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To document patient characteristics and treatment patterns in a real-world population diagnosed with attention-deficit/hyperactivity disorder (ADHD).
This was a retrospective chart review of children/adolescents (6–17 years) diagnosed with ADHD in the UK, Germany and Netherlands who initiated stimulant monotherapy (SM), non-stimulant (atomoxetine) monotherapy (NSM) or polypharmacy (SM/NSM ± SM/NSM or other psychotropics) on/after 1-1-2012. To facilitate descriptive comparisons, cohort quotas were imposed: ∼50% SM; ∼25% NSM; ∼25% polypharmacy. Index date was first SM, NSM or polypharmacy treatment on/after 1-1-2012. Patients were required to have ≥ 6 months’ pre-index (baseline) history and ≥ 12 months’ post-index follow-up. Analyses were descriptive.
In total, 497 patients were included (mean [SD] age: 10.8 [2.9] years; 77% male); 65% (SM), 63% (NSM) and 83% (polypharmacy) had at least marked baseline ADHD severity based on Clinical Global Impressions scale (P < 0.05 SM/NSM vs polypharmacy). Ninety percent (SM), 75% (NSM) and 73% (polypharmacy) were pharmacotherapy naïve at index (all P < 0.10); 61% (SM), 65% (NSM) and 72% (polypharmacy) received previous behavioural therapy. In SM patients, methylphenidate was predominant (most frequent brands: Concerta® [29%], Medikinet® [28%]); in polypharmacy patients, methylphenidate plus atomoxetine (22%) or other psychotropic (19%) was most common. Index therapy switch was common, particularly in polypharmacy patients (25%) (P < 0.05 vs SM [14%] and NSM [13%]). Switches were precipitated by poor response in 75% of cases overall.
Polypharmacy patients generally presented a more complicated history (including higher ADHD severity) and treatment pathway versus monotherapy patients. Index therapy switches were commonplace and more frequent in polypharmacy patients, often due to poor response.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Two category 5 storms hit the US Virgin Islands (USVI) within 13 days of each other in September 2017. This caused an almost complete loss of power and devastated critical infrastructure such as the hospitals and airports
The USVI Department of Health conducted 2 response Community Assessments for Public Health Emergency Response (CASPERs) in November 2017 and a recovery CASPER in February 2018. CASPER is a 2-stage cluster sampling method designed to provide household-based information about a community’s needs in a timely, inexpensive, and representative manner.
Almost 70% of homes were damaged or destroyed, 81.2% of homes still needed repair, and 10.4% of respondents felt their home was unsafe to live in approximately 5 months after the storms. Eighteen percent of individual respondents indicated that their mental health was “not good” for 14 or more days in the past month, a significant increase from 2016.
The CASPERs helped characterize the status and needs of residents after the devastating hurricanes and illustrate the evolving needs of the community and the progression of the recovery process. CASPER findings were shared with response and recovery partners to promote data-driven recovery efforts, improve the efficiency of the current response and recovery efforts, and strengthen emergency preparedness in USVI. (Disaster Med Public Health Preparedness. 2019;13:53-62)
Two Category 5 storms, Hurricane Irma and Hurricane Maria, hit the U.S. Virgin Islands (USVI) within 13 days of each other in September 2017. These storms caused catastrophic damage across the territory, including widespread loss of power, destruction of homes, and devastation of critical infrastructure. During large scale disasters such as Hurricanes Irma and Maria, public health surveillance is an important tool to track emerging illnesses and injuries, identify at-risk populations, and assess the effectiveness of response efforts. The USVI Department of Health (DoH) partnered with shelter staff volunteers to monitor the health of the sheltered population and help guide response efforts.
Shelter volunteers collect data on the American Red Cross Aggregate Morbidity Report form that tallies the number of client visits at a shelter’s health services every 24 hours. Morbidity data were collected at all 5 shelters on St. Thomas and St. Croix between September and October 2017. This article describes the health surveillance data collected in response to Hurricanes Irma and Maria.
Following Hurricanes Irma and Maria, 1130 health-related client visits were reported, accounting for 1655 reasons for the visits (each client may have more than 1 reason for a single visit). Only 1 shelter reported data daily. Over half of visits (51.2%) were for health care management; 17.7% for acute illnesses, which include respiratory conditions, gastrointestinal symptoms, and pain; 14.6% for exacerbation of chronic disease; 9.8% for mental health; and 6.7% for injury. Shelter volunteers treated many clients within the shelters; however, reporting of the disposition (eg, referred to physician, pharmacist) was often missed (78.1%).
