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Appendix: International commentaries
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- By David Ames, Professor of Psychiatry of Old Age, University of Melbourne, Eleanor Flynn, Senior Lecturer in Medical Education, University of Melbourne, Maria Alekxandrova, Associate Professor of Psychiatry, Medical University Pleven, Kaloyan Stoychev, Consultant Psychiatrist, University Hospital Pleven, Kenneth Shulman, Professor of Geriatric Psychiatry, University of Toronto, Ross Upshur, Professor of Primary Care, University of Toronto, Kirsten Abelskov, Old-Age Psychiatrist, Aarhus University Hospital, Kaj Sparle Christensen, General Practitioner, Institut for Almen Medicin, University of Aarhus, Philippe H. Robert, Professor of Psychiatry, Michel Benoit, Psychiatrist Centre Mémoire de Ressources et de Recherche, Nice, Florence Cabane, General Practitioner Nice, Geneviève Ruault, Geriatrician Nice, Helen F. K. Chiu, Professor of Psychiatry, The Chinese University of Hong Kong, D. K. T. Li, Family Physician, Past President Hong Kong College of Family Physicians, Syuichi Awata, Psychiatrist and Director Division of Neuropsychiatry and Center for Dementia, Sendai City Hospital, Akira Honma, Psychiatrist, Tokyo Metropolitan Institute of Gerontology, Els Licht-Strunk, General Practitioner, VU University Medical Centre, Amsterdam, Marijke Bremmer, Consultant Psychiatrist, VU University Medical Centre, Amsterdam, Knut Engedal, Professor of Old-Age Psychiatry, Ullevaal University Hospital, Oslo, Harald Sanaker, Specialist in Family Medicine, Kongsvegen Legesenter, Brummunddal, Nicoleta Tătaru, Senior Consultant Psychiatrist, Forensic Hospital Ştei, Bihor, Monica Bălan, Primary Care Physician Oradea, Alexandru Dicker, Senior Consultant in Internal Medicine Psychiatric Hospital, Nucet, Bihor, Raimundo Mateos, Professor of Psychiatry, University of Santiago de Compostela, Jose Antonio Ferreiro Guri, Specialist in Family and Community, Medicine University of Santiago de Compostela, Tom Campbell, Professor of Family Medicine, University of Rochester, NY, Jeffrey M. Lyness, Professor of Psychiatry, University of Rochester, NY
- Carolyn A. Chew-Graham, University of Manchester, Robert Baldwin, Alistair Burns, University of Manchester
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- Book:
- Integrated Management of Depression in the Elderly
- Published online:
- 18 December 2009
- Print publication:
- 03 April 2008, pp 140-177
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Summary
The editors summarized the contributions written by colleagues in different parts of the world (Chapter 6) to illustrate the similarities, and occasional differences, in the management of depression in older people described in all the contributions. This appendix allows the reader to read the individual contributions.
Australia
Assessment
This 82-year-old woman is chronically disabled by pain and breathlessness and appears to have become socially disengaged. She has several symptoms of depression, including persistent low mood, loss of energy (which sounds to be out of proportion to her medical state), early morning waking, loss of interest in previously enjoyed activities, and persistent feelings that life is not worth living. The vignette does not provide information about her appetite and weight, concentration, any psychomotor changes, guilt feelings or confidence levels, but even so it is clear that, provided the symptoms have been present for two weeks (and this seems highly likely), she meets both DSM-IV diagnostic criteria for a major depressive episode and ICD-10 criteria for a depressive episode.
Australian health-care system
Within the Australian health-care system, in which specialists are accessible only after referral from a general practitioner (GP), this woman would normally be managed by her GP who in all likelihood will already be engaged in the management of her troublesome osteoarthritis and chronic obstructive pulmonary disease (COPD). She might well attend a respiratory outpatient clinic or rheumatology clinic in a public hospital, or (less likely as fewer than one-third of the elderly have private health insurance) be seeing a private medical specialist with expertise in one or both of these two areas.
Compartment models for estimating attributes of digesta flow in cattle*
- K. R. Pond, W. C. Ellis, J. H. Matis, H. M. Ferreiro, J. D. Sutton
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- Journal:
- British Journal of Nutrition / Volume 60 / Issue 3 / November 1988
- Published online by Cambridge University Press:
- 09 March 2007, pp. 571-595
- Print publication:
- November 1988
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1. The basic assumptions involved in one- and two-compartment models with age-independent distributed residence times (exponential, G1) for describing digesta flow are reviewed as the bases for describing families of one- and two-compartment models which assume age-dependent distributions (Gn) of residence times.
