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The family †Peipiaosteidae contains the genera †Peipiaosteus, †Stichopterus, †Spherosteus, †Yanosteus, and †Liaosteus, all from Late Jurassic to Early Cretaceous deposits of China, Russia, Kazakhstan, and Mongolia. Although the family has taxonomically expanded since it was first established for †P. pani Liu and Zhou, 1965, the amount of detailed comparative data for many of the taxa involved is lacking. In this paper, we describe the osteology of the monotypic genus †Yanosteus from the Yixian Formation (Early Cretaceous) of China largely on the basis of a newly prepared, well-preserved specimen. †Yanosteus is characterized by a series of infraorbital ossicles (a characteristic of the family), a broad, rounded palatopterygoid, a robust dentary, an extremely small opercle and a subopercle with distinctly long and rounded anterior process and a posteriorly scalloped margin, a broad and weakly forked caudal fin, an elongate dorsal fin with more than 160–178 fin rays (diagnostic for the genus), and a short but well-formed pectoral fin spine. We use the results of this study to discuss the characters of the †Peipiaosteioidei and the diversity of †peipiaosteioids.
Concomitant antipsychotic prescription is common in clinical psychiatry, although it is not an evidence-based practice. The aim of the study was to describe the prescription of antipsychotics in inpatients with schizophrenia and identify which are the factors associated with this tendency.
Methods
We reviewed retrospectively the psychotropic drugs prescribed at the time of discharge of 177 inpatients who met criteria for schizophrenia [DSM-IV-TR] on an acute psychiatry unit from 2007 to 2008.
Results
One hundred and two patients (57.6%) were male. Mean age (SD) was 38.1 (14.6) years. The percentage of patients discharged on treatment with two or more antipsychotics was 43.5%. Although in the strict sense we should not consider it as polipharmacy, the most frequent combination was long acting injectable risperidone with oral risperidone (21.5%), followed by long acting injectable typical antipsychotic with oral risperidone (3.4%). There was a significant association between the number of prescribed antipsychotics and the total number of previous hospitalizations and the number of hospitalizations during the previous year (ANOVA p=0.001 and p< 0.001 respectively). No correlation was found between polypharmacy and age. There was a significant association between the number of antipsychotics prescribed and the use of anticholinergic treatment (t-test p=0.005).
Conclusions
Our polypharmacy rates are comparable with prior European data (30-76%). Despite of the clinical guidelines, antipsychotic polipharmacy is an extended therapeutic strategy not necessarily related with resistant schizophrenia. Most of the antipsychotic associations identified are not evidenced-based practice. More clinical trials are needed to determine the efficacy of different combinations.
Improving adherence in the early stages of illness by means of long-acting antipsychotics can lead to reduced number of readmissions and enhanced remission rates, which could lead to improved performance in the medium-long term.
Objectives
Assessing clinical remission, number of admissions and personal and social performance in recent-onset schizophrenic patients undergoing LAIR.
Methods
Longitudinal retrospective study of a cohort of thirty-one recent-onset schizophrenic patients ( ≤ 2 years) who started LAIR treatment between 2004–2008. Twenty-six (83.9%) were treated for two years. PANSS scale was assessed at baseline; PANSS, Personal and Social Performance scale (PSP) and remission criteria after two years.
Results
Twenty-six patients (83.9%), 61.5% male aged between 16–44 years old, completed two years of treatment. All patients met criteria for schizophrenia (DSM-IV) with an average duration of 0.8 year since diagnosis. The main reason to using LAIR was poor adherence (76.9%). The PANSS total and all its subscale scores improved significantly (p < 0.005) with 80.8% of patients showing a ≥ 50% improvement on the PANSS total. Seventeen patients (65.4%) achieved remission criteria. Five patients (19.2%) were admitted during the follow-up. The average on global functioning (PSP) was 72.4 (IC 95%, 66.4-78.4). LAIR doses at baseline were 25 mg (46.2%), 37.5 mg (30.8%) or 50 mg (23.1%); after two years, 25 mg (34.6%), 37.5 mg (34.6%), 50 mg (23.1%) or 75 mg (7.7%).
