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This article is a clinical guide which discusses the “state-of-the-art” usage of the classic monoamine oxidase inhibitor (MAOI) antidepressants (phenelzine, tranylcypromine, and isocarboxazid) in modern psychiatric practice. The guide is for all clinicians, including those who may not be experienced MAOI prescribers. It discusses indications, drug-drug interactions, side-effect management, and the safety of various augmentation strategies. There is a clear and broad consensus (more than 70 international expert endorsers), based on 6 decades of experience, for the recommendations herein exposited. They are based on empirical evidence and expert opinion—this guide is presented as a new specialist-consensus standard. The guide provides practical clinical advice, and is the basis for the rational use of these drugs, particularly because it improves and updates knowledge, and corrects the various misconceptions that have hitherto been prominent in the literature, partly due to insufficient knowledge of pharmacology. The guide suggests that MAOIs should always be considered in cases of treatment-resistant depression (including those melancholic in nature), and prior to electroconvulsive therapy—while taking into account of patient preference. In selected cases, they may be considered earlier in the treatment algorithm than has previously been customary, and should not be regarded as drugs of last resort; they may prove decisively effective when many other treatments have failed. The guide clarifies key points on the concomitant use of incorrectly proscribed drugs such as methylphenidate and some tricyclic antidepressants. It also illustrates the straightforward “bridging” methods that may be used to transition simply and safely from other antidepressants to MAOIs.
Radiocarbon (14C) ages cannot provide absolutely dated chronologies for archaeological or paleoenvironmental studies directly but must be converted to calendar age equivalents using a calibration curve compensating for fluctuations in atmospheric 14C concentration. Although calibration curves are constructed from independently dated archives, they invariably require revision as new data become available and our understanding of the Earth system improves. In this volume the international 14C calibration curves for both the Northern and Southern Hemispheres, as well as for the ocean surface layer, have been updated to include a wealth of new data and extended to 55,000 cal BP. Based on tree rings, IntCal20 now extends as a fully atmospheric record to ca. 13,900 cal BP. For the older part of the timescale, IntCal20 comprises statistically integrated evidence from floating tree-ring chronologies, lacustrine and marine sediments, speleothems, and corals. We utilized improved evaluation of the timescales and location variable 14C offsets from the atmosphere (reservoir age, dead carbon fraction) for each dataset. New statistical methods have refined the structure of the calibration curves while maintaining a robust treatment of uncertainties in the 14C ages, the calendar ages and other corrections. The inclusion of modeled marine reservoir ages derived from a three-dimensional ocean circulation model has allowed us to apply more appropriate reservoir corrections to the marine 14C data rather than the previous use of constant regional offsets from the atmosphere. Here we provide an overview of the new and revised datasets and the associated methods used for the construction of the IntCal20 curve and explore potential regional offsets for tree-ring data. We discuss the main differences with respect to the previous calibration curve, IntCal13, and some of the implications for archaeology and geosciences ranging from the recent past to the time of the extinction of the Neanderthals.
Raqqa Governorate, Syria has recently been affected by overlapping conflicts related to the Syrian Civil war and occupation by ISIS, resulting in widespread displacement and disruption of economic livelihoods. However, little information is currently known about mental health needs and risk factors among women. Therefore, this study sought to examine potential risk factors for depressive symptoms among married women living in northern Syria.
Methods.
Data were collected between March and April 2018 as part of an evaluation of an International Rescue Committee cash transfer program targeted toward vulnerable households. Using cross-sectional data from 214 married women participating in the program, linear regression models were generated to explore the associations between depressive symptoms [nine-item Patient Health Questionnaire (PHQ-9)] and its potential risk factors, including food insecurity, perceived deprivation of basic needs [the Humanitarian Emergency Settings Perceived Needs Scale (HESPER) scale], and past-3-month intimate partner violence (IPV).
Results.
