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The effect of treatment (28 days) with zopiclone, triazolam, flunitrazepam and placebo on sleep quality and daytime well-being was proven in a randomised, double-blind, parallel group, multicentre study in private practice. Results of an exploratory statistic of treatment efficacy in a subgroup of 1,291 patients suffering from insomnia are presented. Patients met the following criteria: insomnia lasting at least four weeks and the presence of at least two of the following: 1) sleep latency ≥ 45 minutes, 2) total sleep time ≤ 6 hours, and 3) nocturnal awakening ≥3 times. Treatment efficacy was assessed according to the following factors: either a shortening of sleep latency by at least 15 minutes, or prolongation of total sleep time by at least 20%, or reduction of the number of nocturnal awakenings to three or less and a refreshed feeling in the morning as well as no impairment in daytime well-being due to tiredness or anxiety. The total response rate was markedly higher with zopiclone (42.3%; p = 0.0003) than with placebo (29.0%). Triazolam (36.6%; p = 0.0905) and flunitrazepam (33.1%; p = 0.3401) were also more effective than the placebo, but they both tended to have a lower response rate than with zopiclone (p = 0.1199 and 0.0151, respectively). Total response was found to be essentially a reflection of the response of the socially important parameter of daytime well-being. These results suggest that zopiclone is more effective in the treatment of insomnia than either triazolam or flunitrazepam. Since the response of daytime well-being to therapy was generally poor, this parameter embodies the next main therapeutic challenge in the treatment of patients with insomnia.
Symptoms of attention-deficit/hyperactivity disorder (ADHD) persist into adulthood in many patients.
Analyse post hoc the impact of sex and age on the efficacy of lisdexamfetamine dimesylate (LDX) in the treatment of adult ADHD.
In NRP104.303, a 4-week, double-blind, forced-dose study, adults with ADHD were randomized (2:2:2:1) to receive LDX 30, 50 or 70 mg/day, or placebo. NRP104.304 was a 12-month, open-label, dose-optimized, extension to NRP104.303. In both studies, the primary efficacy outcome was the change from baseline in ADHD Rating Scale (ADHD-RS) total score.
In NRP104.303 (N=420), least-squares mean changes from baseline to endpoint in ADHD-RS total score (standard error) were significantly greater for LDX (range across doses, −16.2 [1.06] to −18.6 [1.03]) than placebo (−8.2 [1.43]). Post hoc analyses revealed similar improvements with LDX in sex (male, LDX −16.7 [1.50] to −18.6 [1.53], placebo, −8.9 [2.12]; female, LDX −15.5 [1.56] to −19.3 [1.46], placebo −8.0 [2.02]) and age (18−39 years, LDX −15.3 [1.34] to −18.9 [1.31], placebo −5.6 [1.87]; 40−55 years, LDX −16.1 [1.81] to −17.1 [1.87], placebo −12.8 [2.52]) subgroups. In study NRP104.304 (N=349), improvements from baseline to endpoint in mean (standard deviation) ADHD-RS total score were similar between the overall population (−24.8 [11.7]) and sex and age subgroups (male −24.5 [11.5]; female −25.2 [12.0]; 18−39 years −25.3 [11.4]; 40–55 years −24.1 [12.2]).
In short- and long-term adult studies, LDX was associated with improvements in ADHD symptoms in sex and age-related subgroups.
Symptoms of attention-deficit/hyperactivity disorder (ADHD) appear in childhood, but are recognised as often persistent into adulthood. Impairments in day-to-day functioning associated with ADHD in adults include deficiency in executive function.
Evaluate the effect of lisdexamfetamine dimesylate (LDX) on ADHD symptoms in adults with ADHD and executive function deficit.
This phase 4, randomized, double-blind study enrolled adults (aged 18–55) with baseline ADHD Rating Scale IV with Adult Prompts (ADHD-RSIV- Adult) total score ≥28 and baseline Global Executive Composite T-score ≥65 on the Behaviour Rating Inventory of Executive Function–Adult Version. Patients were randomized 1:1 to receive optimized doses of LDX (30, 50 or 70 mg/day) or placebo for up to 10 weeks. The change from baseline in the investigator-rated ADHD-RS-IV-Adult total score was a secondary efficacy outcome.
The full analysis set comprised 154 patients (LDX, n=79; placebo, n=75). At baseline, mean ADHD-RS-IV-Adult total score was 39.9 in both groups (standard deviation [SD]: LDX, 6.83; placebo, 7.37) and mean changes from baseline to week 10 or early termination were −21.4 (SD, 11.27) and −10.3 (12.70) in the LDX and placebo groups, respectively. Statistical analysis showed a significant difference (LDX minus placebo) in least-squares mean changes of −11.1 (95% confidence interval: −14.9, −7.3), with an effect size of 0.94 in favour of LDX (p<0.0001). Safety outcomes were consistent with previous studies and the known effects of stimulant treatment.