Conclusions
Despite the limitation of retrospective observational studies, our data, including the good adherence rate (83.9%), suggest that LAIR could be effective in the treatment of recent-onset schizophrenia.
Cognitive reserve (CR) reflects the capacity of the brain to endure neuropathology, minimize clinical manifestations and successfully complete cognitive tasks. The present study aims to determine whether high CR may constitute a moderator of cognitive functioning in bipolar disorder (BD).
Methods
One hundred and two patients with BD and 32 healthy controls were enrolled. All patients met DSM-IV criteria for I or II BD and were euthymic (YMRS ≤ 6 and HDRS ≤ 8) during a 6-month period. All participants were tested with a comprehensive neuropsychological battery, and a Cerebral Reserve Score (CRS) was estimated. Subjects with a CRS below the group median were classified as having low CR, whereas participants with a CRS above the median value were considered to have high CR.
Results
Participants with BD with high CR displayed a better performance in measures of attention (digits forward: F = 4.554, P = 0.039); phonemic and semantic verbal fluency (FAS: F = 9.328, P = 0.004; and Animal Naming: F = 8.532, P = 0.006); and verbal memory (short cued recall of California Verbal Learning Test: F = 4.236, P = 0.046), after multivariable adjustment for potential confounders, including number of admissions and prior psychotic symptoms.
Conclusions
High cognitive reserve may therefore be a valuable construct to explore for predicting neurocognitive performance in patients with BD regarding premorbid status.
Disclosure of interest
Dr. I. Grande has received a Juan Rodés Contract (JR15/00012), Instituto de Salud Carlos III, Spanish Ministry of Economy and Competiveness, Barcelona, Spain and has served as a consultant for Ferrer and as a speaker for AstraZeneca, Ferrer and Janssen-Cilag.
Disclosure of interest
Dr. I. Grande has received a Juan Rodés Contract (JR15/00012), Instituto de Salud Carlos III, Spanish Ministry of Economy and Competiveness, Barcelona, Spain and has served as a consultant for Ferrer and as a speaker for AstraZeneca, Ferrer and Janssen-Cilag.
In young rabbit, digestive disorders are frequently observed around weaning. Stimulating the onset of feed intake in the suckling rabbit might be a way to promote gut health. The aim of this study was to determine the rabbit’s acceptability for different feed presentations and its preferences for flavours at an early stage of life. Two trials were conducted to evaluate the effects of physical form and flavouring on creep feed attractiveness. All the diets tested were provided in the nest from 3 to 17 days, and the daily intake per litter was recorded as of 8 days of age. In the first trial, five feed presentations were tested separately (n = 60 litters). Three dry presentations were chosen: commercial pellet (P), crumb from commercial pellet (cP) and crumb from beet pulp pellet (cBP). Hydrated feeds were also provided with either raw fodder beetroot (B) or a semi-solid feed in agar gel form produced with fodder beetroot juice and pulp (gB). In the second trial, double-choice tests were performed on four feed gels (n = 72 litters), leading to six comparison treatments. These agar gels were made of pellet mash without or with a sensory additive: one non-odorised control gel and three gels with 0.20% banana flavour, 0.06% red berry flavour and 0.10% vanilla flavour, respectively. In the first trial, kits ate more gB in fresh matter than other feed presentations (P < 0.001), with a total intake of 7.0 ± 1.8 g/rabbit from 8 to 17 days. In DM, the total consumption of pellets P (1.6 ± 0.4 g of DM/rabbit) was the highest together with the gB form (1.4 ± 0.4 g of DM/rabbit), whereas cBP was barely consumed (0.3 ± 0.1 g of DM/rabbit). Gel feed supplemented with vanilla was slightly more consumed than other flavoured and non-odorised gels (relative consumption of 57% when compared to control gel; P = 0.001). The gel feed intake was independent of the milk intake but was correlated with the litter weight at 3 days (r = 0.40, P < 0.001). In both trials, rabbit growth before and after weaning was not affected by the type of creep feed provided. Our results confirmed that providing creep feed promotes the solid intake of rabbits at early stages. Gel feed form motivated rabbits to eat and vanilla flavour supplementation increased the feed palatability. Those creep feed characteristics should be explored further for seeking effective stimulation of the onset of the feed intake in suckling rabbit.
