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In the treatment of psychosis, agitation and aggression in Alzheimer's disease, guidelines emphasise the need to ‘use the lowest possible dose’ of antipsychotic drugs, but provide no information on optimal dosing.
Aims
This analysis investigated the pharmacokinetic profiles of risperidone and 9-hydroxy (OH)-risperidone, and how these related to treatment-emergent extrapyramidal side-effects (EPS), using data from The Clinical Antipsychotic Trials of Intervention Effectiveness in Alzheimer's Disease study (Clinicaltrials.gov identifier: NCT00015548).
Method
A statistical model, which described the concentration–time course of risperidone and 9-OH-risperidone, was used to predict peak, trough and average concentrations of risperidone, 9-OH-risperidone and ‘active moiety’ (combined concentrations) (n = 108 participants). Logistic regression was used to investigate the associations of pharmacokinetic biomarkers with EPS. Model-based predictions were used to simulate the dose adjustments needed to avoid EPS.
Results
The model showed an age-related reduction in risperidone clearance (P < 0.0001), reduced renal elimination of 9-OH-risperidone (elimination half-life 27 h), and slower active moiety clearance in 22% of patients, (concentration-to-dose ratio: 20.2 (s.d. = 7.2) v. 7.6 (s.d. = 4.9) ng/mL per mg/day, Mann–Whitney U-test, P < 0.0001). Higher trough 9-OH-risperidone and active moiety concentrations (P < 0.0001) and lower Mini-Mental State Examination (MMSE) scores (P < 0.0001), were associated with EPS. Model-based predictions suggest the optimum dose ranged from 0.25 mg/day (85 years, MMSE of 5), to 1 mg/day (75 years, MMSE of 15), with alternate day dosing required for those with slower drug clearance.
Conclusions
Our findings argue for age- and MMSE-related dose adjustments and suggest that a single measure of the concentration-to-dose ratio could be used to identify those with slower drug clearance.
Despite of the evidence of high psychopathological disorders in patients with ATSCI, few data are available on their psychiatric morbidity prior to the injury.
Objectives
Identify psychiatric morbidity pre-post ATSCI in a sample of patients admitted in the Spinal Injuries Unit of the Vall d’ Hebron University Hospital in Barcelona (Spain).
Material and methods
54 patients with ATSCI patients were admitted between 1st. October 2009 and 1st. October 2010. SPSS (version 16.1) was used to analyze the data.
Results
Seventy-six percent of the inpatients with ATSCI (41 cases) were evaluated by the psychiatrist and constitute the study sample. Twenty-seven (66%) were male and 14 (33%) female. The average age of the sample was 41 years with younger males (p < 0.05).
Reasons for ATSCI in males were traffic accident (26%), accidental falls and sports accidents (both 18.5%). In women were suicidal attempt by precipitation, fall accident (28.6% both) and traffic accident (21.4%).
41% of men versus 14% of women had a history of substance misuse (p < 0.01) while 64% of women versus the 14.8% of males had a prior psychiatric disorder (p < 0.01). 72.5% of men with ATSCI caused by traffic accident had used substances prior to the accident, those association was not found for women.
91% of patients underwent psychopharmacological intervention.
Conclusions
ATSCI patients exhibit high psychiatric morbidity and require specialized assessment. The high incidence of substance use associated with road traffic injuries suggests the need to identify risk groups in order to establish effective preventive measures.
Over the last decade, the frequency of emergency room (ER) visits for pediatric psychiatric disorders has increased in the most western countries. Although data available in France is scarce, a similar trend was observed concerning violent or runaway youth. There is no medical consensus on the status and care management of disruptive behavior (DB) in children and adolescents in ER. Seclusion and physical restraint are often requested to treat violence. With a blur lawful framework for minors, such coercive measures raise ethical issues while contradicting the idea of the patients’ autonomy and well-being. Moreover, consulting in the ER for such situations could lead to an inappropriate use of the healthcare system, a poor assessment of associated psychiatric disorders or comorbidities and an underestimation of suicide risk. Thus, the ER visit for a disruptive child or adolescent is characterized by its uncertainty. It represents a situation of heterogeneity in care management as well as a stake of social exclusion and of dangerous behavior.
The study aims to:.
– analyze these uncertainties by presenting a multidisciplinary and integrative research methodology through combining clinical evidence and social sciences comprehension;
– to implement a cohort to describe children and adolescents admitted to the ER for DB (aggressiveness, violence, fugue or theft), their care management and their social and clinical outcome;
– to pool these clinical data with an ethnographic fieldwork focused on DB as a “trouble” experienced by various professionals in the ER.