2. The two-compartment, age-independent model with exponentially distributed residence times (GIGI) yielded estimates of essentially equal rate parameters when fitted to faecal values for all four cows receiving a diet of 500 g coarsely chopped, sodium hydroxide-treated straw /kg and one of four cows receiving the same diet but with ground and pelleted straw. The incorporation of progressively higher orders of age dependency (G2-G6, Gn) into the faster turnover compartment of two-compartment models (GnG1) resulted in a resolution of equal rate parameters estimated by the G1G1 model and a reduction in standard errors for the rate and the initial concentration parameters.
3. The occurrence of equal rate parameters in two-compartment models indicated an age-dependent process; a process which could equally well be described by a one-compartment, age-dependent compartment having an order of age dependency equal to the sum of these orders in the two-compartment model with equal rate parameters.
4. The age-independent models overestimated time of first appearance in the faeces of a meal's particles. The association of age dependency with the faster turnover compartment resulted in earlier estimates for first appearance of the marked particles; estimates which were more consistent with observed first appearance.
5. The faecal excretion pattern from cows fed on the ground and pelleted straw diet exhibited an age-independent distribution of longer residence times which dominated approximately 80% of the later residence times. Age-dependent, one-compartment models gave a poor fit to such data from these cows fed on ground and pelleted straw. In contrast, age-dependent, one-compartment models provided an excellent fit to data from cows fed on chopped straw; data which indicated that age-independent distributions of residence times were much delayed in appearing or were totally absent.
6. The mean residence time for the slower turnover, age-independent compartment estimated from faecal excretional of stained particles from either diet was similar to that estimated from duodenal concentrations of the stained particles. This suggests that the slower turnover model compartment was confined to preduodenal sites.
7. The mean residence time for the faster turnover, age-dependent compartment estimated from duodenal data was 58–62 % that estimated from faecal data and suggests that the site of this model compartment was both pre- and post-duodenal.
8. It is emphasized that the slow and imperfect mixing of particulate matter that occurs in reticulo-rumen digesta is inconsistent with the assumptions of instantaneous and homogeneous mixing made by models having age-independent distributions of residence times. The use of age-dependent distributed residence times can accommodate such imperfect mixing and is consistent with the existence of age-discriminating processes involved in particle flow from the reticulo-rumen. Age dependency also offers improved precision in estimating parameters of digesta flow via processes having inherent uncertainty in their mixing and age-discriminating mechanisms.
Glucose metabolism in cattle given sugar cane based diets supplemented with varying quantities of rice polishings
- H. M. Ferreiro, A. Priego, J. Lopez, T. R. Preston, R. A. Leng
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- Journal:
- British Journal of Nutrition / Volume 42 / Issue 2 / September 1979
- Published online by Cambridge University Press:
- 09 March 2007, pp. 341-347
- Print publication:
- September 1979
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1. Glucose entry rates were measured with [2−3H]glucose in groups of cattle given sugar-cane diets and between o and 1200 g rice polishings.
2. In the first experiment measurements of glucose metabolism were estimated in four animals (one of each being given 0, 400, 600 and 1000 g supplement) over 24 h using a repeated single injection at 6 h intervals and sampling blood for 3 h.
3. The results indicated that in a short time period of each isotope experiment relatively steady-state conditions existed since the plot of log specific radioactivity v. time was linear with a high correlation coefficient.
4. The pattern of glucose entry rates was variable over the 24 h period being highest shortly after feeding and then declining to quite low levels immediately before the next feed, 24 h later. However, the more rice polishings that were made available to the cattle, the higher the glucose entry rate at 4–7 h, and it remained higher for a longer time.
5. In the second experiment with nineteen animals there was a linear relationship between the glucose entry rate (measured 4–7 h after feeding) and the amount of rice polishings consumed by the animal.
6. The results suggest that glucose is being made available in quite large quantities from the supplement. Using the means of these estimates over 24 h to predict glucose entry rate on a daily basis, it is suggested that at least 50% of the starch in the rice polishings was made available to the animal as glucose.
7. The results are discussed in relation to the suggestion that the availability of glucose may be limiting nutrient in cattle given low-protein diets.