Pro re nata medication for psychoses: the knowledge and beliefs of doctors and nurses

Objective: To examine the knowledge and beliefs of doctors and nurses in inpatient psychiatric units about pro re nata (PRN) (as needed) medications for psychotic disorders. Methods: Medical (n = 44) and nursing (n = 80) staff in two metropolitan public hospital units completed a structured questionnaire about their use of PRN psychotropic medications on one occasion during the four months from March-June 1999. Results: Nurses selected more indications for PRN antipsychotics than doctors (3.49 vs 2.72, p < 0.05), whereas doctors selected more indications for PRN benzodiazepines (3.77 vs 3.19, p < 0.05). The groups did not differ in the number of selected indications for using anticholinergics. For agitation, the majority of nurses viewed both benzodiazepines (56%) and antipsychotics (86%) as effective, with 60% preferring an antipsychotic. For the acute control of psychotic symptoms, 99% of nurses believed antipsychotics were effective and 58% benzodiazepines, with 87% preferring an antipsychotic. A large majority of doctors viewed both PRN benzodiazepines, 94% ,and antipsychotics, 81%, as effective for agitation, and 55% preferred to use a benzodiazepine. For psychotic symptoms, 80% believed PRN antipsychotics were effective, but only 32% viewed benzodiazepines as effective, and 64% preferred to use an antipsychotic. Nursing staff identified more non-pharmacological techniques for managing both agitation and psychotic symptoms and reported using these more often than doctors. Junior staff, both nursing and medical, had less knowledge of non-pharmacological alternatives to PRN medication than senior staff. Conclusions: Disparities existed between doctors and nurses views on the indications for PRN medication in the acute management of psychoses, thus it is important for doctors to specify indications when writing PRN prescriptions. Despite evidence for the safety and effectiveness of benzodiazepines, there was widespread reluctance to use them as PRN medication in acute psychoses. Beliefs of some staff about PRN medications were at odds with the known properties of these medicines. Educational interventions for both nurses and doctors are required to achieve best practice in PRN medication.

The politics of reintegrating Australian Aboriginal and American Indian indigenous knowledge into resource management: The dynamics of resource appropriation and cultural revival

As the United States and Australia struggle with contemporary crises over competing uses of rapidly depleting natural resources, there are striking parallels between American Indian and Australian Aboriginal communities demanding a place at the management table and offering culturally based understandings of and solutions for the ecosystems at risk. These efforts to integrate indigenous knowledge into mainstream natural resource management are part of larger legal and political debates over land tenure, the locus of control, indigenous self-governance, and holistic ecosystems management.

Local complexity of Delone sets and crystallinity

This paper characterizes when a Delone set X in R-n is an ideal crystal in terms of restrictions on the number of its local patches of a given size or on the heterogeneity of their distribution. For a Delone set X, let N-X (T) count the number of translation-inequivalent patches of radius T in X and let M-X (T) be the minimum radius such that every closed ball of radius M-X(T) contains the center of a patch of every one of these kinds. We show that for each of these functions there is a gap in the spectrum of possible growth rates between being bounded and having linear growth, and that having sufficiently slow linear growth is equivalent to X being an ideal crystal. Explicitly, for N-X (T), if R is the covering radius of X then either N-X (T) is bounded or N-X (T) greater than or equal to T/2R for all T > 0. The constant 1/2R in this bound is best possible in all dimensions. For M-X(T), either M-X(T) is bounded or M-X(T) greater than or equal to T/3 for all T > 0. Examples show that the constant 1/3 in this bound cannot be replaced by any number exceeding 1/2. We also show that every aperiodic Delone set X has M-X(T) greater than or equal to c(n)T for all T > 0, for a certain constant c(n) which depends on the dimension n of X and is > 1/3 when n > 1.

Estimating and evaluating the statistics of gapped local-alignment scores

We present a novel maximum-likelihood-based algorithm for estimating the distribution of alignment scores from the scores of unrelated sequences in a database search. Using a new method for measuring the accuracy of p-values, we show that our maximum-likelihood-based algorithm is more accurate than existing regression-based and lookup table methods. We explore a more sophisticated way of modeling and estimating the score distributions (using a two-component mixture model and expectation maximization), but conclude that this does not improve significantly over simply ignoring scores with small E-values during estimation. Finally, we measure the classification accuracy of p-values estimated in different ways and observe that inaccurate p-values can, somewhat paradoxically, lead to higher classification accuracy. We explain this paradox and argue that statistical accuracy, not classification accuracy, should be the primary criterion in comparisons of similarity search methods that return p-values that adjust for target sequence length.

The trematodes of groupers (Serranidae : Epinephelinae) knowledge, nature and evolution

Groupers (Epinephelinae) are prominent marine fishes distributed in the warmer waters of the world. Review of the literature suggests that trematodes are known from only 62 of the 159 species and only 9 of 15 genera; nearly 90% of host-parasite combinations have been reported only once or twice. All 20 families and all but 7 of 76 genera of trematodes found in epinephelines also occur in non-epihephelines. Only 12 genera of trematodes are reported from both the Atlantic-Eastern Pacific and the Indo-West Pacific. Few (perhaps no) species are credibly cosmopolitan but some have wide distributions across the Indo-West Pacific. The hierarchical 'relatedness' of epinephelines as suggested by how they share trematode taxa (families, genera, species) shows little congruence with what is known of their phylogeny. The major determinant of relatedness appears to be geographical proximity. Together these attributes suggest that host-parasite coevolution has contributed little to the evolution of trematode communities of epinephelines. Instead, they appear to have arisen through localized episodes of host-switching, presumably both into and out of the epinephelines. The Epinephelinae may well be typical of most groups of marine fishes both in the extent to which their trematode parasites are known and in that, apparently, co-evolution has contributed little to the evolution of their communities of trematodes.

Children's body knowledge: Understanding 'life' as a biological goal

Two studies assessed the development of children's understanding of life as a biological goal of body functioning. In Study 1, 4-to-10-year-old children were given an interview consisting of a series of structured questions about the location and function of various body organs. Their responses were coded both for factual correctness and for appeals to the goal of maintaining life. The results showed a gradual increase in children's factual knowledge across this age range but an abrupt increase in appeals to life between the ages of 4 and 6. Analyses of the 4-year-olds' responses suggested that appeals to life were associated with increased knowledge of organ function, but not of organ location. Study 2 was designed to replicate the pattern found in Study I. A continuous sample of 4-to 5-year-old children was administered an abbreviated version of the interview from Study 1. Children's understanding of life as a biological goal was again found to be predictive of their knowledge of organ function, but not of organ location. These results indicate a reorganization in children's understanding of the body between the ages of 4 and 6, which coincides with children's discovery of 'life' as a biological goal for bodily function.