Shelter surveillance is an efficient means of quickly identifying and characterizing health issues and concerns in sheltered populations following disasters, allowing for the development of evidence-based strategies to address identified needs. When incorporated into broader surveillance strategies using multiple data sources, shelter data can enable disaster epidemiologists to paint a more comprehensive picture of community health, thereby planning and responding to health issues both within and outside of shelters. The findings from this report illustrated that managing chronic conditions presented a more notable resource demand than acute injuries and illnesses. Although there remains room for improvement because reporting was inconsistent throughout the response, the capacity of shelter staff to address the health needs of shelter residents and the ability to monitor the health needs in the sheltered population were critical resources for the USVI DoH overwhelmed by the disaster. (Disaster Med Public Health Preparedness. 2019;13:38-43)
n-3 Highly unsaturated fatty acids (HUFA), are essential components of neuronal membranes and mediate a range of complex bioactive properties including gene expression, myelination, cell-signalling and dopaminergic function. Deficits in n-3 HUFA have been linked to increased risks for addictive disorders, thus we posited that lower fish consumption would be associated with greater risks for perinatal smoking among 9640 mothers enroled in the Avon Longitudinal Study of Parents and Children. We used univariable and multivariable regression models to examine relationships between self-reported prenatal dietary intakes of n-3 HUFA-rich foods (fish and shellfish) and maternal smoking; outcomes included cessation and the number of cigarettes smoked per d. Both before and during pregnancy, there was consistent evidence (P<0·001) of protective fish intake–smoking associations; relative to mothers reporting no fish consumption, those who reported some fish consumption (<340 g/week) and high fish consumption (340 g+/week) at 32 weeks of gestation showed lower likelihoods of smoking (adjusted P values <0·001). Respective OR for these relationships were 0·87 (95% CI 0·77, 0·97) and 0·73 (95% CI 0·61, 0·86). Although the prevalence of smoking diminished, from a high of 31·6% (pre-pregnancy) to a low of 18·7% (second trimester), the magnitude of fish intake–smoking associations remained stable following adjustment for confounders. These observations suggest that greater fish or n-3 HUFA consumption should be evaluated as an intervention to reduce or prevent smoking in randomised clinical trials.
We report the first occurrence of an actinopterygian fish from the Lower Jurassic Navajo Sandstone, discovered in the Grand Staircase-Escalante National Monument in southern Utah, U.S.A. The site contains multiple individuals, preserved within an interdune deposit, possessing the elongate modified dorsal scales usually characterizing semionotiform fishes. The presence of moderately sized fish provides further evidence that interdune oases were occasionally persistent environmental habitats within the greater Navajo dune system, and that the paleobiota is still woefully undersampled. Additionally, this site could help fill a gap in the actinopterygian fossil record between the patchy Lower Jurassic and better-known Middle Jurassic documentation of western North America.
Trials evaluating efficacy of omega-3 highly unsaturated fatty acids (HUFAs) in major depressive disorder report discrepant findings.
To establish the reasons underlying inconsistent findings among randomised controlled trials (RCTs) of omega-3 HUFAs for depression and to assess implications for further trials.
A systematic bibliographic search of double-blind RCTs was conducted between January 1980 and July 2014 and an exploratory hypothesis-testing meta-analysis performed in 35 RCTs including 6665 participants receiving omega-3 HUFAs and 4373 participants receiving placebo.
Among participants with diagnosed depression, eicosapentaenoic acid (EPA)-predominant formulations (>50% EPA) demonstrated clinical benefits compared with placebo (Hedge's G = 0.61, P<0.001) whereas docosahexaenoic acid (DHA)-predominant formulations (>50% DHA) did not. EPA failed to prevent depressive symptoms among populations not diagnosed for depression.
Further RCTs should be conducted on study populations with diagnosed or clinically significant depression of adequate duration using EPA-predominant omega-3 HUFA formulations.