Short-term treatment with LDX markedly reduced ADHD symptoms in adults with ADHD and impaired executive function.
Symptoms of attention-deficit/hyperactivity disorder (ADHD) appear in childhood, but often persist into adulthood. The prodrug lisdexamfetamine dimesylate (LDX) is an effective once-daily treatment for the symptoms of ADHD in children, adolescent and adults.
To evaluate post hoc the impact of ADHD medication history on the efficacy of LDX in adults.
In this phase 4, double-blind, dose-optimized study, patients aged 18–55 with ADHD and impaired executive function were randomized (1:1) to LDX or placebo for 10 weeks. Patients well controlled on current ADHD medication with acceptable tolerability were ineligible. Self-reported, lifetime ADHD medication histories were recorded at screening. Investigator-rated ADHD Rating Scale IV with adult prompts (ADHD-RS-IV-Adult) was a secondary efficacy measure. Primary efficacy and safety outcomes have been published (J Clin Psychiatry 2013;74:694–702).
Baseline characteristics were similar across treatment arms and previous ADHD medication subgroups. Differences between LDX and placebo in mean change from baseline to endpoint in ADHD-RS-IV-Adult total score were observed in the overall study population (n=154; –11.1 [95% confidence interval: –14.96, –7.32]; effect size, 0.9), treatment-naïve patients (n=80; –11.4 [–16.81, –5.96]; 0.9) and patients previously treated with: any ADHD medication (n=74; –10.9 [–16.50, –5.30]; 0.9), methylphenidate (n=40; –9.9 [–17.44, –2.45]; 0.9), amfetamine (n=38; –13.8 [–20.86, –6.75]; 1.3) and atomoxetine (n=21; –8.4 [–21.97, +5.26]; 0.6).
In these post hocanalyses, the response to LDX was similar in the overall study population and subgroups of patients categorized by ADHD medication history.
This chapter, provides an overview on the concerns centered on neurotoxicity from anesthetics in children following the FDA warning from 2016 and 2017. The authors provide a background for both clinical and basic science evidence on the effects of commonly used anesthetics on neural development. After review of the landmark studies in both animals and humans, the chapter provides suggestions for reducing exposure as well as addressing parental concerns.
Although research has documented factors influencing whether military personnel seek treatment for mental health problems, less research has focused on determinants of treatment-seeking for physical health problems.
To explicitly compare the barriers and facilitators of treatment-seeking for mental and physical health problems.
US soldiers (n = 2048) completed a survey with measures of barriers and facilitators of treatment-seeking for mental and physical health problems as well as measures of somatic symptoms and mental health.
The top barrier for both mental and physical health treatment-seeking was a preference for handling problems oneself. The top facilitators for both symptom types were related to treatment improving quality of life. Differential endorsement of barriers occurred for treatment of mental versus physical health symptoms. In contrast, facilitators were endorsed more for physical than for mental health treatment. While there were few gender differences, officers reported more barriers and facilitators than did enlisted personnel. Screening positive for mental or physical health problems was associated with greater endorsement of both barriers and facilitators for physical and mental health treatment, respectively.
The leading barriers and facilitators for seeking treatment for mental health and physical problems are relatively similar, suggesting that health education should consider decision-making in seeking both mental and physical healthcare. Interventions should be tailored to reduce barriers for officers and improve facilitators for junior enlisted personnel, and address barriers and facilitators for service members screening positive for a mental or physical health problem.
Declaration of interest
T.W.B. reports personal fees from TechWerks Corporation during the conduct of the study.
Introduction: Needle-related procedures are considered the most important source of pain and distress in children in hospital settings. Time constraints, heavy workload, busy and noisy environment represent barriers to the use of available interventions for pain management during needle-related procedures. Therefore, the use of a rapid, easy-to-use intervention could improve procedural pain management practices. The objective was to determine if a device combining cold and vibration (Buzzy) is non-inferior (no worse) to a topical anesthetic (Maxilene) for pain management in children undergoing needle-related procedures in the Emergency Department (ED). Methods: This study was a randomized, controlled, non-inferiority trial. We enrolled children aged between 4-17 years presenting to the ED and requiring a needle-related procedure. Participants were randomly assigned to the Buzzy or Maxilene group. The primary outcome was the mean difference in pain intensity during the procedure, as measured with the CAS (0-10). Secondary outcomes were procedural distress, success of the procedure at first-attempt and satisfaction of parents. Results: A total of 352 participants were enrolled and 346 were randomized (Buzzy = 172; Maxilene = 174). Mean difference in procedural pain scores between groups was 0.64 (95%CI -0.1 to 1.3), showing that the Buzzy device was not non-inferior to Maxilene according to a non-inferiority margin of 0.70. No significant differences were observed for procedural distress (p = .370) and success of the procedure at first attempt (p = .602). Parents of both groups were very satisfied with both interventions (Buzzy = 7.8 ±2.66; Maxilene = 8.1 ±2.4), but there was no significant difference between groups (p = .236). Conclusion: Non-inferiority of the Buzzy device over a topical anesthetic was not demonstrated for pain management of children during a needle-related procedure in the ED. However, considering that topical anesthetics are underused in the ED setting and require time, the Buzzy device seems to be a promising alternative as it is a rapid, low-cost, easy-to-use and reusable intervention.
