Methods. Using a kinetic description of the plasma we derive the dispersion relation for a collisionless thermal plasma with a streaming cosmic ray current. Fluid equations are then used to discuss the effects of neutral-ion collisions.

Results. We calculate the extent to which the environment into which the cosmic rays propagate influences the growth of the magnetic field, and determines the range of possible growth rates.

Conclusions. If the cosmic ray acceleration is efficient, we find that very large neutral fractions are required to stabilise the growth of the non-resonant mode. For typical supernova parameters in our Galaxy, thermal effects do not significantly alter the growth rates. For weakly driven modes, ion-neutral damping can dominate over the instability at more modest ionisation fractions. In the case of a supernova shock interacting with a molecular clouds, such as in RX J1713.7-3946, with high density and low ionisation, the modes can be rapidly damped.

STEADY-STATE SOLUTIONS IN NONLINEAR DIFFUSIVE SHOCK ACCELERATION

Stationary solutions to the equations of nonlinear diffusive shock acceleration play a fundamental role in the theory of cosmic-ray acceleration. Their existence usually requires that a fraction of the accelerated particles be allowed to escape from the system. Because the scattering mean free path is thought to be an increasing function of energy, this condition is conventionally implemented as an upper cutoff in energy space-particles are then permitted to escape from any part of the system, once their energy exceeds this limit. However, because accelerated particles are responsible for the substantial amplification of the ambient magnetic field in a region upstream of the shock front, we examine an alternative approach in which particles escape over a spatial boundary. We use a simple iterative scheme that constructs stationary numerical solutions to the coupled kinetic and hydrodynamic equations. For parameters appropriate for supernova remnants, we find stationary solutions with efficient acceleration when the escape boundary is placed at the point where growth and advection of strongly driven nonresonant waves are in balance. We also present the energy dependence of the distribution function close to the energy where it cuts off-a diagnostic that is in principle accessible to observation.

ENVIRONMENTAL LIMITS ON THE NONRESONANT COSMIC-RAY CURRENT-DRIVEN INSTABILITY

We investigate the so-called nonresonant cosmic-ray streaming instability, first discussed by Bell (2004). The extent to which thermal damping and ion-neutral collisions reduce the growth of this instability is calculated. Limits on the growth of the nonresonant mode in SN1006 and RX J1713.7-3946 are presented.

Observation of Ultrafast Charge Migration in an Amino Acid

We present the first direct measurement of ultrafast charge migration in a biomolecular building block the amino acid phenylalanine. Using an extreme ultraviolet pulse of 1.5 fs duration to ionize molecules isolated in the gas phase, the location of the resulting hole was probed by a 6 fs visible/near-infrared pulse. By measuring the yield of a doubly charged ion as a function of the delay between the two pulses, the positive hole was observed to migrate to one end of the cation within 30 fs. This process is likely to originate from even faster coherent charge oscillations in the molecule being dephased by bond stretching which eventually localizes the final position of the charge. This demonstration offers a clear template for observing and controlling this phenomenon in the future.