Clinical supervision in four mental health professions: A review of the evidence

This paper examines a range of theoretical issues and the empirical evidence relating to clinical supervision in four mental health professions, namely clinical psychology, occupational therapy, social work, and speech pathology. Despite the widespread acceptance of the value of supervision among practitioners and the large quantity of literature on the topic, there is very little empirical evidence in this area. It is not clear whether supervision actually produces a change in clinician behaviour, nor whether it produces benefits in terms of client outcomes. To date, there is insufficient evidence to demonstrate which styles of supervision are most beneficial for particular types of staff, in terms of their level of experience or learning style. The data suggest that directive forms of supervision, rather than unstructured approaches, are preferred by relatively inexperienced practitioners, and that experienced clinicians also value direct supervision methods when learning new skills or dealing with complex or crisis situations. The available evidence suggests that supervisors typically receive little training in supervision methods. However, to date, we have little information to guide us as to the most effective ways of training supervisors. While acknowledging the urgent need for research, the paper concludes that supervision is likely to form a valuable component of professional development for mental health professionals.

The point-of-referral barrier - a factor in the success of telehealth

A feasibility study was carried out to test the hypothesis that, for an effective telehealth service, a full-time coordinator is required to act as a single point of contact for consultation requests. By shifting the responsibility for telepaediatrics from the referrer to the provider, the telehealth process becomes equally (or more) attractive as the conventional alternative. Preliminary results showed that, within six months, telepaediatric activity increased to an average of 8 h per month. Not only did certain health services become more accessible to children and their families in remote areas of Queensland, but significant savings were also made. At least 12 patient transfers were avoided to and from the tertiary facility, with an estimated minimum saving of $18,000 to the health-care provider.

Endocytosis of uncleaved tumor necrosis factor-alpha in macrophages

Activated monocytes and macrophages secrete the inflammatory cytokine tumor necrosis factor-alpha (TNF-alpha) TNF-alpha is produced as a 26 kd transmembrane protein that is cleaved to release a 17 kd soluble protein. TNF-alpha in both forms is biologically active. The intracellular trafficking of membrane-associated TNF-alpha in lipopolysaccharide-activated mouse macrophages was assessed after treatment with the metalloprotease inhibitor BB-3103, which prevents the cleavage of pro-TNF-alpha. Immunoprecipitation and immunofluorescence studies showed sustained expression of cell-associated TNF-alpha in the presence of the inhibitor. Cell immunoreactivity and surface biotinylation revealed that uncleaved TNF-alpha accumulated on the cell surface and was endocytosed, appearing in intracellular vesicles. Perturbation of post-Golgi traffic blocked the surface expression of 26 kd TNF-alpha. Tracking a bolus of TNF-alpha over time in cycloheximide-treated cells confirmed that uncleaved TNF-alpha is first transported to the cell surface and subsequently endocytosed. Vesicular structures immunoreactive for TNF-alpha were identified as endosomes by double labeling. The secretory and membrane-associated endocytic trafficking of TNF-alpha provides a mechanism for modulating the quantity of biologically active 26 kd TNF-alpha expressed on macrophages, allowing regulation of paracrine and autocrine responses.

Habitat complexity, spatial interference, and "minimum risk distribution": a framework for population stability

In the past century, the debate over whether or not density-dependent factors regulate populations has generally focused on changes in mean population density, ignoring the spatial variance around the mean as unimportant noise. In an attempt to provide a different framework for understanding population dynamics based on individual fitness, this paper discusses the crucial role of spatial variability itself on the stability of insect populations. The advantages of this method are the following: (1) it is founded on evolutionary principles rather than post hoc assumptions; (2) it erects hypotheses that can be tested; and (3) it links disparate ecological schools, including spatial dynamics, behavioral ecology, preference-performance, and plant apparency into an overall framework. At the core of this framework, habitat complexity governs insect spatial variance. which in turn determines population stability. First, the minimum risk distribution (MRD) is defined as the spatial distribution of individuals that results in the minimum number of premature deaths in a population given the distribution of mortality risk in the habitat (and, therefore, leading to maximized population growth). The greater the divergence of actual spatial patterns of individuals from the MRD, the greater the reduction of population growth and size from high, unstable levels. Then, based on extensive data from 29 populations of the processionary caterpillar, Ochrogaster lunifer, four steps are used to test the effect of habitat interference on population growth rates. (1) The costs (increasing the risk of scramble competition) and benefits (decreasing the risk of inverse density-dependent predation) of egg and larval aggregation are quantified. (2) These costs and benefits, along with the distribution of resources, are used to construct the MRD for each habitat. (3) The MRD is used as a benchmark against which the actual spatial pattern of individuals is compared. The degree of divergence of the actual spatial pattern from the MRD is quantified for each of the 29 habitats. (4) Finally, indices of habitat complexity are used to provide highly accurate predictions of spatial divergence from the MRD, showing that habitat interference reduces population growth rates from high, unstable levels. The reason for the divergence appears to be that high levels of background vegetation (vegetation other than host plants) interfere with female host-searching behavior. This leads to a spatial distribution of egg batches with high mortality risk, and therefore lower population growth. Knowledge of the MRD in other species should be a highly effective means of predicting trends in population dynamics. Species with high divergence between their actual spatial distribution and their MRD may display relatively stable dynamics at low population levels. In contrast, species with low divergence should experience high levels of intragenerational population growth leading to frequent habitat-wide outbreaks and unstable dynamics in the long term. Six hypotheses, erected under the framework of spatial interference, are discussed, and future tests are suggested.

