Regular medication reviews for children and young people with ADHD

The National Institute for Health and Care Excellence's (2008) guidelines for the diagnosis and management of attention deficit hyperactivity disorder (ADHD) recommend a full clinical and psychological assessment by an appropriately trained clinician; this should include a detailed developmental and psychiatric history. Stimulant medications, which are Schedule II controlled drugs, are the most commonly prescribed medicines in the UK and across the world for the management of ADHD. Children and young people with a diagnosis of ADHD receiving these stimulant medications are required to attend regular review appointments with a consultant child and adolescent psychiatrist or specialist nurse under shared care guidelines with general practices, and it has long been recognized that appropriately educated nurses can assist in the management of ADHD. Owing to the pharmacological action of the stimulant medication on neurotransmission, there is potential for misuse and dependence. A growing body of evidence suggests that adolescents with ADHD can become involved in drug diversion and that the topic should be explored during assessment. The level of misuse of prescribed stimulants is increasing, and adolescents and young people with ADHD may misuse to enhance cognitive function for academic purposes. The following scenario highlights some of the challenges and opportunities for independent nurse prescribers working in child and adolescent mental health services.

A stacked Late Quaternary fluvio-periglacial sequence from the Axe valley, southern England with implications for landscape evolution and Palaeolithic archaeology

The current model of mid-latitude late Quaternary terrace sequences, is that they are uplift-driven but climatically controlled terrace staircases, relating to both regional-scale crustal and tectonic factors, and palaeohydrological variations forced by quasi-cyclic climatic conditions in the 100 K world (post Mid Pleistocene Transition). This model appears to hold for the majority of the river valleys draining into the English Channel which exhibit 8–15 terrace levels over approximately 60–100 m of altitudinal elevation. However, one valley, the Axe, has only one major morphological terrace and has long-been regarded as anomalous. This paper uses both conventional and novel stratigraphical methods (digital granulometry and terrestrial laser scanning) to show that this terrace is a stacked sedimentary sequence of 20–30 m thickness with a quasi-continuous (i.e. with hiatuses) pulsed, record of fluvial and periglacial sedimentation over at least the last 300–400 K yrs as determined principally by OSL dating of the upper two thirds of the sequence. Since uplift has been regional, there is no evidence of anomalous neotectonics, and climatic history must be comparable to the adjacent catchments (both of which have staircase sequences) a catchment-specific mechanism is required. The Axe is the only valley in North West Europe incised entirely into the near-horizontally bedded chert (crypto-crystalline quartz) and sand-rich Lower Cretaceous rocks creating a buried valley. Mapping of the valley slopes has identified many large landslide scars associated with past and present springs. It is proposed that these are thaw-slump scars and represent large hill-slope failures caused by Vauclausian water pressures and hydraulic fracturing of the chert during rapid permafrost melting. A simple 1D model of this thermokarstic process is used to explore this mechanism, and it is proposed that the resultant anomalously high input of chert and sand into the valley during terminations caused pulsed aggradation until the last termination. It is also proposed that interglacial and interstadial incision may have been prevented by the over-sized and interlocking nature of the sub-angular chert clasts until the Lateglacial when confinement of the river overcame this immobility threshold. One result of this hydrogeologically mediated valley evolution was to provide a sequence of proximal Palaeolithic archaeology over two MIS cycles. This study demonstrates that uplift tectonics and climate alone do not fully determine Quaternary valley evolution and that lithological and hydrogeological conditions are a fundamental cause of variation in terrestrial Quaternary records and landform evolution.

Novel microsatellite loci for a deep sea fish (Macrourus berglax) and their amplification in other grenadiers (Gadiformes: Macrouridae)

Over-exploitation of traditional coastal stocks and a rising demand for seafood have resulted in the shift of commercial fishing towards less-known, deep-sea species in many parts of the world. Yet, the lack of knowledge of the biology, ecology and life-history of these species represents a serious impediment for establishing sound stock management plans. With the aim of providing tools that will allow assessment of the population genetic structure of Macrourus berglax, we have isolated and characterised a suite of novel microsatellite loci for this deep sea grenadier. Eight of these markers showed between 4 and 11 alleles per locus in two distant North Atlantic populations, with observed and expected heterozygosities between 0.17-0.83 and 0.35-0.87, respectively. Importantly, eight of these loci also cross-amplify in other Macrourid species. 

