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Introduction: Cannabis Hyperemesis Syndrome (CHS) is a new and poorly understood phenomenon with a subset of patients presenting to emergency departments (ED) for symptomatic control of their refractory nausea and vomiting. Curently, there is a lack of agreement and considerable practice variability on initial treatment modalities for CHS. The objective of this study was to describe the treatment modalities for patients presenting to ED with cannabis-related sequelae. Methods: This was a health records review of patients ≥18 years presenting to one of two tertiary care EDs (annual census: 150,000) with a discharge diagnosis including cannabis use with one of abdominal pain or nausea/vomiting using ICD-10 codes. Trained research personnel collected data from medical records including demographics, clinical history, results of investigations, and utilization of treatment options within the ED. Descriptive statistics are presented where appropriate. Results: From April 2014 to June 2016, 203 unique ED patients had a discharge diagnosis including cannabis use with abdominal pain or nausea/vomiting. Sixty-nine (33.4%) received any treatment during their visit with 28 (40.6%) receiving IV fluids, of which 24 (85.7%) received normal saline. Anti-emetics were used in 21 (30.4%) patients with ondansetron being the first-line agent in 11 (52.4%) patients followed by dimenhydrinate in 6 (28.6%) and haloperidol in 2 (9.5%) cases. Six patients required two doses of anti-emetics, favouring ondansetron in 3 cases followed by haloperidol, dimenhydrinate, and metoclopramide each used once. Thirteen (19%) patients required analgesia, with the first-line preference being non-opioid medications in 11 versus opioids in 2 cases. Seven patients required multiple modes of analgesia, favouring opioid medications in 4 patients. Twenty-eight (40.6%) patients required anxiolytics with lorazepam being used primarily in 16 (57.1%) patients followed by lorazepam/haloperidol in 5 (17.9%) cases. Conclusion: This ED-based study demonstrates variability of practice patterns for symptomatic treatment of cannabis related ED presentations. Despite knowledge of haloperidol being useful in patients with suspected CHS, physicians opted for ondansetron as first line anti-emetics. Future research should focus on studying various treatment modalities of patients with suspected CHS in the ED to optimize symptomatic treatment.
Introduction: Cannabis Hyperemesis Syndrome (CHS) is a poorly understood phenomenon with a subset of patients presenting to the emergency department (ED) for symptomatic control of refractory nausea and vomiting. As legalization of marijuana commenced on October 2018, it is important to recognize the presentation of patients related to marijuana consumption. The objective of this study was to describe demographic and ED visit data of patients presenting to the ED with cannabis-related sequelae. Methods: This was a health records review of patients ≥18 years presenting to one of two tertiary care EDs (annual census 150,000 visits) with a discharge diagnosis including cannabis use with one of abdominal pain or nausea/vomiting using ICD-10 codes. Trained research personnel collected data from medical records including demographics, clinical history, results of investigations within the ED. Descriptive statistics including means and standard deviations are presented where appropriate. Results: From April 2014 to June 2016, 203 unique ED patients had a discharge diagnosis including cannabis use with abdominal pain or nausea/vomiting. Mean (SD) age was 30 (13.04) years and 120 (59.1%) were male. Patients presented to the ED independently 84 (41.4%), via EMS with 104 (51.23%) and 15 (7.39%) by police. The majority of patients were triaged as CTAS-2 in 27 (33%) and CTAS-3 in 106 (52.2%) of all cases. Of patients disclosing their method of consumption, 31 (15.3%) had used combustion methods and 30 (14.8%) had edible marijuana. Mean (SD) serum potassium was 3.71 (0.48) mmol/l. 162 (79.8%) were discharged home and 9 (4.4%) were given follow up (all psychiatric). Twenty-nine (14.3%) were admitted to hospital with 28 (13.8%) admitted to psychiatry and 1 (0.5%) admitted to medicine. Conclusion: This ED-based retrospective chart review reports a description of cannabis-related presentations to the ED. Clinicians should be aware of CHS in patients presenting to the ED, especially as Canada enters the era of legalization. Future research should focus on the impact of federal legalization of marijuana on ED utilization for CHS-related presentations.