OBJECTIVES/SPECIFIC AIMS: The objective of this research was to assess the clinical impact of simulation-based team leadership training on team leadership effectiveness and patient care during actual trauma resuscitations. This translational work addresses an important gap in simulation research and medical education research. METHODS/STUDY POPULATION: Eligible trauma team leaders were randomized to the intervention (4-hour simulation-based leadership training) or control (standard training) condition. Subject-led actual trauma patient resuscitations were video recorded and coded for leadership behaviors (primary outcome) and patient care (secondary outcome) using novel leadership and trauma patient care metrics. Patient outcomes for trauma resuscitations were obtained through the Harborview Medical Center Trauma Registry and analyzed descriptively. A one-way ANCOVA analysis was conducted to test the effectiveness of our training intervention versus a control group for each outcome (leadership effectiveness and patient care) while accounting for pre-training performance, injury severity score, postgraduate training year, and days since training occurred. Association between leadership effectiveness and patient care was evaluated using random coefficient modeling. RESULTS/ANTICIPATED RESULTS: Sixty team leaders, 30 in each condition, completed the study. There was a significant difference in post-training leadership effectiveness [F(1,54)=30.19, p<.001, η2=.36] between the experimental and control conditions. There was no direct impact of training on patient care [F(1,54)=1.0, p=0.33, η2=.02]; however, leadership effectiveness mediated an indirect effect of training on patient care. Across all trauma resuscitations team leader effectiveness correlated with patient care (p<0.05) as predicted by team leadership conceptual models. DISCUSSION/SIGNIFICANCE OF IMPACT: This work represents a critical step in advancing translational simulation-based research (TSR). While there are several examples of high quality translational research programs, they primarily focus on procedural tasks and do not evaluate highly complex skills such as leadership. Complex skills present significant measurement challenges because individuals and processes are interrelated, with multiple components and emergent nature of tasks and related behaviors. We provide evidence that simulation-based training of a complex skill (team leadership behavior) transfers to a complex clinical setting (emergency department) with highly variable clinical tasks (trauma resuscitations). Our novel team leadership training significantly improved overall leadership performance and partially mediated the positive effect between leadership and patient care. This represents the first rigorous, randomized, controlled trial of a leadership or teamwork-focused training that systematically evaluates the impact on process (leadership) and performance (patient care).
Objectives: This study investigated the relationship between close proximity to detonated blast munitions and cognitive functioning in OEF/OIF/OND Veterans. Methods: A total of 333 participants completed a comprehensive evaluation that included assessment of neuropsychological functions, psychiatric diagnoses and history of military and non-military brain injury. Participants were assigned to a Close-Range Blast Exposure (CBE) or Non-Close-Range Blast Exposure (nonCBE) group based on whether they had reported being exposed to at least one blast within 10 meters. Results: Groups were compared on principal component scores representing the domains of memory, verbal fluency, and complex attention (empirically derived from a battery of standardized cognitive tests), after adjusting for age, education, PTSD diagnosis, sleep quality, substance abuse disorder, and pain. The CBE group showed poorer performance on the memory component. Rates of clinical impairment were significantly higher in the CBE group on select CVLT-II indices. Exploratory analyses examined the effects of concussion and multiple blasts on test performance and revealed that number of lifetime concussions did not contribute to memory performance. However, accumulating blast exposures at distances greater than 10 meters did contribute to poorer performance. Conclusions: Close proximity to detonated blast munitions may impact memory, and Veterans exposed to close-range blast are more likely to demonstrate clinically meaningful deficits. These findings were observed after statistically adjusting for comorbid factors. Results suggest that proximity to blast should be considered when assessing for memory deficits in returning Veterans. Comorbid psychiatric factors may not entirely account for cognitive difficulties. (JINS, 2018, 24, 466–475)
This paper describes strategies to search for, detect, and identify organic material on the surface and subsurface of Mars. The strategies described include those applied by landed missions in the past and those that will be applied in the future. The value and role of ESA's ExoMars rover and of her key science instrument Mars Organic Molecule Analyzer (MOMA) are critically assessed.