The average depressive symptom score was 10.5 (s.d.: 4.9; range: 2–27). In the final adjusted model, any form of recent IPV (β = 2.25; 95% CI 0.92–3.57; p = 0.001), severe food insecurity (β = 1.62; 95% CI 0.27–2.96; p = 0.02) and perceived needs (β = 0.38; 95% CI 0.18–0.57; p = 0.0002) were associated with an increase in depressive symptoms.
Conclusion.
Study findings point to the need to address the mental health needs of women in conflict-affected areas of Syria. Programming to address risk factors for depression, including IPV and other factors associated with daily stressors such as food insecurity and deprivation of basic needs, may be effective in reducing depression in this population.
We investigate the interstellar medium towards seven TeV gamma-ray sources thought to be pulsar wind nebulae using Mopra molecular line observations at 7 mm [CS(1–0), SiO(1–0, v = 0)], Nanten CO(1–0) data and the Southern Galactic Plane Survey/GASS Hi survey. We have discovered several dense molecular clouds co-located to these TeV gamma-ray sources, which allows us to search for cosmic rays coming from progenitor SNRs or, potentially, from pulsar wind nebulae. We notably found SiO(1–0, v = 0) emission towards HESS J1809–193, highlighting possible interaction between the adjacent supernova remnant SNR G011.0–0.0 and the molecular cloud at d ∼ 3.7 kpc. Using morphological features, and comparative studies of our column densities with those obtained from X-ray measurements, we claim a distance d ∼ 8.6 − 9.7kpc for SNR G292.2–00.5, d ∼ 3.5 − 5.6 kpc for PSR J1418–6058 and d ∼ 1.5 kpc for the new SNR candidate found towards HESS J1303–631. From our mass and density estimates of selected molecular clouds, we discuss signatures of hadronic/leptonic components from pulsar wind nebulae and their progenitor SNRs. Interestingly, the molecular gas, which overlaps HESS J1026–582 at d ∼ 5 kpc, may support a hadronic origin. We find however that this scenario requires an undetected cosmic-ray accelerator to be located at d < 10 pc from the molecular cloud. For HESS J1809–193, the cosmic rays which have escaped SNR G011.0–0.0 could contribute to the TeV gamma-ray emission. Finally, from the hypothesis that at most 20% the pulsar spin down power could be converted into CRs, we find that among the studied pulsar wind nebulae, only those from PSR J1809–1917 could potentially contribute to the TeV emission.
We present observations of 50 deg2 of the Mopra carbon monoxide (CO) survey of the Southern Galactic Plane, covering Galactic longitudes l = 300–350° and latitudes |b| ⩽ 0.5°. These data have been taken at 0.6 arcmin spatial resolution and 0.1 km s−1spectral resolution, providing an unprecedented view of the molecular clouds and gas of the Southern Galactic Plane in the 109–115 GHz J = 1–0 transitions of 12CO, 13CO, C18O, and C17O.
We present a series of velocity-integrated maps, spectra, and position-velocity plots that illustrate Galactic arm structures and trace masses on the order of ~106 M⊙ deg−2, and include a preliminary catalogue of C18O clumps located between l = 330–340°. Together with the information about the noise statistics of the survey, these data can be retrieved from the Mopra CO website and the PASA data store.
