Effect of closing facilities on electroconvulsive therapy use in Glasgow

<p>Objectives: To assess the effect of closure of electroconvulsive therapy (ECT) centers on ECT use. Electroconvulsive therapy remains a recommended and effective treatment for mental disorders. Declining rates of ECT use in the United Kingdom have been observed over the last 20 years with anecdotal observations that use has declined as the result of centralization of provision. In Glasgow, there have been site closures in the north with no such rationing taking place in the south.</p> <p>Methods: A naturalistic retrospective survey of the number of ECT courses commenced each year in Glasgow, with a comparison made between the north and the south of the city. Data were available from 1996 to 2008.</p> <p>Results: Our analysis showed no change in the mean number of ECT courses commenced in southern AQ2 Glasgow (period 1, 42.25; period 2, 41.83; period 3, 31; F = 1.369; P = 0.298). There was a significant reduction in the mean number of ECT treatments commenced in northern Glasgow (period 1, 91.25; period 2, 51; period 3, 33.33; F = 10.06; P = 0.04).</p> <p>Conclusions: In northern Glasgow, where there have been 2 site closures since 1996, ECT use has declined. This trend was not replicated in the south of the city. This would suggest that the closure of ECT centers does reduce the use of ECT. However, there may be a number of confounding variables that could not be factored into the analysis because of lack of available data.</p&gt

Attitudes towards mental illness in Malawi: a cross-sectional survey

<p><b>Background:</b> Stigma and discrimination associated with mental illness are strongly linked to suffering, disability and poverty. In order to protect the rights of those with mental disorders and to sensitively develop services, it is vital to gain a more accurate understanding of the frequency and nature of stigma against people with mental illness. Little research about this issue has been conducted in sub Saharan Africa. Our study aimed to describe levels of stigma in Malawi.</p> <p><b>Method:</b> A cross-sectional survey of patients and relatives attending mental health and non-mental health related clinics in a general hospital in Blantyre, Malawi. Subjects were interviewed using an adapted version of the questionnaire developed for the World Psychiatric Association Program to Reduce Stigma and Discrimination Because of Schizophrenia.</p> <p><b>Results:</b> 210 subjects participated in our study. Most attributed mental disorder to alcohol and illicit drug abuse (95%). This was closely followed by brain disease (92.8%), spirit possession (82.8%) and then psychological trauma (76.1%). There were some associations found between demographic variables and single question responses, however no consistent trends were observed in stigmatising beliefs. These results should be interpreted with caution and in the context of existing research. Contrary to the international literature, having direct personal experience of mental illness seemed to have no positive effect on stigmatising beliefs in our sample.</p> <p><b>Conclusions:</b> Our study contributes to an emerging picture that individuals in sub Saharan Africa most commonly attribute mental illness to alcohol/ illicit drug use and spiritual causes. Our work adds weight to the argument that stigma towards mental illness is an important global health and human rights issue.</p&gt

Chemokines in depression in health and in inflammatory illness: a systematic review and meta-analysis

Inflammatory illness is associated with depression. Preclinical work has shown that chemokines are linked with peripheral–central crosstalk and may be important in mediating depressive behaviours. We sought to establish what evidence exists that differences in blood or cerebrospinal fluid chemokine concentration discriminate between individuals with depression and those without. Following PRISMA guidelines, we systematically searched Embase, PsycINFO and Medline databases. We included participants with physical illness for subgroup analysis, and excluded participants with comorbid psychiatric diagnoses. Seventy-three studies met the inclusion criteria for the meta-analysis. Individuals with depression had higher levels of blood CXCL4 and CXCL7 and lower levels of blood CCL4. Sensitivity analysis of studies with only physically healthy participants identified higher blood levels of CCL2, CCL3, CCL11, CXCL7 and CXCL8 and lower blood levels of CCL4. All other chemokines examined did not reveal significant differences (blood CCL5, CCL7, CXCL9, CXCL10 and cerebrospinal fluid CXCL8 and CXCL10). Analysis of the clinical utility of the effect size of plasma CXCL8 in healthy individuals found a negative predictive value 93.5%, given the population prevalence of depression of 10%. Overall, our meta-analysis finds evidence linking abnormalities of blood chemokines with depression in humans. Furthermore, we have demonstrated the possibility of classifying individuals with depression based on their inflammatory biomarker profile. Future research should explore putative mechanisms underlying this association, attempt to replicate existing findings in larger populations and aim to develop new diagnostic and therapeutic strategies

The envirome and the connectome: exploring the structural noise in the human brain associated with socioeconomic deprivation