Age-related prevalence and met need for correctable and uncorrectable near vision impairment in a multi-country study

Purpose: To estimate the prevalence, potential determinants, and proportion of met need for near vision impairment (NVI) correctable with refraction approximately 2 years after initial examination of a multi-country cohort. Design: Population-based, prospective cohort study. Participants: People aged ≥35 years examined at baseline in semi-rural (Shunyi) and urban (Guangzhou) sites in China; rural sites in Nepal (Kaski), India (Madurai), and Niger (Dosso); a semi-urban site (Durban) in South Africa; and an urban site (Los Angeles) in the United States. Methods: Near visual acuity (NVA) with and without current near correction was measured at 40 cm using a logarithm of the minimum angle of resolution near vision tumbling E chart. Participants with uncorrected binocular NVA ≤20/40 were tested with plus sphere lenses to obtain best-corrected binocular NVA. Main Outcome Measures: Prevalence of total NVI (defined as uncorrected NVA ≤20/40) and NVI correctable and uncorrectable to >20/40, and current spectacle wearing among those with bilateral NVA ≤20/63 improving to >20/40 with near correction (met need). Results: Among 13 671 baseline participants, 10 533 (77.2%) attended the follow-up examination. The prevalence of correctable NVI increased with age from 35 to 50-60 years and then decreased at all sites. Multiple logistic regression modeling suggested that correctable NVI was not associated with gender at any site, whereas more educated persons aged >54 years were associated with a higher prevalence of correctable NVI in Nepal and India. Although near vision spectacles were provided free at baseline, wear among those who could benefit was <40% at all but 2 centers (Guangzhou and Los Angeles). Conclusions: Prevalence of correctable NVI is greatest among persons of working age, and rates of correction are low in many settings, suggesting that strategies targeting the workplace may be needed.

Issues in the epidemiology and population-based screening of primary angle-closure glaucoma

Among Caucasians, it is well known that 75-95% of primary glaucoma is due to open-angle glaucoma (POAG), with angle-closure (PACG) comprising only a very small minority of cases. These figures are reversed among other groups such as Asians and Eskimos, where PACG makes up 80-90% of primary glaucoma. Among Eskimos, the prevalence of PACG has been reported as 2-8%, as compared to 0.1% among Caucasians. It appears that a population tendency toward shallow anterior chambers may explain the excess burden of PACG morbidity. Among Asians, the prevalence of PACG is intermediate between Caucasians and Eskimos. Existing biometrical data do not show a clear tendency toward shallower anterior chambers among Asians. PACG may be screened for on a population basis by means of various techniques that estimate axial or limbal anterior chamber depth, measure intraocular pressure, or evaluate the optic disc or visual fields. Demographic information and medical and family history will also be of great importance in screening for PACG in large populations. Groups at increased risk for the disease include women, individuals over 50, first-degree relatives of PACG probands, and hyperopes.

Use of eye care services among diabetic patients in urban and rural China.

OBJECTIVE: To assess the use of eye care and its predictors among diabetic patients in China. DESIGN: Cross-sectional, clinic-based study. PARTICIPANTS: Diabetic patients 18 years of age or older were recruited consecutively from an urban tertiary and community hospitals and from a rural clinic in Guangdong, China. METHODS: Information obtained by questionnaire and chart review included: demographic and socioeconomic status, knowledge about diabetic retinopathy (DR), and ocular and medical history. MAIN OUTCOME MEASURES: Self-reported or chart history of an eye examination ever or within the preceding 12 months. RESULTS: The participation rate among 889 eligible subjects was 92.7%. Among 824 participants (mean age, 62.6+/-12.9 years; 58.8% female), 550 (66.7%) had not been examined in the last year as recommended by the American Academy of Ophthalmology, and 356 (43.2%) had never been examined. For the rural hospital, these figures were 81.1% and 68.7%, respectively. In regression analyses, factors associated with having an eye examination in the last year were: attendance at urban hospitals (odds ratio [OR], 3.46 [P<0.001] and 1.76 [P = 0.021] for the tertiary and community hospitals, respectively, compared with the rural clinic), higher DR knowledge score (OR, 1.24; P = 0.001), greater concern about vision loss (OR, 1.22; P = 0.007), and recommendation of regular eye examinations by the provider (OR, 2.36; P = 0.011). Predictors of ever having an eye examination were similar. Monthly income and health insurance status were not predictive of being examined. CONCLUSIONS: These results suggest that the low proportion of diabetic receiving recommended annual eye examinations in China may be improved through patient and physician education. Copyright © 2010 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Present, imagination and memory in Zakes Mda and Mia Couto