Identifying the origin of single corneal cells by DNA fingerprinting - Part I - Implications for corneal limbal allografting

Purpose. To demonstrate that the combination of impression cytology and single cell DNA fingerprinting represents a powerful tool that is suitable for detecting transplanted cells after corneal limbal allografting. Methods, Fifty single cells were obtained by corneal impression cytology from 12 patients undergoing cataract surgery. Individual cells were isolated from samples by micromanipulation. Polymerase chain reaction and short tandem repeat profiling was used to obtain forensic standard DNA fingerprints from single cells. Blood samples taken at the time of impression cytology provided control fingerprints. Results, informative DNA fingerprints were obtained from all corneal samples and 66% (33 of 50 cells) of isolated single cells, Of all fingerprints obtained, most (91%, 30 of 33 fingerprints) corneal fingerprints matched corresponding blond sample fingerprints. At least one corneal fingerprint matched the corresponding blood sample fingerprint in 83% (10 of 12 patients) of the patients in the study, Conclusions. This extremely specific single cell DNA fingerprinting system permits accurate identification of individual corneal epithelial cells, allowing very reliable determination of their origin, which will enable host and donor cells to be distinguished from each other after keratolimbal allografting procedures. even if the host and donor are the same sex or siblings. These DNA fingerprinting methods allow assessment of quality and quantity of donor cell survival, as well as survival time. The extreme sensitivity and accuracy of the technique means that should contamination occur, it would be identified, thus ensuring meaningful results.

Patchy populations in stochastic environments: Critical number of patches for persistence

We introduce a model for the dynamics of a patchy population in a stochastic environment and derive a criterion for its persistence. This criterion is based on the geometric mean (GM) through time of the spatial-arithmetic mean of growth rates. For the population to persist, the GM has to be greater than or equal to1. The GM increases with the number of patches (because the sampling error is reduced) and decreases with both the variance and the spatial covariance of growth rates. We derive analytical expressions for the minimum number of patches (and the maximum harvesting rate) required for the persistence of the population. As the magnitude of environmental fluctuations increases, the number of patches required for persistence increases, and the fraction of individuals that can be harvested decreases. The novelty of our approach is that we focus on Malthusian local population dynamics with high dispersal and strong environmental variability from year to year. Unlike previous models of patchy populations that assume an infinite number of patches, we focus specifically on the effect that the number of patches has on population persistence. Our work is therefore directly relevant to patchily distributed organisms that are restricted to a small number of habitat patches.

An in situ study of photosynthetic oxygen exchange and electron transport rate in the marine macroalga Ulva lactuca (Chlorophyta)

Direct comparisons between photosynthetic O-2 evolution rate and electron transport rate (ETR) were made in situ over 24 h using the benthic macroalga Ulva lactuca (Chlorophyta), growing and measured at a depth of 1.8 m, where the midday irradiance rose to 400-600 mumol photons m(-2) s(-1). O-2 exchange was measured with a 5-chamber data-logging apparatus and ETR with a submersible pulse amplitude modulated (PAM) fluorometer (Diving-PAM). Steady-state quantum yield ((Fm'-Ft)/Fm') decreased from 0.7 during the morning to 0.45 at midday, followed by some recovery in the late afternoon. At low to medium irradiances (0-300 mumol photons m(-2) s(-1)), there was a significant correlation between O-2 evolution and ETR, but at higher irradiances, ETR continued to increase steadily, while O-2 evolution tended towards an asymptote. However at high irradiance levels (600-1200 mumol photons m-(2) s(-1)) ETR was significantly lowered. Two methods of measuring ETR, based on either diel ambient light levels and fluorescence yields or rapid light curves, gave similar results at low to moderate irradiance levels. Nutrient enrichment (increases in [NO3-], [NH4+] and [HPO42-] of 5- to 15-fold over ambient concentrations) resulted in an increase, within hours, in photosynthetic rates measured by both ETR and O-2 evolution techniques. At low irradiances, approximately 6.5 to 8.2 electrons passed through PS II during the evolution of one molecule of O-2, i.e., up to twice the theoretical minimum number of four. However, in nutrient-enriched treatments this ratio dropped to 5.1. The results indicate that PAM fluorescence can be used as a good indication of the photosynthetic rate only at low to medium irradiances.