Complex cognitive functions are widely recognized to be the result of a number of brain regions working together as large-scale networks. Recently, complex network analysis has been used to characterize various structural properties of the large scale network organization of the brain. For example, the human brain has been found to have a modular architecture i.e. regions within the network form communities (modules) with more connections between regions within the community compared to regions outside it. The aim of this study was to examine the modular and overlapping modular architecture of the brain networks using complex network analysis. We also examined the association between neighborhood level deprivation and brain network structure – modularity and grey nodes. We compared network structure derived from anatomical MRI scans of 42 middle-aged neurologically healthy men from the least (LD) and the most deprived (MD) neighborhoods of Glasgow with their corresponding random networks. Cortical morphological covariance networks were constructed from the cortical thickness derived from the MRI scans of the brain. For a given modularity threshold, networks derived from the MD group showed similar number of modules compared to their corresponding random networks, while networks derived from the LD group had more modules compared to their corresponding random networks. The MD group also had fewer grey nodes – a measure of overlapping modular structure. These results suggest that apparent structural difference in brain networks may be driven by differences in cortical thicknesses between groups. This demonstrates a structural organization that is consistent with a system that is less robust and less efficient in information processing. These findings provide some evidence of the relationship between socioeconomic deprivation and brain network topology

Resting state connectivity and cognitive performance in adults with cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy

Cognitive impairment is an inevitable feature of cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), affecting executive function, attention and processing speed from an early stage. Impairment is associated with structural markers such as lacunes, but associations with functional connectivity have not yet been reported. Twenty-two adults with genetically-confirmed CADASIL (11 male; aged 49.8 ± 11.2 years) underwent functional magnetic resonance imaging at rest. Intrinsic attentional/executive networks were identified using group independent components analysis. A linear regression model tested voxel-wise associations between cognitive measures and component spatial maps, and Pearson correlations were performed with mean intra-component connectivity z-scores. Two frontoparietal components were associated with cognitive performance. Voxel-wise analyses showed an association between one component cluster and processing speed (left middle temporal gyrus; peak −48, −18, −14; ZE = 5.65, pFWEcorr = 0.001). Mean connectivity in both components correlated with processing speed (r = 0.45, p = 0.043; r = 0.56, p = 0.008). Mean connectivity in one component correlated with faster Trailmaking B minus A time (r = −0.77, p < 0.001) and better executive performance (r = 0.56, p = 0.011). This preliminary study provides evidence for associations between cognitive performance and attentional network connectivity in CADASIL. Functional connectivity may be a useful biomarker of cognitive performance in this population

Investigation of Founder Effects for the Thr377Met Myocilin Mutation in Glaucoma Families from Differing Ethnic Backgrounds

Purpose: The aim of this study was to determine if there is a common founder for the Thr377Met myocilin mutation in primary open angle glaucoma (POAG) families with various ethnic backgrounds. Methods: Genomic DNA of 24 POAG-affected individuals from nine pedigrees with the Thr377Met mutation and 104 unaffected family members was genotyped with six microsatellite markers and four single nucleotide polymorphisms. The families were from Greece, India, Finland, the USA, and Australia. To assess the degree of linkage disequilibrium across MYOC in the general population we also investigated data generated from the HapMap consortium. Results: Three distinct haplotypes associated with the Thr377Met myocilin mutation were identified. The families from the USA and Greece, as well as the three Australian families originating from Greece and the former Yugoslavian Republic of Macedonia had one common haplotype. Interestingly, however, HapMap data suggest that linkage disequilibrium across MYOC was not strong. Conclusions: The Thr377Met myocilin mutation has arisen at least three separate times. Evidence for genetic founder effects in this prevalent age-related, yet heterogeneous, disease has important implications for future gene identification strategies

Optimization of Islanded Microgrid Operation

Presently a lot of effort is being deployed in the area of microgrid development. In this aspect, the work presented here is in the direction of developing and coordinating various operational modules in an isolated microgrid system. The work presented in this report looks at the prospects of incorporating a consumer side load-scheduling algorithm that works in conjunction with the unit commitment and economic load dispatch. The unit commitment and economic load dispatch are run a day in advance to determine generator outputs for the following day. From the microgrid operator point of view, the load side scheduling helps reduce the stress on the system especially during peak hours thereby ensuring system stability and security. From the consumers’ point of view, the dynamic electricity prices within a day, which are a reflection of this time varying stress on the system, encourage them to endorse such a scheme and reduce their bills incurred. Owing to unpredictable weather conditions, running unit commitment and economic load dispatch in advance does not guarantee planned real-time generation in the microgrid scenario. Such variability in forecasted generation must be handled in any microgrid, while accounting for load demand uncertainties. To address this issue a load side energy management system and power balance scheme is proposed in this paper. The objective is to ascertain uninterrupted power to critical loads while managing other non-critical loads based on their priorities

Fault Tolerant Power Balancing Strategy in an Isolated Microgrid via Optimization

The increasing penetration of renewable energy generation (REG) in t he m icrogrid paradigm has brought with it larger uncertainty in the scheduled generation. This along with the inevitable variation between actual load and for ecasted load has further accentuated the issue of real - time power balancing. With the advent of sm art loads and meters supported by advanced communication technologies , several new possibilities for demand side management have opened up . In this paper , a real time optimization strategy for load side energy management system (EMS) and for power balance is proposed. The proposed strategy achieves power balance by optimizing load reduction . The objective is to ascertain uninterrupted power to critical loads and reduce non - critical loads depending on the priorities for various loads. To further enhance the flexibility of the system, the addition of a battery to the management model is also discussed. The proposed algorithm also makes the system tolerant to possible generator failures if battery is added to the system. The effectiveness of the proposed online power balancing strategy via optimization is demonstrated through various simulation case studies