Improved understanding of the pattern of white matter changes in early and prodromal Alzheimer's disease (AD) states such as mild cognitive impairment (MCI) is necessary to support earlier preclinical detection of AD, and debate remains whether white matter changes in MCI are secondary to gray matter changes. We applied neuropsychologically based MCI criteria to a sample of normally aging older adults; 32 participants met criteria for MCI and 81 participants were classified as normal control (NC) subjects. Whole-head high resolution T1 and diffusion tensor imaging scans were completed. Tract-Based Spatial Statistics was applied and a priori selected regions of interest were extracted. Hippocampal volume and cortical thickness averaged across regions with known vulnerability to AD were derived. Controlling for cortical thickness, the MCI group showed decreased average fractional anisotropy (FA) and decreased FA in parietal white matter and in white matter underlying the entorhinal and posterior cingulate cortices relative to the NC group. Statistically controlling for cortical thickness, medial temporal FA was related to memory and parietal FA was related to executive functioning. These results provide further support for the potential role of white matter integrity as an early biomarker for individuals at risk for AD and highlight that changes in white matter may be independent of gray matter changes. (JINS, 2013, 19, 1–13)
Systemic corticosteroids are a mainstay of treatment for many pediatric medical conditions. Although their impact on the central nervous system has been well-studied in animal models and adults, less is known about such effects in pediatric populations. The current study investigated acute effects of corticosteroids on memory, executive functions, emotion, and behavior in children and adolescents with inflammatory bowel disease (IBD). Patients 8–17 years with IBD (Crohn's disease, CD; ulcerative colitis, UC) on high-dose prednisone (n = 33) and IBD patients in remission off steroids (n = 33) completed standardized neuropsychological tests and behavior rating scales. In the IBD sample as a whole, few steroid effects were found for laboratory cognitive measures, but steroid-treated patients were rated as exhibiting more problems with emotional, and to a lesser extent with cognitive function in daily life. Steroid effects, assessed by laboratory measures and questionnaires, were more prevalent in CD than UC patients; UC patients on steroids sometimes performed better than controls. Sleep disruption also predicted some outcomes, diminishing somewhat the magnitude of the steroid effects. Corticosteroid therapy can have acute effects on cognition, emotion, and behavior in chronically ill children; the clinical and long-term significance of these effects require further investigation. (JINS, 2012, 19, 1–14)
This protocol is used to evaluate the liver parenchyma for suspected mass, including screening for hepatocellular carcinoma, evaluation for metastatic disease, and characterization of lesions detected on other modalities (CT or ultrasound). Other common indications include elevated liver function tests and evaluation of tumor extent (i.e. multifocality).
Preparation
IV contrast agent: 1 mmol/kg gadopentetate dimeglumine at 2 cc/s
Oral contrast agent: none
2 L nasal oxygen
At least 24-gauge IV; connect to power injector
Cover from dome thru entire liver
Exam sequences and what we are looking for
(1) Diffusion-weighted imaging b50, 500/ADC – Very sensitive sequence for lesion detection.
(4-5) Axial T1 in- and out-of-phase (IP/OOP) – Identify geographic and microscopic focal fat.
(6) Axial T1-weighted volume-interpolated gradient echo BH pre – Identify anything that is T1-bright before contrast administration, so we don’t mistake it for enhancement.
(7) Axial T1-weighted volume-interpolated gradient echo BH post IV administration of contrast at 20 s – Evaluate for hypervascular lesions.
(8) Axial T1-weighted volume-interpolated gradient echo BH post IV administration of contrast at 1 minute.