For livestock production systems to play a positive role in global food security, the balance between their benefits and disbenefits to society must be appropriately managed. Based on the evidence provided by field-scale randomised controlled trials around the world, this debate has traditionally centred on the concept of economic-environmental trade-offs, of which existence is theoretically assured when resource allocation is perfect on the farm. Recent research conducted on commercial farms indicates, however, that the economic-environmental nexus is not nearly as straightforward in the real world, with environmental performances of enterprises often positively correlated with their economic profitability. Using high-resolution primary data from the North Wyke Farm Platform, an intensively instrumented farm-scale ruminant research facility located in southwest United Kingdom, this paper proposes a novel, information-driven approach to carry out comprehensive assessments of economic-environmental trade-offs inherent within pasture-based cattle and sheep production systems. The results of a data-mining exercise suggest that a potentially systematic interaction exists between ‘soil health’, ecological surroundings and livestock grazing, whereby a higher level of soil organic carbon (SOC) stock is associated with a better animal performance and less nutrient losses into watercourses, and a higher stocking density with greater botanical diversity and elevated SOC. We contend that a combination of farming system-wide trials and environmental instrumentation provides an ideal setting for enrolling scientifically sound and biologically informative metrics for agricultural sustainability, through which agricultural producers could obtain guidance to manage soils, water, pasture and livestock in an economically and environmentally acceptable manner. Priority areas for future farm-scale research to ensure long-term sustainability are also discussed.
Training for the clinical research workforce does not sufficiently prepare workers for today’s scientific complexity; deficiencies may be ameliorated with training. The Enhancing Clinical Research Professionals’ Training and Qualifications developed competency standards for principal investigators and clinical research coordinators.
Methods
Clinical and Translational Science Awards representatives refined competency statements. Working groups developed assessments, identified training, and highlighted gaps.
Results
Forty-eight competency statements in 8 domains were developed.
Conclusions
Training is primarily investigator focused with few programs for clinical research coordinators. Lack of training is felt in new technologies and data management. There are no standardized assessments of competence.
The translation of discoveries to drugs, devices, and behavioral interventions requires well-prepared study teams. Execution of clinical trials remains suboptimal due to varied quality in design, execution, analysis, and reporting. A critical impediment is inconsistent, or even absent, competency-based training for clinical trial personnel.
Methods
In 2014, the National Center for Advancing Translational Science (NCATS) funded the project, Enhancing Clinical Research Professionals’ Training and Qualifications (ECRPTQ), aimed at addressing this deficit. The goal was to ensure all personnel are competent to execute clinical trials. A phased structure was utilized.
Results
This paper focuses on training recommendations in Good Clinical Practice (GCP). Leveraging input from all Clinical and Translational Science Award hubs, the following was recommended to NCATS: all investigators and study coordinators executing a clinical trial should understand GCP principles and undergo training every 3 years, with the training method meeting the minimum criteria identified by the International Conference on Harmonisation GCP.
Conclusions
We anticipate that industry sponsors will acknowledge such training, eliminating redundant training requests. We proposed metrics to be tracked that required further study. A separate task force was composed to define recommendations for metrics to be reported to NCATS.
Indigenous Australians have high rates of chronic diseases, the causes of which are complex and include social and environmental determinants. Early experiences in utero may also predispose to later-life disease development. The Gomeroi gaaynggal study was established to explore intrauterine origins of renal disease, diabetes and growth in order to inform the development of health programmes for Indigenous Australian women and children. Pregnant women are recruited from antenatal clinics in Tamworth, Newcastle and Walgett, New South Wales, Australia, by Indigenous research assistants. Measures are collected at three time points in pregnancy and from women and their children at up to eight time points in the child’s first 5 years. Measures of fetal renal development and function include ultrasound and biochemical biomarkers. Dietary intake, infant feeding and anthropometric measurements are collected. Standardized procedures and validated tools are used where available. Since 2010 the study has recruited over 230 women, and retained 66 postpartum. Recruitment is ongoing, and Gomeroi gaaynggal is currently the largest Indigenous pregnancy-through-early-childhood cohort internationally. Baseline median gestational age was 39.1 weeks (31.5–43.2, n=110), median birth weight was 3180 g (910–5430 g, n=110). Over one third (39.3%) of infants were admitted to special care or neonatal nursery. Nearly half of mothers (47.5%) reported tobacco smoking during pregnancy. Results of the study will contribute to knowledge about origins of chronic disease in Indigenous Australians and nutrition and growth of women and their offspring during pregnancy and postpartum. Study strengths include employment and capacity-building of Indigenous staff and the complementary ArtsHealth programme.