We will focus our presentation on these methodological considerations.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Life in the terrestrial and marine subsurface has adapted and evolved mechanisms to survive under extremes of energy limitation, temperature, pressure, radiation, and/or water availability. New developments in nucleic acid sequencing, high-pressure biochemistry, and high-pressure biophysics have expanded our understanding of the mechanisms used by deep life. This chapter synthesizes these new developments and highlights remaining gaps in understanding.
Objectives: To evaluate prospective and retrospective memory abilities in Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND) Veterans with and without a self-reported history of blast-related mild traumatic brain injury (mTBI). Methods: Sixty-one OEF/OIF/OND Veterans, including Veterans with a self-reported history of blast-related mTBI (mTBI group; n=42) and Veterans without a self-reported history of TBI (control group; n=19) completed the Memory for Intentions Test, a measure of prospective memory (PM), and two measures of retrospective memory (RM), the California Verbal Learning Test-II and the Brief Visuospatial Memory Test-Revised. Results: Veterans in the mTBI group exhibited significantly lower PM performance than the control group, but the groups did not differ in their performance on RM measures. Further analysis revealed that Veterans in the mTBI group with current PTSD (mTBI/PTSD+) demonstrated significantly lower performance on the PM measure than Veterans in the control group. PM performance by Veterans in the mTBI group without current PTSD (mTBI/PTSD-) was intermediate between the mTBI/PTSD+ and control groups, and results for the mTBI/PTSD- group were not significantly different from either of the other two groups. Conclusions: Results suggest that PM performance may be a sensitive marker of cognitive dysfunction among OEF/OIF/OND Veterans with a history of self-reported blast-related mTBI and comorbid PTSD. Reduced PM may account, in part, for complaints of cognitive difficulties in this Veteran cohort, even years post-injury. (JINS, 2018, 24, 324–334)
Livestock farming is an essential activity in many rural areas, where it contributes to the maintenance of soil fertility and farmland biodiversity, as well as to a set of social public goods including food security, rural vitality and culture. However, livestock sustainability assessments tend to focus primarily on environmental and economic dimensions; therefore, these valuations might be limited because they do not consider the complete set of associated goods and services (GS). Hence, a need exists to recognise the multiple contributions provided by livestock to human well-being and society. The objective of this study was to analyse the provision of multiple GS derived from livestock across regions in France and empirically demonstrate sets of GS that repeatedly appeared together. We designated these multiple GS provided by livestock as contributions to productive, environmental, rural vitality and cultural benefits that human populations derive directly or indirectly from livestock agroecosystems. First, we combined expert knowledge with results of a literature review to define a bundle of GS provided by livestock. We then described indicators that quantified each good or service and screened national databases to determine the availability of supporting data. Finally, we assessed the GS and their relationships (synergies or trade-offs) on a nation-wide gradient in France at the department level (Nomenclature of Territorial Units for Statistics 3). Four main categories of GS were considered: provisioning (e.g. food quantity and quality), environmental quality (e.g. biodiversity, landscape heterogeneity, water quality), rural vitality (e.g. employment, rural dynamism) and culture (e.g. gastronomy and landscape heritage). Four major types of GS bundles were identified, which suggested strong contrasts among French rural areas in terms of the nature of the GS that occurred together and their levels of provision. GS bundles in France had a non-random spatial distribution. This study represents an initial step towards developing a methodology to consider GS bundles provided by livestock. Nonetheless, further research is needed to understand socio-economic, environmental, political and geographic determinants of the composition of GS bundles.
Breed risk status assessment methods are key components of country-based early warning and response systems. In this study, a multi-indicator method was developed to assess the risk status of livestock populations. Six indicators were used: (i) the current number of breeding females; (ii) the change in the number of breeding females over the last 5 years or generations (depending on the species); (iii) percentage of cross-breeding; (iv) effective population size; (v) breeders organization and technical support; and (vi) socio-economic context. To make these indicators comparable, observed values were converted into scores on a six-point scale (from 0 = no threat to 5 = maximum threat); a specific conversion method was used for each indicator. For each breed, the different scores were analysed graphically and an overall score was calculated by averaging the six separate indicator scores. This approach was applied to 178 French local breeds, belonging to ten different species: horse, donkey, goat, pig, chicken, turkey, goose and Pekin duck. A large percentage of local breeds were found to be at risk to be lost for farming, although the results were species dependent. All local equine and pig breeds, as well as almost all local poultry breeds appeared to be endangered. About 80 percent of local goat and cattle breeds, and half local sheep breeds were also found to be at risk. The usefulness of this method with regards to conservation strategies and public policy is discussed.