Organizations are undergoing unprecedented transformation in the area of talent management (TM). Companies are rapidly adopting new tools and approaches in a variety of what has traditionally been core areas of industrial and organizational (I-O) psychology such as performance management, employee attitudes, recruiting, testing and assessment, and career development. Increasingly, however, these new approaches have little to no research backing behind them, and they do not tend to be the focus of I-O psychology theory and research. We call this trend anti-industrial and organizational psychology (AIO), as we believe these forces to do not advance the field for long-term strategic impact. We present a framework that describes how AIO practices are adopted by organizations, and how I-O psychologists often gravitate away from these practices rather than actively help to separate the wheat from the chaff. We found support for our hypothesis through a brief analysis of Industrial and Organizational Psychology: Perspectives on Science and Practice, the peer-reviewed journal of the Society of Industrial and Organizational Psychology (SIOP). In this analysis, we found that only 10% of the focal articles from 2008 to 2016 represented topics that we call frontier—emerging areas in organizations but where there is no research support for them. We propose a set of recommendations for the field of I-O psychology and call for a more strategic approach to identifying and vetting new TM trends in order to increase the relevancy and impact of I-O psychology for our key stakeholders.
Studies with members of the armed forces have found a gap between reports
of mental health symptoms and treatment-seeking.
To assess the impact of attitudes on treatment-seeking behaviours in
soldiers returning from a combat deployment.
A sample of 529 US soldiers were surveyed 4 months (time 1) and 12 months
(time 2) post-deployment. Mental health symptoms and treatment-seeking
attitudes were assessed at time 1; reported mental healthcare visits were
assessed at time 2.
Factor analysis of the total time 1 sample revealed four attitude
factors: professional concerns, practical barriers, preference for
self-management and positive attitudes about treatment. For the subset of
160 soldiers reporting a mental health problem at time 1, and controlling
for mental health symptom severity, self-management inversely predicted
treatment-seeking; positive attitudes were positively related.
Results demonstrate the importance of broadening the conceptualisation of
barriers and facilitators of mental healthcare beyond stigma. Techniques
and delivery models emphasising self-care may help increase soldiers'
interest in using mental health services.
Research of military personnel who deployed to the conflicts in Iraq or
Afghanistan has suggested that there are differences in mental health
outcomes between UK and US military personnel.
To compare the prevalence of post-traumatic stress disorder (PTSD),
hazardous alcohol consumption, aggressive behaviour and multiple physical
symptoms in US and UK military personnel deployed to Iraq.
Data were from one US (n = 1560) and one UK
(n = 313) study of post-deployment military health of
army personnel who had deployed to Iraq during 2007–2008. Analyses were
stratified by high- and low-combat exposure.
Significant differences in combat exposure and sociodemographics were
observed between US and UK personnel; controlling for these variables
accounted for the difference in prevalence of PTSD, but not in the total
symptom level scores. Levels of hazardous alcohol consumption (low-combat
exposure: odds ratio (OR) = 0.13, 95% CI 0.07–0.21; high-combat exposure:
OR = 0.23, 95% CI 0.14–0.39) and aggression (low-combat exposure: OR =
0.36, 95% CI 0.19–0.68) were significantly lower in US compared with UK
personnel. There was no difference in multiple physical symptoms.
Differences in self-reported combat exposures explain most of the
differences in reported prevalence of PTSD. Adjusting for self-reported
combat exposures and sociodemographics did not explain differences in
hazardous alcohol consumption or aggression.
Over 50 years ago, Hutchinson (1941) noted that variation in environmental conditions could alter the outcome of competition. One implication of his observation was that environmental fluctuations could promote coexistence, allowing many species to persist in a habitat where all but one would be excluded under constant conditions. By the end of the 1980s, Chesson and colleagues had clearly described the theoretical requirements for coexistence via the storage effect (Chesson and Warner 1981, Warner and Chesson 1985, Chesson and Huntly 1989). Yet despite the long history of these ideas, relatively few direct empirical tests of the storage effect exist. Studies from a variety of natural ecosystems provide partial evidence for the storage effect (Pake and Venable 1995, 1996, Kelly and Bowler 2002, Descamps-Julien and Gonzalez 2005, Facelli et al. 2005, Kelly et al. 2008), but tests of all the required conditions or quantification of the strength of the effect are much rarer (Cáceres 1997, Adler et al. 2006, 2009, Angert et al. 2009).