Apesar de marcadas por contextos históricos e culturais distintos, é possível observar nas obras de dois dos autores mais significativos da África do Sul e de Moçambique, Zakes Mda e Mia Couto respectivamente, perspectivas semelhantes no que diz respeito à recuperação das memórias históricoculturais e à sua contribuição para a construção e compreensão das identidades pós-coloniais. Através da ficção, Zakes Mda e Mia Couto combinam a ligação da História a factos concretos com a necessidade de revelação associada à memória, criando assim espaços importantes para a discussão de algumas das mais complexas questões colocadas às identidades pós-coloniais. Para além dos contextos políticos, culturais e históricos que caracterizam e distinguem as literaturas sul-africana e moçambicana, tanto Zakes Mda como Mia Couto assumem nas suas obras a necessidade de analisar as identidades pós-coloniais contemporâneas dos dois países através da recuperação das suas memórias históricas.

Vertebrate diversity in the Bussaco Mountain and surrounding areas

A biodiversidade é fundamental para o funcionamento dos ecossistemas e, além do seu valor intrínseco, fornece bens e serviços essenciais ao Homem. É consensual que as reservas naturais, por si só, não conseguirão preservar a biodiversidade de modo a que seja travada a perda de espécies que vem acontecendo a ritmos sem precedente. Assim, compreender os padrões de distribuição das espécies à escala regional ou sub-regional, ainda que em territórios não classificados, é crucial para o estabelecimento de políticas de gestão que visem a conservação da biodiversidade. O principal objectivo deste trabalho centrou-se na descrição e compreensão dos padrões de riqueza específica, distribuição e abundância de Vertebrados face aos diversos habitats que constituem a área de estudo. Constituíram, assim, objecto de estudo os anfíbios, aves, morcegos, micromamíferos e mamíferos de médio porte. A Serra do Bussaco e áreas envolventes encontram-se dominadas por vastas extensões de monocultura de Pinus pinaster e Eucalyptus globulus e por terrenos agrícolas. A Mata Nacional do Bussaco, bosque extremamente diverso, é outro importante elemento de paisagem. Pretendeu-se então analisar o efeito das práticas silvícolas actuais e da intensificação da agricultura sobre a biodiversidade, averiguando a importância de cada tipo de habitat para os Vertebrados em geral, e para algumas classes em particular. De entre os terrenos agrícolas, é bastante claro que a agricultura tradicional, com a sua típica complexidade e disponibilidade de água, constitui um habitat muito importante para a maioria dos Vertebrados, tendo também apresentado o maior valor conservacionista. No que respeita aos habitats florestais, o bosque misto apresentou consistentemente maior riqueza específica e diversidade, afirmando-se como o habitat preferido para a maioria das espécies e aquele com maior valor conservacionista. Do ponto de vista da conservação, as monoculturas, especialmente as da uma espécie exótica, revelaram-se habitats relativamente pobres. No entanto, estas conclusões referem-se às tendências gerais, sendo que taxa particulares respondem de forma diferente, atendendo aos seus requisitos específicos. A informação recolhida fornece bases essenciais para a construção de linhas de orientação que visem a integração das actividades humanas com a manutenção da biodiversidade e respectivos serviços, presumivelmente com aplicação a outras áreas geográficas.

