Colwyn Bay Community Hospital

OBJECTIVE: This article reviews obsessive-compulsive disorder (OCD) following acquired brain injury. OCD type symptomatology without any other cognitive, behavioral, or emotional problems following a brain injury appears to be rare. However, the first onset of obsessions and compulsions following a brain injury has been described, but cognitive impairments can potentially color the presentation. METHOD: This article reviews obsessive-compulsive disorder (OCD) after brain injury, including traumatic brain injury, cerebrovascular accidents, brain tumors and brain infections. Overlapping symtomatology between OCD and brain injury is discussed. RESULTS: Findings regarding the neuro-imaging of OCD after brain injury are reviewed and integrated with neuropsychological data from studies with idiopathic OCD. CONCLUSION: There appears to be some convergance between findings from studies of the neuropsychology of idiopathic OCD and neuro-imaging of OCD following brain injury.

OBJECTIVE: Despite clinical observation that stroke survivors frequently experience loneliness, there is no large-scale empirical evidence to support this observation. Therefore, the primary objective of this research was to provide the first large-scale and comprehensive estimate of loneliness in the stroke survivor population. METHOD: To address this issue, we completed two preregistered analyses of a nationally representative annual survey (N > 21,000). A two-phase approach was adopted combining both exploratory (Study 1) and confirmatory (Study 2) phases. The benefit of such an approach is that replication is built into the design, which considerably strengthens the inferences that can be made. RESULTS: Across two separate cohorts, the results consistently showed that human stroke survivors report higher levels of loneliness compared with healthy individuals, and this relationship could not be accounted for by demographic factors (e.g., age, sex) or objective measures of social isolation (e.g., marital status, number of household members). CONCLUSIONS: These findings demonstrate that elevated levels of loneliness poststroke are robust in that they replicate in large nationally representative samples and cannot be reduced to objective measures of social isolation. The work has clinical and societal relevance by suggesting that loneliness poststroke is unlikely to be adequately "treated" if only the quantity and not the quality of social experiences are considered.

Many persons with traumatic brain injury (TBI) are young adults who, prior to their TBI, were in paid employment. Psychosocial outcome after TBI, for many, remains poor. This includes low rates of return to pre-injury work or education, among others. This qualitative study explored the experience of return to work (RTW) rehabilitation with 10 individuals who sustained TBI. Data were collected from semi-structured interviews. Transcripts were analysed using interpretative phenomenological analysis (IPA). Some of the main findings from this study included the following: Individuals find the RTW experience difficult and painful. They experience a distinct grief reaction in the process of exploring re-engagement in occupation following TBI. In view of these and other findings, changes to RTW rehabilitation should be considered to facilitate the optimal support for patients with TBI engaging in the RTW rehabilitation process.

Slight attention was paid to the epidemiology of congenital malformations before the discovery that exposure of the mother to infection by rubella during early pregnancy could affect the development of the fetus (Gregg, 1941; Swan, Moore, Mayo and Black, 1943). Most malformations had been looked upon as inevitable happenings due to faults of development which were outside the scope of preventive medicine. Increasing use of X rays during pregnancy and studies of background radiation then suggested that these might be concerned in initiating malforma tions, and in 1959 a study was published associating their incidence in parts of New York State with natural radiation from the ground (Gentry, Park hurst and Bulin, 1959). Subsequent work has not, however, so far established the existence of any significant association with background radiation arising from either soil or water supply. In 1968 Laurence, Carter and David reported a thorough investigation of the possible factors which might be concerned in the incidence of 835 cases of congenital malformation of the central nervous system discovered among births occurring during 1956-62 in the mining valleys of Glamorgan and Monmouth and the Vale of Glamorgan. Local variations in the incidence rates of such malforma tions were compared with geological features, water supplies, rainfall, sunshine, background radiation, radioactive fall-out and population density but none of these factors seemed to account for the differences. The only pregnancy factor with evident significance was an increased incidence of influenza. The incidence rate per 1,000 live and stillbirths found in this South Wales survey for anencephaly, spina bifida and hydrocephalus malformations was 8-1, similar to that found in Liverpool (7-4) by Smithells (1962) and in Belfast (8-3) by Stevenson and Warnock (1959). Lower incidence rates had been found in population surveys elsewhere. A nation-wide survey of perinatal mortality resulting from 7,117 singleton births and com prising deaths in the first four weeks of life and stillbirths, which occurred in Great Britain in March to May 1958, was carried out by the National Birthday Trust (Butler and Bonham, 1963). This yielded some 500 congenital malformations of all kinds, but the total was insufficient for assessment of significant differences in incidence in the separate regions. By the registration of causes of stillbirth based on certification according to the International List it becomes possible to bring together for each sex in 1963-66 the prenatal deaths from each kind of neural tube malformation (rubrics Y 38-0 anencephaly, Y 38-1 hydrocephalus, Y 38*2 spina bifida), with all other congenital malformations (Y 38*3?Y 38-7) and postnatal deaths from corresponding causes at ages under 1 year and at 1-4 years in categories 750-752 and 753-759. In 1963-66 there were 24,458 stillbirths and deaths at 0-1 year assigned to these numbers arising from three and a half million live and stillbirths in all, and the various rates for each sex have been calculated in the present paper for each Hospital Region in the hope that geogra phical variations will provide some clue to the causes of malformations, particularly those of the neural tube. The total incidence of malformations in infants is not fully revealed by the deaths classified to them as underlying cause, since some affected children die of concomitant causes and others continue to live with the disability, but within England and Wales, where the rules and procedure of certification are tolerably constant, one can assume that regional rates compounded of prenatal and postnatal deaths are comparable with each other though lower than total incidence rates derived from surveys. In the final section of the paper the various regional distributions are compared with those for mortality of females from cardiovascular diseases, and other conditions for which there are indications of a 'water factor' apparently related to hardness of local water supplies (Morris, Crawford and Heady, 1961; Crawford, Gardner and Morris, 1968). 67