(9) Axial T1-weighted volume-interpolated gradient echo BH post IV administration of contrast at 2 minutes.
(10) Axial T1-weighted volume-interpolated gradient echo BH post IV administration of contrast at 3 minutes.
Since the dawn of radiology, mankind has struggled to image the vasculature and conventional, or catheter-based, angiography has been the gold standard. Advantages of catheter-based angiography include: very high spatial resolution, temporal resolution (allowing the operator to follow the bolus of injected contrast from the artery through the vein), and the opportunity to intervene and treat a vascular abnormality. Many advances have been made in therapeutic interventional techniques particularly angioplasty, stenting, and embolization. However catheter angiography has several disadvantages including expense, imaging time, radiation exposure, and complications. Complications can be severe including hemorrhage, dissection, pseudoaneurysm, and inadvertent vascular occlusion.
Rapid advances in MRI, CT and ultrasound have led to the increasing use of these modalities to diagnose vascular abnormalities. The advantages of these modalities exactly address the disadvantages of catheter angiography including: decreased expense, imaging time, and, in the case of MRI and ultrasound, no ionizing radiation. Cross-sectional imaging has largely replaced catheter angiography for the diagnosis of vascular abnormalities. Catheter-based angiography is now used primarily for therapeutic interventions.
This protocol is used for evaluation of the biliary tree and pancreas. Indications include biliary ductal dilatation, suspicion of choledocholithiasis, jaundice, pancreatitis, pancreatic mass.
Preparation
IV contrast agent: 1 mmol/kg gadopentetate dimeglumine at 2 cc/s
Oral contrast agent: Mixture 3 oz. ferumoxsil and 3 oz. barium sulfate 30 minutes prior to study. If 30 minutes is not available, have patient lie on right side for 5 minutes prior to study
2 L nasal oxygen
At least 24-gauge IV; connect to power injector
Cover from dome thru entire liver
Find the best visualization of the ducts and repeat coronal single-shot fast-spin echo slab 30 mm thick 10 times.
Exam sequences
(1) Diffusion-weighted imaging b50, 500/ADC – Very sensitive sequence for lesion detection.
(4) Coronal single-shot fast-spin echo thick slab (30 mm) – Repeat 10 x – Assess distal CBD (ampulla), nice overall image of biliary tree. Repeated images to assure at least one with open sphincter of Oddi.
(5–6) Axial T1 in- and out-of-phase (IP/OOP) – Identify focal fat in the pancreas, don’tmistake it for a mass.
(7) Axial T1-weighted volume-interpolated gradient echo pre-contrast BH – Identify masses/material which are T1-bright before contrast administration. The fat saturation of this sequence increases relative signal in the pancreas and is good for identifying more subtle pancreatic masses.
(8) Axial T1-weighted volume-interpolated gradient echo BH post IV administration of contrast at 20 seconds. Look for hypervascular lesions such as islet cell tumours.
(9) Axial T1-weighted volume-interpolated gradient echo BH post IV administration of contrast at 1 minute.
(10) Axial T1-weighted volume-interpolated gradient echo BH post IV administration of contrast at 2 minutes.
(11) Axial T1-weighted volume-interpolated gradient echo BH post IV administration of contrast at 3 minutes.
This protocol is used to evaluate patients' with known or suspected Crohn's disease.
Preparation
IV contrast: 1 mmol/kg gadopentetate dimeglumine at 2 cc/s
Oral contrast: Have patient begin drinking the first 450 cc barium sulfate 0.1% 30 minutes prior to exam time. Give patient second 450 cc barium sulfate 0.1% 15 minutes prior to exam time. At exam time, give 450 cc water
2 L nasal oxygen
Start IV with at least 24-gauge needle; connect to power injector
Use 2-phased array coils to cover entire abdomen and pelvis
(3) Axial T2 single-shot fast-spin echo FS BH – Cover entire abdomen and pelvis. Identify T2-bright signal within or adjacent to bowel wall. Evaluate for perianal disease.