Auditory hallucinations (AH) are often considered a sign of a psychotic disorder. This is promoted by the DSM-5 category of Other Specified Schizophrenia Spectrum And Other Psychotic Disorder (OSSSOPD), the diagnostic criteria for which are fulfilled with the sole presence of persistent AH, in the absence of any other psychotic symptoms. And yet, persistent AH are not synonymous with having a psychotic disorder, and should therefore not be uncritically treated as such. Many people who seek treatment for persistent AH have no other psychotic symptoms, have preserved reality-testing capacities, and will never develop a schizophrenia spectrum disorder. Instead, hallucinations may be the result of many different causes, including borderline personality disorder, post-traumatic stress disorder (PTSD), hearing loss, sleep disorders or brain lesions, and they may even occur outside the context of any demonstrable pathology. In such cases, the usage of the DSM-5 diagnosis of OSSSOPD would be incorrect, and it may prompt unwarranted treatment with antipsychotic medication. We therefore argue that a DSM-5 diagnosis of Schizophrenia Spectrum Disorder (or any other type of psychotic disorder) characterized by AH should require at least one more symptom listed under the A-criterion (i.e. delusions, disorganized speech, disorganized or catatonic behavior or negative symptoms). Adhering to these more stringent criteria may help to distinguish between individuals with persistent AH which are part of a psychotic disorder, for whom antipsychotic medication may be helpful, and individuals with AH in the absence of such a disorder who may benefit from other approaches (e.g. different pharmacological interventions, improving coping style, trauma-related therapy).
Mindfulness-based cognitive therapy (MBCT) and maintenance antidepressant medication (mADM) both reduce the risk of relapse in recurrent depression, but their combination has not been studied.
To investigate whether MBCT with discontinuation of mADM is non-inferior to MBCT+mADM.
A multicentre randomised controlled non-inferiority trial (ClinicalTrials.gov: NCT00928980). Adults with recurrent depression in remission, using mADM for 6 months or longer (n = 249), were randomly allocated to either discontinue (n = 128) or continue (n = 121) mADM after MBCT. The primary outcome was depressive relapse/recurrence within 15 months. A confidence interval approach with a margin of 25% was used to test non-inferiority. Key secondary outcomes were time to relapse/recurrence and depression severity.
The difference in relapse/recurrence rates exceeded the non-inferiority margin and time to relapse/recurrence was significantly shorter after discontinuation of mADM. There were only minor differences in depression severity.
Our findings suggest an increased risk of relapse/recurrence in patients withdrawing from mADM after MBCT.
This study evaluates the effects of Age of Exposure to English (AoEE) and Current Input/Output on language performance in a cross-sectional sample of Spanish–English bilingual children. First- (N = 586) and third-graders (N = 298) who spanned a wide range of bilingual language experience participated. Parents and teachers provided information about English and Spanish language use. Short tests of semantic and morphosyntactic development in Spanish and English were used to quantify children's knowledge of each language. There were significant interactions between AoEE and Current Input/Output for children at third grade in English and in both grades for Spanish. In English, the relationship between AoEE and language scores were linear for first- and third-graders. In Spanish a nonlinear relationship was observed. We discuss how much of the variance was accounted for by AoEE and Current Input/Output.
Prevalence of blaKPC-encoding Enterobacteriaceae (KPC) in Chicago long-term acute care hospitals (LTACHs) rose rapidly after the first recognition in 2007. We studied the epidemiology and transmission capacity of KPC in LTACHs and the effect of patient cohorting.
Data were available from 4 Chicago LTACHs from June 2012 to June 2013 during a period of bundled interventions. These consisted of screening for KPC rectal carriage, daily chlorhexidine bathing, medical staff education, and 3 cohort strategies: a pure cohort (all KPC-positive patients on 1 floor), single rooms for KPC-positive patients, and a mixed cohort (all KPC-positive patients on 1 floor, supplemented with KPC-negative patients). A data-augmented Markov chain Monte Carlo (MCMC) method was used to model the transmission process.