Background Individuals with intellectual disability are at higher risk of premature death compared with individuals without intellectual disability, and therefore parents of people with intellectual disability are more likely to outlive their children. However, there has been relatively little research investigating the bereavement experiences of parents of deceased children with intellectual disability. Method Semi‐structured interviews were used to explore the experiences of nine mothers whose child with intellectual disability had died. The transcripts were analysed qualitatively using Interpretative Phenomenological Analysis. Results Five themes emerged from the analysis: loss, benefit finding, coping, sources of support and medical relationships. An analysis of the accounts indicated similarities and differences between the experiences of the mothers. In particular, continuing in their caring role by working within the world of intellectual disability following the death of their child was important to all of the mothers. Support from similarly bereaved parents was the most useful source of support, although it was not always readily accessible. Conclusions Implications for theory and practice are described including suggestions that service providers should aim to maintain links with families after the death of their child, a parent‐to‐parent programme that enables parents to contact others in a similar situation might be beneficial, and further research into the functions of coping strategies and supports in loss would be worthwhile.

Psychotherapy is now an approach used within several models of neurorehabilitation. However, a core theoretical model to guide psychotherapeutic practice is lacking. This article attempts to illustrate how the Generic Model of Psychotherapy of Orlinsky and Howard, which emphasizes the common factors shared by many psychotherapies, can be applied in neurorehabilitation settings. A case report is presented to illustrate how this model can potentially inform psychotherapeutic practice. The use of a theoretical model to underpin psychotherapeutic interventions in neurorehabilitation settings has the potential to facilitate our understanding of the psychotherapeutic process following traumatic brain injury in this evolving area of professional practice.

The shale‐gas potential of mid‐Carboniferous mudrocks in the Bowland‐Hodder unit in the Cleveland Basin (Yorkshire, northern England) was investigated through the analysis of a cored section from the uppermost part of the unit in the Malton‐4 well using a multidisciplinary approach. Black shales are interbedded with bioturbated and bedded sandstones, representing basinal‐offshore to prodelta – delta‐front lithofacies. The total organic carbon (TOC) content of the shales ranges from 0.37 to 2.45 wt %. Rock‐Eval pyrolysis data indicate that the organic matter is mainly composed of Type III kerogen with an admixture of Type II kerogen. T max (436–454°C), 20S/(20S+20R) C 29 sterane ratios, and vitrinite reflectance values indicate that organic matter is in the mid‐ to late‐ mature (oil) stage with respect to hydrocarbon generation. Sedimentological and geochemical redox proxies suggest that the black shales were deposited in periodically oxic‐dysoxic and anoxic bottom waters with episodic oxic conditions, explaining the relatively low TOC values. The Rock‐Eval parameters indicate that the analysed mudrocks have a limited shale‐gas potential. However, burial and thermal history modelling, and VR r data from other wells in the region, indicate that where they are more deeply‐buried, the Bowland‐Hodder shales will be within the gas window with VR r > 1.1 % at depths in excess of 2000 m. Therefore although no direct evidence for a high shale‐gas potential in the Cleveland Basin has been found, this cannot be precluded at greater depths especially if deeper horizons are more organic rich.