Reducing the delay of backend interconnects is critical in delivering improved performance in next generation computer chips. One option is to implement interlayer dielectric (ILD) materials with increasingly lower dielectric constant (k) values. Despite industry need, there has been a recent decrease in study and production of these materials in academia and business communities. We have generated a backbone and porogen system that allows us to control porosity from 0 to 60% volume, achieve k-values from 3.4 to 1.6, maintain high chemical stability to various wet cleans, and deliver uniquely high mechanical strength at a given porosity. Finite element modeling and experimental results demonstrate that further improvements can be achieved through control of the pore volume into an ordered network. With hopes to spur more materials development, this paper discusses some molecular design and nanoscale hierarchical principles relevant to making next generation low-k ILD materials.
To cope with phosphorus (P) deficiency, plants adapt root morphology to enhance inorganic P (Pi) acquisition from soil by allocating more biomass to roots, but whether the responses can be modified across gradients of P supply is not fully understood. The present study examined changes in root-length density (RLD), root-hair density (RHD) and root-hair length (RHL) of wheat (Triticum aestivum L.) in two contrasting soils, the Rough and Barnfield soils. Wheat plants were grown for 3 weeks in thin-plate rhizotrons in two soils with additions of 0, 10, 25, 50, 100 and 200 mg P/kg soil. Contrary to published literature, as P additions increased it was observed that a concomitant increase in RHL (250 to 1054 µm in the Rough soil and 303–1075 µm in the Barnfield soil) and RHD (57 to 122/mm in the Rough soil and 56–120/mm in the Barnfield soil), while RLD generally decreased (2480–1130 cm/cm3 in the Rough soil and 1716–865 cm/cm3 in the Barnfield soil). The levels of added P that resulted in critical P concentrations in the soils enabling maximum shoot biomass production were 50 mg/kg P in the Rough soil and 100 mg/kg P in the Barnfield soil, and these additions influenced root morphological changes. Under severe P deficiency, P supply increased RHL and RHD, but RLD was decreased. Improvement in lateral root and root-hair responses in wheat at extreme P deficiency may be a worthy target for breeding more sustainable genotypes for future agroecosystems.
We present observations of the first 10° of longitude in the Mopra CO survey of the southern Galactic plane, covering Galactic longitude l = 320–330° and latitude b = ±0.5°, and l = 327–330°, b = +0.5–1.0°. These data have been taken at 35-arcsec spatial resolution and 0.1 km s−1 spectral resolution, providing an unprecedented view of the molecular clouds and gas of the southern Galactic plane in the 109–115 GHz J = 1–0 transitions of 12CO, 13CO, C18O, and C17O. Together with information about the noise statistics from the Mopra telescope, these data can be retrieved from the Mopra CO website and the CSIRO-ATNF data archive.
The IntCal09 and Marine09 radiocarbon calibration curves have been revised utilizing newly available and updated data sets from 14C measurements on tree rings, plant macrofossils, speleothems, corals, and foraminifera. The calibration curves were derived from the data using the random walk model (RWM) used to generate IntCal09 and Marine09, which has been revised to account for additional uncertainties and error structures. The new curves were ratified at the 21st International Radiocarbon conference in July 2012 and are available as Supplemental Material at www.radiocarbon.org. The database can be accessed at http://intcal.qub.ac.uk/intcal13/.
This article outlines the Bayesian models and methods used to facilitate construction of the 2013 internationally agreed radiocarbon calibration curves known as IntCal13, Marine13, and SHCal13. The models build on those used for the 2004 and 2009 estimates of the curves and, as in 2009, arc implemented using Markov chain Monte Carlo sampling, specifically a Metropolis-within-Gibbs sampler. In addition to the data structures accounted for within the 2004 and 2009 models, the approach outlined here also allows for: the presence of additional uncertainty that the data providers have been unable to quantify; tree-ring data that derive their calendar age from wiggle-matching (in addition to ring counting); varve-counted data that exhibit zero increase in calendar age error between 2 or more consecutive layers; and any data source for which we have dependent calendar age uncertainties.