(4) Coronal T2 single-shot fast-spin echo FS BH – Cover entire abdomen and pelvis. Identify T2-bright signal within or adjacent to bowel wall.
(5) Coronal volume-interpolated gradient echo BH pre-contrast – Identify anything T1-bright which could be mistaken later for enhancement.
(8) Coronal volume-interpolated gradient echo BH post 3 minutes – Identify delayed enhancement which, in the absence of early enhancement, indicates chronic, fibrotic disease.
This protocol is used for evaluating venous flow through the pelvis.
Preparation
IV contrast agent: 1 mmol/kg gadopentetate dimeglumine at 2 cc/s
Oral contrast agent: None
No IV contrast if the patient is pregnant
Utilize a superior saturation pulse to saturate arterial flow
Cover from above aortic bifurcation (approximately L3) through iliacs
If flow is absent on one or both sides, add repeat axial SSFP in the decubitus position with the affected side up. This is done to determine if the void is due to a compression rather than a blockage.
This protocol is most frequently used to characterize incidentally detected adrenal masses (incidentalomas) found on other imaging modalities.
Preparation
IV contrast agent: None used routinely. If radiologist chooses to administer contrast, use 1 mmol/kg gadopentetate dimeglumine at 2 cc/s
Oral contrast agent: None
At completion of exam, page radiologist to check if intravenous contrast is necessary
Give patient 2 L nasal oxygen
Continue axial single-shot fast-spin echo FS to level of bladder
Exam sequences
(1) Coronal T1 spoiled gradient echo BH – Anatomic overview. Assess for adrenal mass. Be certain that “adrenal” masses are really in the adrenal gland.
(2–3) Axial T1 in and out of phase (IP/OOP) – Assess for intracellular lipid (microscopic fat) within adrenal lesions. This is by far the most important sequence for the adrenal gland.
(4) Axial T2 single-shot fast-spin echo – Identify T2-bright lesions within the adrenal glands.
(5) Axial T2 single-shot fast-spin echo FS – Compare to prior sequence to identify macroscopic fat.
(6) Radiologist check for contrast. If contrast is to
be used run:
(7) Volume-interpolated gradient echo BH pre.
(8) Volume-interpolated gradient echo BH post 20 seconds.
(9) Volume-interpolated gradient echo BH post 1 minute.
(10) Volume-interpolated gradient echo BH post 2 minutes.
This protocol is most commonly used for assessment of aortic size as well as for evaluation and follow-up of aortic dissection. It may also be used to evaluate for stenosis of the great vessels. If the thoracic aorta is not the primary vessel of interest, consider changing the plane of acquisition of the pre- and post-contrast SPGRs (although they are 3D, so they can be reformatted later in any plane).
Preparation
IV contrast agent: gadobenate dimeglumine 0.1 mmol/kg at 2 cc/s
Oral contrast agent: None
2 L nasal oxygen
At least 22-gauge IV; connect to power injector
Scan with patient's arms overhead, if patient can tolerate, for smallest field of view possible
All sequences are cardiac-gated except the SPGRs.
Exam sequences and what we are looking for
(1) Axial double-inversion recovery SSFSE BH (dark blood) – Carefully evaluate the vessel wall and look for dissection flaps.
(2) Axial SSFP BH (bright blood; non cine) – Confirm vessel size and presence/absence of dissection flap.
(3) Coronal double-inversion recovery SSFSE BH – Examine aortic root, typically better seen in coronal plane.
(4) Sagittal oblique 3D-SPGR pre-contrast BH.
(5) Sagittal oblique 3D-SPGR post-contrast BH arterial – Best evaluation of great vessel anatomy and presence/absence of stenosis.
(7) Parasagittal cine SFFP 2D (candy-cane) – View the thoracic aorta in its natural plane. Lumen and wall can be evaluated. And as below dissection flaps may be identified.
(8) Axial SSFP cine (optional) if aortic dissection is known, suspected, or discovered. This essentially gives us 20–25 images at the same axial location. A flap can be detected, confirmed, and observed through the cardiac cycle.