Expose is a multi-user instrument for astrobiological and astrochemical experiments in space. Installed at the outer surface of the International Space Station, it enables investigators to study the impact of the open space environment on biological and biochemical test samples. Two Expose missions have been completed so far, designated as Expose-E (Rabbow et al. 2012) and Expose-R (Rabbow et al. this issue). One of the space-unique environmental factors offered by Expose is full-spectrum, ultraviolet (UV)-rich electromagnetic radiation from the Sun. This paper describes and analyses how on Expose-R, access of the test samples to Solar radiation degraded during space exposure in an unpredicted way. Several windows in front of the Sun-exposed test samples acquired a brown shade, resulting in a reduced transparency in visible light, UV and vacuum UV (VUV). Post-flight investigations revealed the discolouration to be caused by a homogenous film of cross-linked organic polymers at the inside of the windows. The chemical signature varied per sample carrier. No such films were found on windows from sealed, pressurized compartments, or on windows that had been kept out of the Sun. This suggests that volatile compounds originating from the interior of the Expose facility were cross-linked and photo-fixed by Solar irradiation at the rear side of the windows. The origin of the volatiles was not fully identified; most probably there was a variety of sources involved including the biological test samples, adhesives, plastics and printed circuit boards. The outer surface of the windows (pointing into space) was chemically impacted as well, with a probable effect on the transparency in VUV. The reported analysis of the window contamination on Expose-R is expected to help the interpretation of the scientific results and offers possibilities to mitigate this problem on future missions – in particular Expose-R2, the direct successor of Expose-R.
In a non-obstetric population, the optimization of cardiac output (CO) had been shown to improve survival and to reduce postoperative complications, organ failure and the length of stay1. CO monitoring might be very useful in the obstetric population as well, as physiologic changes of CO during pregnancy are mandatory for a normal outcome. An uncomplicated pregnancy is associated with a 50% increase in maternal CO, which is mediated by plasma volume expansion and a decrease in peripheral resistance2. An aberrant change of this maternal CO might influence pregnancy outcome: pregnancies complicated with foetal growth restriction and/or preeclampsia are characterized by increased total vascular resistance and reduced systolic function (i.e. lower CO and stroke volume (SV))3–5.
Large social aggregations are among the most highly organized events associated with mobile hunter-gatherers. The Bull Brook Paleoindian site in Ipswich, Massachusetts provides the strongest case for large-scale Paleoindian aggregation in North America, with 36 discrete concentrations of artifacts arranged in a large circle. Avocational archaeologists who salvaged the site in the 1950s interpreted it as a single occupation. Professionals first rejected and then revived this hypothesis, but the site remained insufficiently analyzed to evaluate. New research supports the single occupation hypothesis with a fully reconstructed site plan and the first complete analysis of artifact distributions. Clear spatial structure of activities within the ring-shaped site plan provides a window on social contexts that are also visible in smaller Paleoindian settlements.
Energy requirements for veal calves have not been updated recently despite the increased age at slaughter and the predominance of the Prim’Holstein breed in Europe. The objectives of this study were to determine the effects of four feeding levels (FLs) on protein and fat deposition and heat production in milk-fed calves at three stages of fattening and to determine energy requirements of calves. At each stage, 16 Prim’Holstein male calves (mean body weight (BW): 73.4, 151.6 and 237.4 kg) were fed a milk replacer at 79%, 87%, 95% or 103% of a reference FL. Measurements for one stage were conducted over 4 successive weeks in two open-circuit respiration chambers and consisted of a 6-day nitrogen and energy balance followed by a fasting day for estimating fasting heat production (FHP) of the calves. Heat production (HP) measurements were analyzed using a modeling approach to partition it between HP due to physical activity (AHP), feed intake (thermic effect of feeding (TEF)) and FHP. There was no effect of FL and stage on apparent digestibility coefficients, except for a tendency for increased digestibility coefficient of fat as animals got older. The metabolizable energy (ME)/digestible energy (DE) ratio did not depend on FL but decreased (P < 0.01) as animals got older in connection with marked increases in urinary glucose and urea excretion. The AHP and TEF components of HP were not affected by stage or FL and averaged 8.4% and 7.8% of ME intake, respectively. The FHP, expressed per kg BW0.85, increased with increasing FL, suggesting that also ME requirement for maintenance (MEm) may depend on FL. For an average intake of 625 kJ ME/kg BW0.85 per day (95% of the reference FL), FHP was 298 kJ/kg BW0.85 per day. Energy retention as protein and fat increased with increasing FL resulted in higher BW gain. But the rate of increase depended on stage of growth. The slope relating protein deposition to FL was lower in the finishing phase than in the growing phase, while the slope for lipid deposition was greater. Protein and fat contents of BW gain were not affected by FL but increased as animals got older. From these results, the energy requirements of veal calves are proposed according to a new approach, which considers that MEm (expressed per kg BW0.85) depends on ME intake (kJ/kg BW0.85) according to the following relationship: MEm = 197 + 0.25 × ME intake. The corresponding marginal efficiencies of ME utilization for protein and fat deposition are then 82% and 87%, respectively.