Average prevalence of KPC colonization was 29.3%. On admission, 18% of patients were colonized; the sensitivity of the screening process was 81%. The per admission reproduction number was 0.40. The number of acquisitions per 1,000 patient days was lowest in LTACHs with a pure cohort ward or single rooms for colonized patients compared with mixed-cohort wards, but 95% credible intervals overlapped.
Prevalence of KPC in LTACHs is high, primarily due to high admission prevalence and the resultant impact of high colonization pressure on cross transmission. In this setting, with an intervention in place, patient-to-patient transmission is insufficient to maintain endemicity. Inclusion of a pure cohort or single rooms for KPC-positive patients in an intervention bundle seemed to limit transmission compared to use of a mixed cohort.
Infect Control Hosp Epidemiol 2015;36(10):1148–1154
Donor-acceptor mixed-stack charge-transfer (CT) compounds can be regarded as a model system for charge carrier separation in molecular-scale donor-acceptor heterojunctions. Here we investigated fundamental photocarrier generation characteristics in single crystals of a donoracceptor mixed-stack system, phenothiazine-tetracyanoquinodimethane (PTZ-TCNQ). The laser beam-induced current (LBIC) measurement on the crystals allowed the discrimination between the exciton and the photocarrier diffusion on the basis of the observed spatial decay profiles. We found that the photocarriers are directly generated by higher-lying CT band excitation and exhibit extremely long diffusion length reaching more than 10 μm. We discuss the origin of the efficient photocarrier generation in terms of the geminate electron-hole pair formation.
Introduction: Early detection of cardiovascular disease in children with end-stage renal disease is essential in order to prevent cardiovascular morbidity and mortality in early adulthood. Tissue Doppler imaging has shown to be a promising method to detect and quantify subtle abnormalities in diastolic function. We therefore compared assessment of diastolic function by conventional echocardiography and tissue Doppler imaging. Methods: We performed conventional echocardiography and tissue Doppler imaging in 38 children with end-stage renal disease and 76 healthy controls. We compared outcomes on parameters related to diastolic function (E/a ratio for conventional echocardiography and E/E′ ratio for tissue Doppler imaging) for both groups using multiple linear regression analysis. Diastolic dysfunction was defined as E/a ratio <1 or E/E′ ratio > 95th percentile for age. To assess the intra-observer reproducibility, the coefficient of variation was calculated. Results: Children with end-stage renal disease had on average a lower E/a ratio (p = 0.004) and a higher mitral and septal E/E′ ratio (both p < 0.001) compared with controls. In all, two children with end-stage renal disease (5%) had diastolic dysfunction according to the E/a ratio, 11 according to the mitral E/E′ ratio (29%), and 16 according to the septal E/E′ ratio (42%) compared with none of the controls (p = 0.109, p < 0.001, and p < 0.001, respectively). The coefficients of variation of the mitral (7%) and septal E/E′ ratio (4%) were smaller than the coefficient of variation of the E/a ratio (11%). Conclusions: Tissue Doppler imaging is a more sensitive and reliable method to detect diastolic dysfunction than conventional E/a ratio in children with end-stage renal disease.
In the past decades organic thin film transistors (OTFTs) have been notably studied due to their interesting properties. Not only they can be processed by simple methods such as inkjet printing but also open the doors to new applications for cheap plastic electronics including electronic tags, biosensors, flexible screens,… However, the measured field-effect mobility in OTFTs is relatively low compared to inorganic devices. Generally, such low field-effect mobility values result from extrinsic effects such as grain boundaries or imperfect interfaces with source and drain electrodes. It has been shown that reducing the number of grain boundaries between the source and drain electrodes improves the field effect mobility.1-3 Therefore, it is important to understand the transport mechanisms by studying the structure of organic thin films and local electrical properties within the channel and at the interfaces with source and drain electrodes in order to improve the field-effect mobility in OTFTs. Kelvin probe force microscopy (KPFM) is an ideal tool for that purpose since it allows to simultaneously investigation of the local structure and the electrical potential distribution in electronic devices. In this work, the structure and the electrical properties of OTFTs based on dioctylterthiophene (DOTT) were studied. The transistors were fabricated by spin-coating of DOTT on the transistor structures with treated (silanized) and untreated channel oxide. The potential profiles across the channel and at the metal-electrode interfaces were measured by KPFM. The effect of surface treatment on hysteresis effects was also studied. Smaller crystals and a lower threshold voltage were observed for the silanized devices. Hysteresis effects appeared to be less important in modified devices compared to the untreated ones.