Evolutionary diversification in Central Brazil: where Amazonia and Cerrado meet

Apesar da fauna de mamíferos Neotropicais ser uma das mais ricas do mundo, o nosso conhecimento sobre os limites de espécies, distribuições geográficas e relações filogenéticas está ainda agora no seu início. As áreas de transição entre os dois maiores biomas da América do Sul, o Cerrado e a Amazónia, são ainda menos conhecidas. Até ao momento, escassos estudos focaram os pequenos mamíferos destas áreas. Destes estudos, apenas dois apresentam dados taxonómicos e de distribuição geográfica de uma lista de espécies reduzida e, nenhum é focado nos processos evolutivos que conduziram à diversidade destas áreas. O presente trabalho tem como objectivo aumentar o conhecimento básico sobre a diversidade do médio Rio Araguaia, na região central do Brasil, através da amostragem e análise de espécies de pequenos mamíferos, integrando um intenso trabalho de campo, de laboratório e de museu. Desta forma, um total de 22 espécies é registado para o médio Araguaia. De entre estas espécies, descreve-se uma espécie nova de Rhipidomys, regista-se uma espécie não descrita de Thrichomys e uma potencial nova forma de Oligoryzomys, e também se apresenta uma diagnose emendada do obscuro Oecomys cleberi. Para cada espécie, são também descritas as suas características morfológicas e resumem-se os seus aspectos de distribuição geográfica e história natural. Para os quatro géneros acima referidos, são apresentadas as análises filogenéticas que permitem a identificação das espécies. Adicionalmente, os princípios da filogeografia são aplicados para estudar os padrões da distribuição geográfica da diversidade genética de três roedores sigmodontíneos e seis marsupiais didelphídeos. Os resultados obtidos demonstram que o Rio Araguaia forma uma barreira geográfica para espécies especialistas em florestas não-alagáveis; por outro lado, espécies generalistas apresentam partilha de haplótipos em ambas as margens do rio. Argumentamos também que os refúgios florestais e os gradientes poderão ter tido um papel importante para moldar a estrutura genética de populações de pequenos mamíferos no Brasil central. Em suma, os resultados apresentados corroboram a proposição de que a diversidade Neotropical não poderá ser explicada através de um único modelo de especiação e que estes não são mutuamente exclusivos. O entendimento integral dos processos ecológicos e históricos que deram origem à fauna Neotropical, assim como a continuidade de estudos sistemáticos, depende da realização de novas amostragens e consequente enriquecimento dos museus com colecções apropriadas.

Intimate Ecologies: An exploration of the languages of contemporary exhibitions and making in museums and related cultural spaces in the UK

Intimate Ecologies considers the practice of exhibition-making over the past decade in formal museum and gallery spaces and its relationship to creating a concept of craft in contemporary Britain. Different forms of expression found in traditions of still life painting, film and moving image, poetic text and performance are examined to highlight the complex layers of language at play in exhibitions and within a concept of craft. The thesis presents arguments for understanding the value of embodied material knowledge to aesthetic experience in exhibitions, across a spectrum of human expression. These are supported by reference to exhibition case studies, critical and theoretical works from fields including social anthropology, architecture, art and design history and literary criticism and a range of individual, original works of art. Intimate Ecologies concludes that the museum exhibition, as a creative medium for understanding objects, becomes enriched by close study of material practice, and embodied knowledge that draws on a concept of craft. In turn a concept of craft is refreshed by the makers’ participation in shifting patterns of exhibition-making in cultural spaces that allow the layers of language embedded in complex objects to be experienced from different perspectives. Both art-making and the experience of objects are intimate, and infinitely varied: a vibrant ecology of exhibition-making gives space to this diversity.

A fauna do Novo Mundo e o dealbar da alimentação científica na Europa

As preocupações médicas com o equilíbrio alimentar remontam à Antiguidade, mas apenas a partir do século XVII o assunto começou a ser questionado de modo mais científico e preciso. Dois médicos holandeses de renome, Luís Nunes (1553-1645) e Willem Piso (1611-1678), estudaram esta questão e legaram-nos tratados de inquestionável relevância historiográfica. Destacamos, em particular, Ichtyophagia sive de piscium esu commentarius (“Ictiofagia ou comentário sobre uma alimentação piscívora”, Antuérpia, 1616) e De Indiae utriusque re naturali et medica. Libri quatuordecim (“Sobre a Índia e sua história natural e médica”, Amesterdão, 1658). A defesa de uma dieta que inclua o consumo de peixe é transversal aos dois textos, pois ambos fundam um discurso inaugural em defesa de hábitos alimentares equilibrados numa época de profundas mudanças históricas e culturais impostas pelo contacto com as realidades do exótico Novo Mundo. Esta influência é sobretudo evidente na obra de Piso, especialmente nas suas descrições de espécies de peixes endémicas do Brasil.

