Home based care and standard hospital care for patients with severe mental illness: a randomised controlled trial.

OBJECTIVE--To compare the efficacy of home based care with standard hospital care in treating serious mental illness. DESIGN--Randomised controlled trial. SETTING--South Southwark, London. PATIENTS--189 patients aged 18-64 living in catchment area. 92 were randomised to home based care (daily living programme) and 97 to standard hospital care. At three months'' follow up 68 home care and 60 hospital patients were evaluated. MAIN OUTCOME MEASURES--Use of hospital beds, psychiatric diagnosis, social functioning, patients'' and relatives'' satisfaction, and activity of daily living programme staff. RESULTS--Home care reduced hospital stay by 80% (median stay six days in home care group, 53 days in hospital group) and did not increase the number of admissions compared with hospital care. On clinical and social outcome there was a non-significant trend in favour of home care, but both groups showed big improvements. On the global adjustment scale home care patients improved by 26.8 points and the hospital group by 21.6 points (difference 5.2; 95% confidence interval -1.5 to 12). Other rating scales showed similar trends. Home care patients required a wide range of support in areas such as housing, finance, and work. Only three patients dropped out from the programme. CONCLUSIONS--Home based care may offer some slight advantages over hospital based care for patients with serious mental illness and their relatives. The care is intensive, but the low drop out rate suggests appreciation. Changes to traditional training for mental health workers are required.     

The discovery and preclinical evaluation of BMS-707035, a potent HIV-1 integrase strand transfer inhibitor

BMS-707035 is an HIV-1 integrase strand transfer inhibitor (INSTI) discovered by systematic optimization of N-methylpyrimidinone carboxamides guided by structure-activity relationships (SARs) and the single crystal X-ray structure of compound 10. It was rationalized that the unexpectedly advantageous profiles of N-methylpyrimidinone carboxamides with a saturated C2-substitutent may be due, in part, to the geometric relationship between the C2-substituent and the pyrimidinone core. The single crystal X-ray structure of 10 provided support for this reasoning and guided the design of a spirocyclic series 12 which led to discovery of the morpholino-fused pyrimidinone series 13. Several carboxamides derived from this bicyclic scaffold displayed improved antiviral activity and pharmacokinetic profiles when compared with corresponding spirocyclic analogs. Based on the excellent antiviral activity, preclinical profiles and acceptable in vitro and in vivo toxicity profiles, 13a (BMS-707035) was selected for advancement into phase I clinical trials.     

Tracking elusive cargo: Illuminating spatio‐temporal Type 3 effector protein dynamics using reporters

Type 3 secretion systems form an integral part of the arsenal of many pathogenic bacteria. These injection machines, together with their cargo of subversive effector proteins, are capable of manipulating the cellular environment of the host in order to ensure persistence of the pathogen. In order to fully appreciate the functions of Type 3 effectors, it is necessary to gain spatio‐temporal knowledge of each effector during the process of infection. A number of genetic modifications have been exploited in order to reveal effector protein secretion, translocation and subsequent activity, and localisation within host cells. In this review, we will discuss the many available approaches for tracking effector protein dynamics and discuss the challenges faced to improve the current technologies and gain a clearer picture of effector protein function.     

Postharvest disinfestation of diapausing and non-diapausing twospotted spider mite (Tetranychus urticae) on persimmons: hot water immersion and coolstorage

The mortality response of diapausing and non-diapausing twospotted spider mite (Tetranychus urticae Koch) on persimmons to hot water immersion treatments between 44 and 54 °C was examined, for potential as a quarantine treatment. The mean immersion time for mean 99% mortality (LT₉₉) of diapausing mites at 44 °C was 211 min, and this time decreased with increasing temperature to 3.6 min at 54 °C. Non-diapausing mites were found to be less tolerant to temperatures below 48 °C, with an estimated LT₉₉ of 102 min at 44 °C, but had similar thermotolerance above 48 °C. In 47 °C water the immersion time required to kill 99% of diapausing mites was estimated at 67 min. This time was not reduced by subsequent coolstorage at 0 °C for up to eight weeks. Rather, coolstorage had the effect of keeping mites alive, relative to LT₉₉ estimates calculated for mites stored at 20 °C. Similarly the thermotolerance of mites did not change with increased time in diapause, even though mites in diapause for 12 weeks had high control mortality. Hot water immersion appears to be a potentially useful disinfestation method for persimmons.     

Patterns of movement and habitat use by leafy seadragons tracked ultrasonically

Nine adult leafy seadragons Phycodurus eques were tracked using ultrasonic telemetry for between 2-10 days around West Island, Australia. All fish except one moved within well-defined home ranges of up to 5 ha (using minimum convex polygon method). Short bursts of movement (at average velocities of 2-17 m h⁻¹) punctuated long periods (up to 68 h) without movement. The exceptional fish moved almost in a straight line away from its tagging location near the end of the tracking period, at a maximum velocity of 146 m h⁻¹. There was no constant diel pattern in movements; some fish moved more at night, others during the day. The time leafy seadragons spent over particular habitats compared to the area of those habitats available at the study site was greater for Posidonia seagrass, about as expected for kelp-covered reefs and bare sand patches, and less than expected for Amphibolis seagrass and boulders covered with brown algae. In searching for tagging effects, a comparison of movement immediately after tagging showed no difference with subsequent movements for most fish. The lack of tagging effect may be because the transmitter can be attached to the bony appendages away from the body of the fish. There was no sign of damage to fish upon removal of transmitters after tracking.