Initiation of biological agents in patients with ankylosing spondylitis: results of a Delphi study by the ASAS Group

Background: There is ample evidence of important symptomatic efficacy of tumour necrosis factor alpha (TNFalpha) inhibition in ankylosing spondylitis (AS). Moreover, studies suggest that anti-TNF could be considered as the first disease controlling antirheumatic treatment (DC-ART) for AS. Objective: To determine precisely which patients with AS are most likely to benefit from anti-TNFalpha treatment because of the cost and possible long term side effects of such treatment. Methods: Assessment in Ankylosing Spondylitis (ASAS) members were asked to use a Delphi technique to name the characteristics of patients with AS for whom they would start DC-ART, in three different clinical presentations (isolated axial involvement, peripheral arthritis, enthesitis). Results: Among the 62 invited ASAS members, more than 50% actively participated in the four phases of definition according to the Delphi technique. For each of the three clinical presentations, a combination of five to six domains was proposed, with an evaluation instrument and a cut off point defining a minimum level of activity for each domain. Conclusion: This study provides a profile for a patient with AS for considering initiation of biological agents that reflects the opinion of the ASAS members, using a Delphi exercise. Further studies are required to assess their relevance and their consistency with clinical practice.

More on exact bicoverings of 12 points

The minimum number of incomplete blocks required to cover, exactly lambda times, all t-element subsets from a set V of cardinality v (v > t) is denoted by y(lambda, t; v). The value of g(2, 2; v) is known for v = 3, 4,..., 11. It was previously known that 14 less than or equal to g(2, 2; 12) less than or equal to 16. We prove that g(2, 2; 12) greater than or equal to 15.

Kinetic parameters associated with self-heating of New Zealand coals under adiabatic conditions

Adiabatic self-heating tests were carried out on five New Zealand coal samples ranging in rank from lignite to high-volatile bituminous. Kinetic parameters of oxidation were obtained front the self-heating curves assuming Arrhenius behaviour. The activation energy E (kJ mol(-1)) and the pre-exponential factor A (s(-1)) were determined in the temperature range of 70-140 degreesC. The activation energy exhibited a definite rank relationship with a minimum E of 55 kJ mol(-1) occurring at a Suggate rank of similar to6.2 corresponding to subbituminous C. Either side of this rank there was a noticeable increase in the activation energy indicating lower reactivity of the coal. A similar rank trend was also observed in the R-70 self-heating rate index values that were taken from the initial portion of the self-heating curve front 40 to 70 degreesC. From these results it is clear that the adiabatic method is capable of providing reliable kinetic parameters of coal oxidation.

A comprehensive insight into floc characteristics and their impact on compressibility and settleability of activated sludge

This paper presents a comprehensive study of sludge floc characteristics and their impact on compressibility and settleability of activated sludge in full scale wastewater treatment processes. The sludge flocs were characterised by morphological (floc size distribution, fractal dimension, filament index), physical (flocculating ability, viscosity, hydrophobicity and surface charge) and chemical (polymeric constituents and metal content) parameters. Compressibility and settleability were defined in terms of the sludge volume index (SVI) and zone settling velocity (ZSV). The floc morphological and physical properties had important influence on the sludge compressibility and settleability. Sludges containing large flocs and high quantities of filaments, corresponding to lower values of fractal dimension (D-f), demonstrated poor compressibility and settleability. Sludge flocs with high flocculating ability had lower SVI and higher ZSV, whereas high values of hydrophobicity, negative surface charge and viscosity of the sludge flocs correlated to high SVI and low ZSV. The quantity of the polymeric compounds protein. humic substances and carbohydrate in the sludge and the extracted extracellular polymeric substances (EPS) had significant positive correlations with SVI. The ZSV was quantitatively independent of the polymeric constituents. High concentrations of the extracted EPS were related to poor compressibility and settleability. The cationic ions Ca, Mg, Al and Fe in the sludge improved significantly the sludge compressibility and settleability. (C) 2003 Elsevier Science B.V. All rights reserved.