The lack of rigorous case studies limits our ability to generalise about the role of the temporal storage effect in maintaining diversity. We know that multiple coexistence mechanisms will operate in different communities, but currently we cannot say where the storage effect makes an especially important contribution. This information will be essential for understanding the consequences of expected increases in climate variability (Karl and Trenberth 2003, Jain et al. 2005, Salinger 2005, Allan and Soden 2008), which could impact species diversity in systems where the storage effect is important (Adler and Drake 2008). Understanding the influence of the storage effect on coexistence across a variety of ecosystems is therefore a prerequisite for anticipating future changes in species diversity.
For learning to take place with any kind of efficiency students must be motivated. To be motivated, they must become interested. And they become interested when they are actively working on projects which they can relate to their values and goals in life.
Gus Tuberville, President, Penn College
There is no debate that combat places tremendous psychological and physical demands on those involved. And as we learn more about how combat affects the psychological well-being of those involved, a set of central questions emerge. What can we do to prepare service members for the psychological demands of combat? What can we do to sustain the mental health and well-being of those deployed in a combat environment? What can we do to facilitate the return of these service members from the combat environment to home? In short, what do service members need to know about how combat can affect them?
In response to these questions, the US Army developed the Battlemind Training System, a mental health resilience building program (US Army Medical Command, 2007). This system established several fundamental principles of mental health training, identified key implementation principles, and defined several important terms. Throughout this chapter, the Battlemind Training System will be used as an exemplar to highlight how a military mental health training program can be created that employs theses principles of mental health training and implementation.
Leptospires (Leptospira interrogaus serovar pomona) grown in chemically defined medium were immunogenic when given intradermally in humans if the leptospires were killed with formalin but not if they were boiled. Boiled leptospires were immunogenic for rabbits and hamsters and protected hamsters from challenge infection. On the other hand, boiled leptospires of the biflexa complex, serovar patoc, did retain some immunogenicity in humans, but the antisera did not protect hamsters against challenge with serovar pomona.
Serum samples obtained from patients hospitalized in Barbados with severe leptospirosis were tested by the microscopic agglutination test (MAT), enzyme immunoassay (EIA) and immunoblotting with leptospires that had been isolated from these patients. While serum samples taken a few days after onset of symptoms often showed no apparent correlation between MAT and EIA, later sequential serum samples produced similar profiles in both tests during the course of infection. Immunoblotting sonicate from Leptospira interrogans serovars arborea, copenhageni and bim with patients' sera, revealed reactions with a number of bands that corresponded with outer envelope components. These components included lipopolysaccharide (LPS), flagella and other outer membrane proteins, in addition to a low-molecular-weight (MW) carbohydrate cross-reactive with members of the Leptospiraceae. IgM antibodies elicited in the first to second week after infection reacted mainly with LPS and the low-MW cross-reactive carbohydrate. Comparative analysis of isolates of the same serovar by sodium dodecyl sulphate polyacrylamide gel electrophoresis and immunoblotting showed that while two serovar arborea isolates were identical, serovar bim isolates differed significantly from each other. This difference was also observed in comparative MAT testing.
This paper proves a theorem about bounding orbits of a time dependent dynamical system. The maps that are involved are examples in convex dynamics, by which we mean the dynamics of piecewise isometries where the pieces are convex. The theorem came to the attention of the authors in connection with the problem of digital halftoning. Digital halftoning is a family of printing technologies for getting full-color images from only a few different colors deposited at dots all of the same size. The simplest version consists in obtaining gray-scale images from only black and white dots. A corollary of the theorem is that for error diffusion, one of the methods of digital halftoning, averages of colors of the printed dots converge to averages of the colors taken from the same dots of the actual images. Digital printing is a special case of a much wider class of scheduling problems to which the theorem applies. Convex dynamics has roots in classical areas of mathematics such as symbolic dynamics, Diophantine approximation, and the theory of uniform distributions.
The finite Pfaff lattice is given by a commuting Lax pair involving a
finite matrix L (zero above the first subdiagonal) and a projection onto
The lattice admits solutions such that the entries of the matrix
L are rational in the time parameters t_1,t_2,\dotsc, after conjugation by a diagonal matrix. The sequence of polynomial \tau-functions, solving the problem, belongs to an intriguing chain of subspaces of Schur polynomials, associated to Young diagrams, dual with respect to a finite chain of rectangles. Also, this sequence of \tau-functions is given inductively by the action of a fixed vertex operator.
As an example, one such sequence is given by Jack polynomials for rectangular Young diagrams, while another chain starts with any two-column Jack polynomial.