The complete second-order theory of the multiple water-bag model is developed for one-dimensional collisionless electrostatic waves, in terms of the initial value problem. Nonlinear frequency spectra are obtained in Van Kampen's formulation, and a new pole, already predicted by R. W. B. Best, appears for hot plasmas. This theory is successfully checked by a full numerical experiment of the Vlasov–Poisson system.
In periodic, inhomogeneous plasma, the dispertion relation w(k) can begeneralized to a relation w(k, K), where K is the wave-number of the periodic steady state. Two models are studied: the ‘water-bag’ model and the ‘two-stream’ model. The solution for these models is obtained easily by the introduction of a Lagrangian formulation. Results are presented. It is shown that, in the water-bag case, the appearance of narrow bands of allowed frequencies practically discretizes the lower part of the spectrum. In the two-stream case, while the long wavelengths have a smaller growth rate, an increased instability is found for k/K = ½
To assess the proportion of children being stunted and underweight-for-age at 3, 9 and 15 months in Lambaréné, Gabon, using the WHO child growth standards released in 2006 as compared with the Centers for Disease Control and Prevention (CDC) 2000 and the National Center for Health Statistics (NCHS) 1978 child growth charts/references.
Design and setting
Prospective birth cohort in Lambaréné, Gabon.
Subjects
Two hundred and eighty-nine children from birth to 15 months of age.
Methods
Weight and length were recorded at 3, 9 and 15 months. Corresponding Z scores for stunting and underweight-for-age were calculated for the three different standards/references. Children with a height-for-age or weight-for-age below –2 sd of the corresponding reference median (Z score ≤−2) were classified as stunted or underweight-for-age, respectively.
Results
With the new WHO 2006 standards a higher proportion (4·0 %) of 3-month-old infants were underweight compared with the CDC (1·0 %) or the NCHS (0·7 %) child growth charts/references. In contrast to the NCHS references or the CDC charts, this proportion did not increase from 3 to 9 months or from 9 to 15 months. The proportion of children being stunted was highest (above 20 %) with the WHO 2006 standards at all three ages. Again, in contrast to the old standards, this proportion did not increase from 3 to 9 months or from 9 to 15 months.
Conclusions
The present results show considerably different growth faltering patterns for Gabonese children depending on the growth charts used to assess the prevalence of stunting and underweight. Shifting to the new WHO child growth standards may have important implications for child health programmes.
Red supergiants (RSGs) are an evolved stage in the life of intermediate massive stars (≤ 25 M⊙). For many years, their location in the H-R diagram was at variance with the evolutionary models. Using the MARCS stellar atmospheres, we have determined new effective temperatures and bolometric luminosities for RSGs in the Milky Way, LMC, and SMC, and our work has resulted in much better agreement with the evolutionary models. We have also found evidence of significant visual extinction due to circumstellar dust. Although in the Milky Way the RSGs contribute only a small fraction (< 1%) of the dust to the interstellar medium (ISM), in starburst galaxies or galaxies at large look-back times, we expect that RSGs may be the main dust source. We are in the process of extending this work now to RSGs of higher and lower metallicities using the galaxies M31 and WLM.
New radiocarbon calibration curves, IntCal04 and Marine04, have been constructed and internationally ratified to replace the terrestrial and marine components of IntCal98. The new calibration data sets extend an additional 2000 yr, from 0–26 cal kyr BP (Before Present, 0 cal BP = AD 1950), and provide much higher resolution, greater precision, and more detailed structure than IntCal98. For the Marine04 curve, dendrochronologically-dated tree-ring samples, converted with a box diffusion model to marine mixed-layer ages, cover the period from 0–10.5 cal kyr BP. Beyond 10.5 cal kyr BP, high-resolution marine data become available from foraminifera in varved sediments and U/Th-dated corals. The marine records are corrected with site-specific 14C reservoir age information to provide a single global marine mixed-layer calibration from 10.5–26.0 cal kyr BP. A substantial enhancement relative to IntCal98 is the introduction of a random walk model, which takes into account the uncertainty in both the calendar age and the 14C age to calculate the underlying calibration curve (Buck and Blackwell, this issue). The marine data sets and calibration curve for marine samples from the surface mixed layer (Marine04) are discussed here. The tree-ring data sets, sources of uncertainty, and regional offsets are presented in detail in a companion paper by Reimer et al. (this issue).