Aims and Method Outcome measurement has become increasingly important in brain injury rehabilitation. Health of the Nation Outcome Scale-Acquired Brain Injury (HoNOS–ABI) is a new outcome measure targeting psychiatric and other sequelae of brain injury. Forty patients' scores on three outcome measures and other ecologically valid markers of outcome were compared. Results Significant correlation coefficients between HoNOS–ABI and two other outcome measures were found. Post-injury employment status correlated with HoNOS–ABI rating. Although there was a significant increase in need for psychiatric intervention following brain injury, this did not correlate with HoNOS–ABI ratings. Clinical Implications HoNOS–ABI may be a useful additional measure of outcome following brain injury, specifically identifying the often missed psychiatric sequelae of a brain injury.

Chapter One: Introduction.- Chapter Two: The Rise and Rise of the Marine Reserves 'Bandwagon.- Chapter Three: Bibliometric Test of the MR 'Bandwagon'.- Chapter Four: Bias in the Peer-Reviewed Literature, and Crossing the Science/Policy Divide.- Chapter Five: Critique of the Scientific Evidence for Fisheries Benefits of MRs.- Chapter Six: Case study of the 'English Patient'.- Chapter Seven: Conclusion.

PRIMARY OBJECTIVE: To investigate the utility of feedback of brain-imaging findings as an intervention for improving impaired awareness, depression and anxiety levels. RESEARCH DESIGN AND METHODS: A prospective within-subjects repeated measures design was used with an intervention sample of 17 adults with acquired brain injury. Baseline and post-intervention measures included self-report and questionnaire-based self-awareness instruments and self-report questionnaires for depression and anxiety. Participants also completed a range of neuropsychological tests. INTERVENTION: The intervention consisted of a session where a Consultant Neurologist explained the findings of brain scans in terms of pathological findings and possible neurobehavioural outcome. RESULTS: Scores on measures of unawareness and two of three mood measures decreased significantly following the intervention. This improvement was maintained at 2-week follow-up. CONCLUSION: Individuals with an acquired brain injury may benefit from a feedback procedure where the findings of brain scans are presented.

One of the major sequelae following traumatic brain injury is a change in employment status. This poses significant challenges for rehabilitation services. Several studies have investigated the longer-term outcome after traumatic brain injury. Longer-term outcome in an economically disadvantaged rural environment with limited rehabilitation services has not been studied extensively. A group of individuals (n = 65) who sustained a traumatic brain injury were compared regarding pre- and post-employment status. The moderate and severely injured sub-groups showed a significant change in employment status. Ideally rehabilitation programs should target re-employment as an outcome. Limited employment opportunities in rural areas may make this more difficult to achieve.

Relative rates of proportionate mortality from cancer of six sites based on total cancer deaths and the proportions expected in all towns, and from four types of cardiovascular disease based on total deaths from all causes, have been related in the 80 county boroughs of England and Wales to the sources of water supply and to the average hardness of water in the towns. The sources of water, from upland surfaces, artesian wells and rivers, were classified in eight groups, and significant associations were found for cancers of the stomach, oesophagus, prostate, male bladder and female breast, and for hypertensive and chronic rheumatic heart disease. No associations were apparent with intestinal cancer, vascular disease of the nervous system or arteriosclerotic heart disease. Hardness or softness of the water was classified in seven groups and significant associations were found for the same diseases as for source of water, none being evident for coronary disease.

Arsenic is a very common by-product of the processing of Cu, Au and polymetallic ores worldwide, where the ore is roasted (calcined) to remove volatile elements. In southwest England, a diverse range of As-mineral species occur as efflorescent secondary mineral growths on historic calciner buildings. Gypsum occurs as abundant dendritic growths comprising either interlocking blades or tabular crystals. Ca-arsenate minerals are locally very abundant as white colloform masses. Positively identified Ca arsenates include pharmacolite, weilite and haidingerite. Other secondary minerals include arsenolite, scorodite, bukovskyite and an As-bearing potassium alum, together with a wide variety of unidentified minerals, including an Al-As-S phase and As-rich F-bearing phases. Gypsum contains As concentrations up to ~7 wt.%. Efflorescent growth at sites exposed to the prevailing weather systems is less abundant than at sheltered sites. This is interpreted as being due to ‘pressure washing’ of exposed sites by driving rain. Successive concentric growths of gypsum and Ca arsenate on masonry are interpreted as being the result of seasonal crystallization. Understanding both current and historicalmining and mineralprocessing methods is criticalin the evaluation of the potential impact on the modern environment. In particular, due to the abundance of As-bearing minerals in a wide range of ore types, many buildings worldwide are potentially significantly contaminated with As even though few are directly related to As production or handling. Characterizing the secondary As mineralspecies present at mine and mineralprocessing sites is critical in understanding the potentialheal th risk these sites might pose.

This outcome study investigated the effectiveness of community based multi-disciplinary neuro-rehabilitation for persons with a traumatic brain injury (TBI) at varying times since injury. From case records all persons with a (TBI) who had two-point outcome data (European Brain Injury Questionnaire) available (n=55) were identified and included in this study. Significantly improved outcome on self-rating were observed for the group, not only for those less than 2 years post-injury, but also for those more than 2 years after (TBI). Family/care ratings also confirmed improved outcome, except for the group of patients who were more than 2 years post-(TBI).