Palmer amaranth and waterhemp have become increasingly troublesome weeds throughout the United States. Both species are highly adaptable and emerge continuously throughout the summer months, presenting the need for a residual PRE application in soybean. To improve season-long control of Amaranthus spp., 19 PRE treatments were evaluated on glyphosate-resistant Palmer amaranth in 2013 and 2014 at locations in Arkansas, Indiana, Nebraska, Illinois, and Tennessee; and on glyphosate-resistant waterhemp at locations in Illinois, Missouri, and Nebraska. The two Amaranthus species were analyzed separately; data for each species were pooled across site-years, and site-year was included as a random variable in the analyses. The dissipation of weed control throughout the course of the experiments was compared among treatments with the use of regression analysis where percent weed control was described as a function of time (the number of weeks after treatment [WAT]). At the mean (i.e., average) WAT (4.3 and 3.2 WAT for Palmer amaranth and waterhemp, respectively) isoxaflutole + S-metolachlor + metribuzin had the highest predicted control of Palmer amaranth (98%) and waterhemp (99%). Isoxaflutole + S-metolachlor + metribuzin, S-metolachlor + mesotrione, and flumioxazin + pyroxasulfone had a predicted control ≥ 97% and similar model parameter estimates, indicating control declined at similar rates for these treatments. Dicamba and 2,4-D provided some, short-lived residual control of Amaranthus spp. When dicamba was added to metribuzin or S-metolachlor, control increased compared to dicamba alone. Flumioxazin + pyroxasulfone, a currently labeled PRE, performed similarly to treatments containing isoxaflutole or mesotrione. Additional sites of action will provide soybean growers more opportunities to control these weeds and reduce the potential for herbicide resistance.
Herbicide-resistant Amaranthus spp. continue to cause management difficulties in soybean. New soybean technologies under development, including resistance to various combinations of glyphosate, glufosinate, dicamba, 2,4-D, isoxaflutole, and mesotrione, will make possible the use of additional herbicide sites of action in soybean than is currently available. When this research was conducted, these soybean traits were still regulated and testing herbicide programs with the appropriate soybean genetics in a single experiment was not feasible. Therefore, the effectiveness of various herbicide programs (PRE herbicides followed by POST herbicides) was evaluated in bare-ground experiments on glyphosate-resistant Palmer amaranth and glyphosate-resistant waterhemp (both tall and common) at locations in Arkansas, Illinois, Indiana, Missouri, Nebraska, and Tennessee. Twenty-five herbicide programs were evaluated; 5 of which were PRE herbicides only, 10 were PRE herbicides followed by POST herbicides 3 to 4 wks after (WA) the PRE application (EPOST), and 10 were PRE herbicides followed by POST herbicides 6 to 7 WA the PRE application (LPOST). Programs with EPOST herbicides provided 94% or greater control of Palmer amaranth and waterhemp at 3 to 4 WA the EPOST. Overall, programs with LPOST herbicides resulted in a period of weed emergence in which weeds would typically compete with a crop. Weeds were not completely controlled with the LPOST herbicides because weed sizes were larger (≥ 15 cm) compared with their sizes at the EPOST application (≤ 7 cm). Most programs with LPOST herbicides provided 80 to 95% control at 3 to 4 WA applied LPOST. Based on an orthogonal contrast, using a synthetic-auxin herbicide LPOST improves control of Palmer amaranth and waterhemp over programs not containing a synthetic-auxin LPOST. These results show herbicides that can be used in soybean and that contain auxinic- or HPPD-resistant traits will provide growers with an opportunity for better control of glyphosate-resistant Palmer amaranth and waterhemp over a wide range of geographies and environments.
Fall-applied residual and spring preplant burn-down herbicide applications are typically used to control winter annual weeds and may also provide early-season residual control of summer annual weed species such as giant ragweed. Field experiments were conducted from 2006 to 2008 in southern Illinois to (1) assess the emergence pattern of giant ragweed, (2) evaluate the efficacy of several herbicides commonly used for soil-residual control of giant ragweed, and (3) investigate the optimal application timing of soil-residual herbicides for control of giant ragweed. Six herbicide treatments were applied at four application timings: early fall, late fall, early spring, and late spring. Giant ragweed first emerged in mid- and late-March in 2007 and 2008, respectively. The duration of emergence varied by year, with 95% of emergence complete in late May of 2008, but not until early July in 2007. Giant ragweed emergence occurred more quickly in plots that received a fall application of glyphosate + 2,4-D compared with the nontreated. Fall-applied residual herbicides did not reduce giant ragweed emergence in 2007 when compared with the nontreated, with the exception of chlorimuron + tribenuron applied in late fall. Giant ragweed control from early- and late-spring herbicide applications was variable by year. In 2007, saflufenacil (50 and 100 g ai ha−1) and simazine applied in early spring reduced giant ragweed densities by 95% or greater through mid-May; however, in 2008, early-spring applications failed to reduce giant ragweed emergence in mid-April. The only treatments that reduced giant ragweed densities by > 80% through early July were late-spring applications of chlorimuron + tribenuron or saflufenacil at 100 g ha−1. Thus, the emergence patterns of giant ragweed in southern Illinois dictates that best management with herbicides would include late-spring applications of soil-residual herbicides just before crop planting and most likely requires subsequent control with foliar or soil-residual herbicides after crop emergence.