The influence of key chemical constituents in activated sludge on surface and flocculating properties

This paper examines the influence of the chemical constituents of activated sludge and extracted extracellular polymeric substances (EPS) on the surface properties, hydrophobicity, surface charge (SC) and flocculating ability (FA) of activated sludge floes. Activated sludge samples from 7 different full-scale wastewater treatment plants were examined. Protein and humic substances were found to be the dominant polymeric compounds in the activated sludges and the extracted EPS, and they significantly affected the FA and surface properties, hydrophobicity and SC, of the sludge floes. The polymeric compounds proteins, humic substances and carbohydrates in the sludge floes and the extracted EPS contributed to the negative SC, but correlated negatively to the hydrophobicity of sludge floes. The quantity of protein and carbohydrate within the sludge and the extracted EPS was correlated positively to the FA of the sludge floes, while increased amounts of humic substances resulted in lower FA. In contrast, increased amounts of total extracted EPS had a negative correlation to FA. The results reveal that the quality and quantity of the polymeric compounds within the sludge floes is more informative, with respect to understanding the mechanisms involved in flocculation, than if only the extracted EPS are considered. This is an important finding as it indicates that extracting EPS may be insufficient to characterise the EPS. This is due to the low extraction efficiency and difficulties involved in the separation of EPS from other organic compounds. Correlations were observed between the surface properties and FA of the sludge floes., This confirms that the surface properties of the, sludge flocs play an important role in the bioflocculation process but that also other interactions like polymer entanglement are important. (C) 2002 Elsevier Science Ltd. All rights reserved.

Economic viability of the third milking in systems of production using closed-circuit mechanical milking

This study aimed to analyze the economic viability of the third milking in production systems using mechanical milking in a closed circuit, aiming to provide technicians and farmers with information to assist them in decision-making. Specifically, it intended: (a) to estimate the cost of one milking; (b) to estimate the cost of the third milking; (c) to develop a mathematical equation to estimate the minimum amount of milk produced with two milkings, from which it would be economically feasible to do the third milking. Data were collected from three dairy farms, from November 2010 to March 2011, keeping a twice-a-day milking frequency, with three data collections in each farm, totalizing nine collections. Considering the average data, it would be feasible to do the third milking if the average milk yield per day of lactating cows in a twice-a-day milking frequency was greater than or equal to 24.43 kg of milk.