Although memory for spatial location has been frequently investigated with mentally retarded populations, it is not clear that these individuals possess the same spatial memory skills as do their peers without mental retardation. We compared 30 persons with and 30 persons without mental retardation. Following either intentional or incidental learning, participants recalled and then relocated 16 objects on a matrix. The control group recalled more intentionally learned than incidentally learned material. The experimental group performed both tasks better after incidental learning than after intentional learning and scored as highly as the controls on incidental spatial memory. Results suggest that memory for spatial location is an automatic process and, to some extent at least, is not directly affected by the individual's level of intelligence.

Seasonal underground hydrogen storage (UHS) in porous media provides an as yet untested method for storing surplus renewable energy and balancing our energy demands. This study investigates the technical suitability for UHS in depleted hydrocarbon fields and one deep aquifer site in Taranaki Basin, Aotearoa New Zealand. Prospective sites are assessed using a decision tree approach, providing a “fast-track” method for identifying potential sites, and a decision matrix approach for ranking optimal sites. Based on expert elicitation, the most important factors to consider are storage capacity, reservoir depth, and parameters that affect hydrogen injectivity/withdrawal and containment. Results from both approaches suggest that Paleogene reservoirs from gas (or gas cap) fields provide the best option for demonstrating UHS in Aotearoa New Zealand, and that the country’s projected 2050 hydrogen storage demand could be exceeded by developing one or two high ranking sites. Lower priority is assigned to heterolithic and typically finer grained, labile and, clay-rich Miocene oil reservoirs, and to deep aquifers that have no proven hydrocarbon containment.

Emotional difficulties, such as anxiety and depression, are common after acquired brain injury in adults and can influence long-term outcome. Diagnosis in a brain injury context can be difficult. Ideally, rehabilitation approaches should consider the specific treatment of anxiety and depression as well and may include pharmacotherapy, individual psychotherapy, and family interventions. Psychotherapy, especially in regards to longer-term adjustment to brain injury, may have an important adjunctive role in treatment approaches, but adaptations of techniques may be needed. A clinical pathway is described which can help to raise clinicians awareness, as well as increase detection rates and consideration of the specific role of individual psychotherapy in this clinical population. However, an important caveat is that clinical pathways should not serve as a substitute, but rather a facilitator, for the process of reasoning about individual patients in everyday clinical practice.

OPINION article Front. Integr. Neurosci., 14 July 2022 https://doi.org/10.3389/fnint.2022.883746

Background: Delusional infestation (DI) is a well-recognised delusional disorder presenting as the persisting belief in the presence of parasitic or other infestations. Combined clinics have been run by dermatology and psychiatry in a small number of centres. Here we report the first few years of a unique combined clinic run with experts in infectious diseases/tropical medicine and psychiatric management of DI. Methods: We reviewed all patients seen at the combined assessment clinics run at the Liverpool School of Tropical Medicine between 19 December 2011 and 31 October 2016. Data were collected prospectively as part of clinical assessment. Descriptive analysis of these data was performed to examine clinical features at assessment, investigations performed and treatment outcomes. Results: A total of 75 patients were assessed and 52 (69%) were given the formal diagnosis of DI. A history of travel was given by 64% of individuals but no significant tropical or infectious diagnosis was made. Of those who returned for follow-up, 61% reported improvement in symptoms. The Clinical Global Impressions Severity scale improvement was 1.36 for DI patients but only 0.63 for non-DI patients. DI patients were more impaired at baseline (5.0 vs 4.1). Health anxiety was the most common diagnosis seen in those not considered to have DI. Conclusions: Combined clinics to treat DI are effective in improving patient outcome. A significant minority of patients referred do not have a diagnosis of DI.

BACKGROUND: The transition from paediatric to adult services for young people with complex disabilities is fraught with anxieties for families. To facilitate the transition process a portfolio comprising reports from parents, paediatrician and therapists was collected and given to the young person and family on leaving school. AIM: To evaluate the young people and their parents' views of the usefulness of portfolios in providing comprehensive picture of their health needs. METHODS: A prospective study was performed. Eight families were interviewed and semi-quantitative feedback obtained using standardized questionnaires. RESULTS: Seven out of eight young people and their families were satisfied with the portfolios they received. All of them found the portfolios worthwhile and useful. A quarter of the families would like to have been consulted more about the content of the individual reports. CONCLUSIONS: Portfolios of health reports facilitate transfer of information when young people with disabilities move from paediatric to adult services. Ideally portfolios should be interagency, and include reports from education and social services.