In this paper we study the density of states in n-type N,N’-ditridecylperylene-3,4,9,10-tetracarboxylic diimide organic semiconductor using two different methods. The first one is based on the temperature dependence of the channel conductance in field-effect transistors. The second one is based on the subgap optical absorption coefficient measured using the Photothermal Deflection Spectroscopy technique. Both techniques allow estimating the distribution of localized states in the band gap of the semiconductor.
Transparent conductive oxide less flexible dye-sensitized solar cells (TCO-less DSC) with flat and cylinder shapes are reported. The cell consists of a plastic cover, a flexible titania/dye sheet back contacted with a metal mesh sheet, a gel electrolyte sheet, and Pt layer on a Ti sheet. How to increase the efficiency were discussed. We concluded that making a titania/dye layer on a metal mesh sheet thinner and using a thinner electrolyte layer were effective for increasing the efficiency. A flat TCO-less DSC with 6.1 % efficiency and a cylindrical TCO-less DSC with 5.1 % efficiency are reported.
We have studied the effect of pentacene purity and evaporation rate on low-voltage organic thin-film transistors (OTFTs) prepared solely by dry fabrication techniques. The maximum field-effect mobility of 0.07 cm2/Vs was achieved for the highest pentacene evaporation rate of 0.32 Å/s and four-time purified pentacene. Four-time purified pentacene also led to the lowest threshold voltage of -1.1 V and inverse subthreshold slope of ∼100 mV/decade. In addition, pentacene surface was imaged using atomic force microscopy, and the transistor channel and contact resistances for various pentacene evaporation rates were extracted and compared to field-effect mobilities.
To improve the conversion efficiency of polymer photodetectors (PDs) fabricated by solution process, the properties of fluorene-type polymer photodetectors doped with iridium (Ir) and platinum (Pt) complexes were investigated. The devices based on poly(dioctylfluorene) and poly(dioctylfluorene-co-benzothiadiazole) (F8BT) had violet and blue sensitivity, respectively. Triplet materials can enhance the incident-photon-to-current conversion efficiency of the devices utilizing the fluorene-type polymers when their triplet levels are lower than the lowest excited singlet states of the host and higher than the lowest excited triplet states of the host. The transmission of a moving picture was successfully demonstrated using the bilayer F8BT device with green Ir complex as an opto-electrical conversion device. We demonstrate that the polymer PDs fabricated by solution process can be applied to short-range optical communication fields, such as opto-electrical conversion devices for optical links.
A comparison of the photocurrent spectra of organic bulk heterojunction solar cells of various thicknesses is presented. Increasing the thickness of the active layer in both MDMO-PPV /PCBM and P3HT/PCBM solar cells reduces the magnitude of the photocurrent due to the low mobility of the photogenerated holes. Measurements show that the photocurrent reduction is predominately due to a loss in carriers generated at the polymer absorption maximum, while the low energy response is relatively unaffected. In a thick enough sample, the low energy response (1.5-2 eV) dominates, and a photocurrent peak is no longer observed at the main absorption maximum (2.6 eV). The results imply that hole transport is blocked for carriers generated in the polymer at higher energy. Because these holes are generated at the absorption maximum their low mobility could be a major factor limiting solar cell efficiency.
Short channel organic thin film transistors in bottom-gate, bottom contact configuration use typically gold metallization for the source and drain contacts because this metal can easily be cleaned from photoresist residuals by oxygen plasma or ultraviolet-ozone and allows also surface modification by self-assembled monolayers (e.g. thiols). Alternative low-cost bottom contact metallization for high performance short-channel organic thin film transistors are scarce because of the incompatibility of the bottom contact material with the cleaning step. In this work a new process flow, involving a temporary thin aluminum protection layer, is presented. Short channel (3.4 μm) pentacene transistors with lithographical defined and thiol modified silver source/drain bottom contacts (25 nm thick, on a 2 nm titanium adhesion layer) prepared according to this process achieved a saturation mobility of 0.316 cm2/(V.s), and this at a metal cost below 1% of the standard 30 nm thick gold metallization.