Influence of LPG composition on straw applied one componente PU winter foam

O principal objectivo desta tese é obter uma relação directa entre a composição dos gases liquefeitos de petróleo (GLP), propano, n-butano e isobutano, usados como aerossóis propulsores numa lata de poliuretano de um componente, com as propriedades das espumas produzidas por spray. As espumas obtidas, terão de ter como requisito principal, um bom desempenho a temperaturas baixas, -10ºC, sendo por isso designadas por espumas de Inverno. Uma espuma é considerada como tendo um bom desempenho se não apresentar a -10/-10ºC (temperatura lata/ spray) glass bubbles, base holes e cell collapse. As espumas deverão ainda ter densidades do spray no molde a +23/+23ºC abaixo dos 30 g/L, um rendimento superior a 30 L, boa estabilidade dimensional e um caudal de espuma a +5/+5ºC superior a 5 g/s. Os ensaios experimentais foram realizados a +23/+23ºC, +5/+5ºC e a -10/-10ºC. A cada temperatura, as espumas desenvolvidas, foram submetidas a testes que permitiram determinar a sua qualidade. Testes esses que incluem os designados por Quick Tests (QT): o spray no papel e no molde das espumas nas referidas temperaturas. As amostras do papel e no molde são especialmente analisadas, quanto, às glass bubbles, cell collapse, base holes, cell structur e, cutting shrinkage, para além de outras propriedades. Os QT também incluem a análise da densidade no molde (ODM) e o estudo do caudal de espumas. Além dos QT foram realizados os testes da estabilidade dimensional das espumas, testes físicos de compressão e adesão, testes de expansão das espumas após spray e do rendimento por lata de espuma. Em todos os ensaios foi utilizado um tubo adaptador colocado na válvula da lata como método de spray e ainda mantida constante a proporção das matérias-primas (excepto os gases, em estudo). As experiências iniciaram-se com o estudo de GLPs presentes no mercado de aerossóis. Estes resultaram que o GLP: propano/ n-butano/ isobutano: (30/ 0/ 70 w/w%), produz as melhores espumas de inverno a -10/-10ºC, reduzindo desta forma as glass bubbles, base holes e o cell collapse produzido pelos restantes GLP usados como aerossóis nas latas de poliuretano. Testes posteriores tiveram como objectivo estudar a influência directa de cada gás, propano, n-butano e isobutano nas espumas. Para tal, foram usadas duas referências do estudo com GLP comercializáveis, 7396 (30 /0 /70 w/w %) e 7442 (0/ 0/ 100 w/w %). Com estes resultados concluí-se que o n-butano produz más propriedades nas espumas a -10/- 10ºC, formando grandes quantidades de glass bubbles, base holes e cell collapse. Contudo, o uso de propano reduz essas glass bubbles, mas em contrapartida, forma cell collapse.Isobutano, porém diminui o cell collapse mas não as glass bubbles. Dos resultados experimentais podemos constatar que o caudal a +5/+5ºC e densidade das espumas a +23/+23ºC, são influenciados pela composição do GLP. O propano e n-butano aumentam o caudal de espuma das latas e a sua densidade, ao contrário com o que acontece com o isobutano. Todavia, pelos resultados obtidos, o isobutano proporciona os melhores rendimentos de espumas por lata. Podemos concluir que os GLPs que contivessem cerca de 30 w/w % de propano (bons caudais a +5/+5ºC e menos glass bubbles a -10/-10ºC), e cerca 70 w/w % de isobutano (bons rendimentos de espumas, bem como menos cell collapse a -10/-10ºC) produziam as melhores espumas. Também foram desenvolvidos testes sobre a influência da quantidade de gás GLP presente numa lata. A análise do volume de GLP usado, foi realizada com base na melhor espuma obtida nos estudos anteriores, 7396, com um GLP (30 / 0/ 70 w/w%), e foram feitas alterações ao seu volume gás GLP presente no pré-polímero. O estudo concluiu, que o aumento do volume pode diminuir a densidade das espumas, e o seu decréscimo, um aumento da densidade. Também indico u que um mau ajuste do volume poderá causar más propriedades nas espumas. A análise económica, concluiu que o custo das espumas com mais GLP nas suas formulações, reduz-se em cerca de 3%, a quando de um aumento do volume de GLP no pré-polímero de cerca de 8 %. Esta diminuição de custos deveu-se ao facto, de um aumento de volume de gás, implicar uma diminuição na quantidade das restantes matérias-primas, com custos superiores, já que o volume útil total da lata terá de ser sempre mantido nos 750 mL. Com o objectivo de melhorar a qualidade da espuma 7396 (30/0/70 w/w %) obtida nos ensaios anteriores adicionou-se à formulação 7396 o HFC-152a (1,1-di fluoroetano). Os resultados demonstram que se formam espumas com más propriedades, especialmente a -10/-10ºC, contudo proporcionou excelentes shaking rate da lata. Através de uma pequena análise de custos não é aconselhável o seu uso pelos resultados obtidos, não proporcionando um balanço custo/benefício favorável. As três melhores espumas obtidas de todos os estudos foram comparadas com uma espuma de inverno presente no mercado. 7396 e 7638 com um volume de 27 % no prépolímero e uma composição de GLP (30/ 0 / 70 w/w%) e (13,7/ 0/ 86,3 w/w%), respectivamente, e 7690, com 37 % de volume no pré-polímero e GLP (30/ 0 / 70 w/w%), apresentaram em geral melhores resultados, comparando com a espuma benchmark . Contudo, os seus shaking rate a -10/-10ºC, de cada espuma, apresentaram valores bastante inferiores à composição benchmarking.

Design of a sea-level tsunami detection network for the Gulf of Cadiz

The devastating impact of the Sumatra tsunami of 26 December 2004, raised the question for scientists of how to forecast a tsunami threat. In 2005, the IOC-UNESCO XXIII assembly decided to implement a global tsunami warning system to cover the regions that were not yet protected, namely the Indian Ocean, the Caribbean and the North East Atlantic, the Mediterranean and connected seas (the NEAM region). Within NEAM, the Gulf of Cadiz is the more sensitive area, with an important record of devastating historical events. The objective of this paper is to present a preliminary design for a reliable tsunami detection network for the Gulf of Cadiz, based on a network of sea-level observatories. The tsunamigenic potential of this region has been revised in order to define the active tectonic structures. Tsunami hydrodynamic modeling and GIS technology have been used to identify the appropriate locations for the minimum number of sea-level stations. Results show that 3 tsunameters are required as the minimum number of stations necessary to assure an acceptable protection to the large coastal population in the Gulf of Cadiz. In addition, 29 tide gauge stations could be necessary to fully assess the effects of a tsunami along the affected coasts of Portugal, Spain and Morocco.