Ecological niche modeling, cytogenetics and phylogeography of the genera Geomalacus and Letourneuxia (Gastropoda, Pulmonata) from the Iberian-Moroccan region

First described more that 150 years ago, the systematics of the genera Geomalacus and Letourneuxia (Arionidae, Gastropoda, Pulmonata) is still challenging. The taxonomic classification of arionid species is based on extremely labile characters such as body size or color that depends both on diet and environment, as well as age. Moreover, there is little information on the genetic diversity and population structure of the Iberian slugs that could provide extra clues to disentangle their problematic classification. The present work uses different analytical tools such as habitat suitability (Ecological Niche Modeling - ENM), cytogenetic analysis and phylogeography to establish the geographical distribution and evolutionary history of these pulmonate slugs. The potential distribution of the four Geomalacus species was modeled using ENM, which allowed the identification of new locations for G. malagensis, including a first report in Portugal. Also, it was predicted a much wider distribution for G. malagensis and G. oliveirae than previously known. Classical cytogenetic analyses were assayed with reproductive and a novel use of somatic tissues (mouth and tentacles) returning the number of chromosomes for the four Geomalacus species and L. numidica (n = 31, 2n = 62) and the respective karyotypes. G. malagensis and L. numidica present similar chromosome morphologies and karyotypic formulae, being more similar to each other than the Geomalacus among themselves. We further reconstructed the phylogeny of the genera Geomalacus and Letourneuxia using partial sequences of the mitochondrial cytochrome oxidase subunit I (COI) and the nuclear ribosomal small subunit (18S rRNA), and applied an independent evolutionary rate method, the indicator vectors correlation, to evaluate the existence of cryptic diversity within species. The five nominal species of Geomalacus and Letourneuxia comprise 14 well-supported cryptic lineages. Letourneuxia numidica was retrieved as a sister group of G. malagensis. G. oliveirae is paraphyletic with respect to G. anguiformis. According to our dating estimates, the most recent common ancestor of Geomalacus dates back to the Middle Miocene (end of the Serravallian stage). The major lineage splitting events within Geomalacus occurred during the dry periods of the Zanclean stage (5.3-3.6 million years) and some lineages were confined to more humid mountain areas of the Iberian Peninsula, which lead to a highly geographically structured mitochondrial genetic diversity. The major findings of this are the following: (1) provides updated species distribution maps for the Iberian Geomalacus expanding the known geographic distribution of the concerned species, (2) unravels the cryptic diversity within the genera Geomalacus and Letourneuxia, (3) Geomalacus oliveirae is paraphyletic with G. anguiformis and (4) Letourneuxia numidica is sister group of G. malagensis.

A question of tomorrow: Blanchot, surrealism and the time of the fragment

This article offers a close critical reading of Blanchot's essay on Surrealism, 'Tomorrow at Stake', raising a series of questions concerning the time of 'Surrealist experience' and its relation to those temporal structures inscribed within the concepts of modernity, the avant-garde, and (art) history itself. It is argued, through a posited connection to Romantic conceptions of the fragment, that those 'reflexes of the future' which for Surrealism determine the value of the present, may be understood, philosophically, in relation to diverse conceptions of the 'openness' of the question, in turn suggesting a more complex understanding of Surrealism's 'avant-garde' character.

Migration, Space and Transnational Identities: The British in South Africa

This timely text explores the lives, histories and identities of white British-born immigrants in South Africa, twenty years after the post-apartheid Government took office. Drawing on over sixty in depth biographical interviews and ethnographic work in Johannesburg, Pietermaritzburg and Cape Town, Daniel Conway and Pauline Leonard analyse how British immigrants' relate to, participate in and embody South Africa's complex racial and political history. Through their everyday lives, political and social attitudes, relationships with the places and spaces of South Africa, as well as their expectations of the future, the complexities of their transnational, raced and classed identities and senses of belonging are revealed. Migration, Space and Transnational Identities makes an important contribution to sociological, geographical, political and anthropological debates on transnational migration, whiteness, Britishness and lifestyle, tourism and labour migration.

History of Electrex 1950-1993

Electrex developed from a small exhibition at the start of the 1950s into the top electrotechnical exhibition of products and related services in the UK by the 1990s. Its emergence reflected a complex relationship with the key trade association, BEAMA (the British Electrical and Allied Manufacturers' Association). This history places this development in a wider context marked by the disappearance of the British Industries Fair in the 1950s, the entry to Europe and the establishment of the National Exhibition Centre in Birmingham. In the process it is also a rare case study of the under-explored business histories of exhibitions, as well as casting light on the changing post-war fortunes of the British electrical industries.