The Southern Hemisphere SHCal04 radiocarbon calibration curve has been updated with the addition of new data sets extending measurements to 2145 cal BP and including the ANSTO Younger Dryas Huon pine data set. Outside the range of measured data, the curve is based upon the ern Hemisphere data sets as presented in IntCal13, with an interhemispheric offset averaging 43 ± 23 yr modeled by an autoregressive process to represent the short-term correlations in the offset.
High-quality data from appropriate archives are needed for the continuing improvement of radiocarbon calibration curves. We discuss here the basic assumptions behind 14C dating that necessitate calibration and the relative strengths and weaknesses of archives from which calibration data are obtained. We also highlight the procedures, problems, and uncertainties involved in determining atmospheric and surface ocean 14C/12C in these archives, including a discussion of the various methods used to derive an independent absolute timescale and uncertainty. The types of data required for the current IntCal database and calibration curve model are tabulated with examples.
Results are presented for modeling the growth of TiO2 on the rutile (110) surface. We illustrate how long time scale dynamics techniques can be used to model thin film growth at realistic growth rates. The system evolution between deposition events is achieved through an on-the-fly Kinetic Monte Carlo method, which finds diffusion pathways and barriers without prior knowledge of transitions. We examine effects of various experimental parameters, such as substrate bias, plasma density, and stoichiometry of the deposited species. Growth of TiO2 via three deposition methods has been investigated: evaporation (thermal and electron beam), ion-beam assist, and reactive magnetron sputtering. We conclude that the evaporation process produces a void filled, incomplete structure even with the low-energy ion-beam assist, but that the sputtering process produces crystalline growth. The energy of the deposition method plays an important role in the film quality.
Results are presented for modeling the deposition of Ag and rutile TiO2. The model can be used to examine the effect of varying experimental parameters, such as the substrate bias in the magnetron and the stoichiometry of the deposition species. We illustrate how long time scale dynamics techniques can be used to model the process over experimental time scales. Long time dynamics is achieved through an on-the-fly Kinetic Monte Carlo (otf-KMC) method, which determines diffusion pathways and barriers, in parallel, with no prior knowledge of the involved transitions. Using this otf-KMC method we have modeled the deposition of Ag and TiO2 for various plasma deposition energies, in the range 1 eV to 100 eV. It was found that Ag {111} produces the most crystalline growth when deposited at 40 eV. TiO2 growth showed that at energies of 1 eV and 100 eV a porous structure occurs with void formation. At deposition energies of 30 eV and 40 eV, a more dense and crystalline rutile growth forms. The results show that deposition energy plays an important role in the resulting thin film quality and surface morphology.
In November 1986 a large-scale survey was undertaken in the Gloucestershire town of Stonehouse during an outbreak of meningococcal disease due to group B type 15 subtype Pl. 16 sulphonamide-resistant strains. There were 15 cases in Stonehouse residents during the 4 years from April 1983, an annual attack rate of 56·5 per 100000. Four secondary cases occurred despite rifampicin prophylaxis. The objectives of this community survey were to investigate patterns of meningococcal carriage, transmission and immunity and to determine the proportion of non-secretors of blood group antigens in the Stonehouse population find amongst meningococcal carriers. A total of 6237 subjects participated including 75% of the 6635 Stonehouse residents. Over 97% of the participants provided all three of the requested specimens – nasopharyngeal swabs, saliva and blood samples.
The co-operation between the many organizations involved in the detailed preliminary planning was instrumental in the success of the survey; in particular the value of effective collaboration between Departments of Community Medicine and Microbiology and of the Public Health Laboratory Service network of laboratories in undertaking investigations of this size and type was clearly demonstrated.