The complex admittance of the Si+/SiO2/Pentacene/Au (metal/oxide/pentacene) thin film junctions is investigated under ambient conditions. The results are compared with the ones obtained for the corresponding Si+/SiO2/Au junctions (i.e. a small part of the surface left free from pentacene) which constitutes the “reference” of our samples. This allows us to extract the “organic” part of the dielectric response from the whole spectrum. Our data clearly show that the admittance is decomposed in three main contributions. At low frequencies, a contribution attributed to proton diffusion through the oxide is seen. This diffusion is shown to be anomalous and is believed to be also at the origin of the bias stress effect observed in organic field effect transistors. At higher frequencies, two dipolar contributions are evidenced, attributed to defects located one at the organic/oxide interface or within the organic, and the other in the bulk of the oxide. These two dipolar responses show different dynamic properties that manifest themselves in the admittance in the form of a Debye contribution for the defects located in the oxide, and of a Cole-Cole contribution for the defects related to the organic.
We report high-efficiency phosphorescent blue OLEDs with an organic three stacked structure. Using a high-triplet-energy-hole transporting material of TAPC and a high-triplet-energy-electron transporting material of TmPyPB, the organic three stacked structure has been realized with three new narrow band-gap blue host materials. These host materials have bipolar characteristics and high triplet energy of >2.8 eV. Very low onset voltages of 2.8~3.0 V and driving voltages of 4.2~4.6 V to obtain a brightness of 1000 cd/m2 are achieved in this three stacked device configuration. Maximum external quantum efficiency above 20% is reported.
Auditory verbal hallucinations (AVH) in patients with borderline personality disorder (BPD) are frequently claimed to be brief, less severe and qualitatively different from those in schizophrenia, hence the term ‘pseudohallucinations’. AVH in BPD may be more similar to those experienced by healthy individuals, who experience AVH in a lower frequency and with a more positive content than AVH in schizophrenia. In this study the phenomenology of AVH in BPD patients was compared to that in schizophrenia and to AVH experienced by non-patients.
In a cross-sectional setting, the phenomenological characteristics of AVH in 38 BPD patients were compared to those in 51 patients with schizophrenia/schizoaffective disorder and to AVH of 66 non-patients, using the Psychotic Symptom Rating Scales (PSYRATS).
BPD patients experienced AVH for a mean duration of 18 years, with a mean frequency of at least daily lasting several minutes or more. The ensuing distress was high. No differences in the phenomenological characteristics of AVH were revealed among patients diagnosed with BPD and those with schizophrenia/schizoaffective disorder, except for ‘disruption of life’, which was higher in the latter group. Compared to non-patients experiencing AVH, BPD patients had higher scores on almost all items.
AVH in BPD patients are phenomenologically similar to those in schizophrenia, and different from those in healthy individuals. As AVH in patients with BPD fulfil the criteria of hallucinations proper, we prefer the term AVH over ‘pseudohallucinations’, so as to prevent trivialization and to promote adequate diagnosis and treatment.
Silicon nanoparticles are formed during pulsed laser ablation under a background atmosphere of Ar gas. In this paper we have characterized the nanoparticles that are backscattered via collisions in the gas phase and redeposited on the target surface. Clustering in an O2/Ar gas atmosphere resulted in the formation of unique nanostructures that photoluminesce in the violet and blue-green portions of the electromagnetic spectrum. Ablating a (001) Si target in the presence of ultra-high purity (UHP) argon produced Si nanoparticles outside the irradiated region. The mean diameter of these particles decreases from 50 nm to 5 nm with increasing distance from the laser spot. The nanoparticle distribution can be induced to self-organize in linear arrays by simultaneously irradiating the nanoparticles as they deposit.