Nitrous oxide (N2O) is a potent greenhouse gas with implication
for climate change. Agriculture accounts for 10% of all greenhouse gas
emissions in the United States, but 75% of the country's N2O
emissions. In the absence of PRE herbicides, weeds compete with soybean for
available soil moisture and inorganic N, and may reduce N2O
emissions relative to a weed-free environment. However, after weeds are
killed with a POST herbicide, the dead weed residues may stimulate
N2O emissions by increasing soil moisture and supplying carbon
and nitrogen to microbial denitrifiers. Wider soybean rows often have more
weed biomass, and as a result, row width may further impact how weeds
influence N2O emissions. To determine this relationship, field
studies were conducted in 2013 and 2014 in Arlington, WI. A two-by-two
factorial treatment structure of weed management (PRE + POST vs. POST-only)
and row width (38 or 76 cm) was arranged in a randomized complete block
design with four replications. N2O fluxes were measured from
static gas sampling chambers at least weekly starting 2 wk after planting
until mid-September, and were compared for the periods before and after weed
termination using a repeated measures analysis. N2O fluxes were
not influenced by the weed by width
interaction or width before termination, after termination,
or for the full duration of the study at P ≤ 0.05. Interestingly, we
observed that POST-only treatments had lower fluxes on the sampling day
immediately prior to POST application (P = 0.0002), but this was the only
incidence where weed influenced N2O fluxes, and
overall, average fluxes from PRE + POST and POST-only treatments were not
different for any period of the study. Soybean yield was not influenced by
width (P = 0.6018) or weed by
width (P = 0.5825), but yield was 650 kg ha−1
higher in the PRE + POST than POST-only treatments (P = 0.0007). These
results indicate that herbicide management strategy does not influence
N2O emissions from soybean, and the use of a PRE herbicide
prevents soybean yield loss.
Atrazine has been used for control of many weeds, primarily broadleaf weeds, in U.S. corn fields since 1957. Recently, the adoption of glyphosate-resistant corn hybrids have led to glyphosate eclipsing atrazine as the most commonly used herbicide in corn production. However, the evolution and spread of glyphosate-resistant weeds is a major concern. Atrazine use in Wisconsin is prohibited in 102 areas encompassing 0.49 million ha where total chlorinated residues were found in drinking water wells at concentrations > 3 μg L−1. Atrazine has been prohibited in many of those areas for > 10 yr, providing an opportunity to evaluate weed community composition differences due to herbicide regulation. In question, has the abundance of broadleaf weeds increased, coupled with an increased reliance on glyphosate, where atrazine use has been discontinued? To answer this, an online questionnaire was distributed to Wisconsin growers in June and then weeds present in 343 fields in late July through mid-September in 2012 and 2013 were counted. Data were summarized for frequency, uniformity, density, and relative abundance to compare weed community composition in fields with discontinued vs. recent atrazine use. Growers used glyphosate in 70 vs. 54% of fields with discontinued vs. recent atrazine use, respectively (P = 0.021). Moreover, broadleaf weeds were found more frequently, (73 vs. 61%; P = 0.03), they had 50% greater in-field uniformity (P = 0.002), and density was 0.4 vs. 0.19 plants m−2 (i.e., twofold greater; P < 0.0001) in discontinued vs. recent atrazine-use fields. Changes were most evident with troublesome glyphosate-resistant broadleaf weeds such as Amaranthus species and giant ragweed. In conclusion, weed community composition consisted of more broadleaf weeds in fields where atrazine has not been used in the recent decade coupled with greater glyphosate use. These results provide evidence of negative long-term implications for glyphosate resistance where growers increased reliance on glyphosate in place of atrazine.
Atrazine is an important herbicide for broadleaf weed control in corn. Use rates have declined in many corn production systems due to environmental concerns and the availability of other effective herbicides, especially glyphosate in glyphosate-resistant hybrids. However, using multiple effective herbicide modes of action is ever more important because occurrence of herbicide-resistant weeds is increasing. An experiment to compare application timings of reduced rates of atrazine to benefit resistance management in broadleaf weeds while protecting corn yield was conducted in Wisconsin across four site-years in 2012 and 2013. Herbicide treatments consisted of five atrazine rate and timing combinations and three POST base herbicides: glyphosate, glufosinate, and tembotrione. Metolachlor was applied PRE at 2.1 kg ai ha−1 for grass control in all treatments. A linear regression model estimated that atrazine rates ≥ 1.0 kg ai ha−1 applied PRE would prevent exposure of common lambsquarters plants to POST herbicides, but giant ragweed and velvetleaf exposure was not influenced by timing. Corn yield was also not influenced by atrazine rate and timing combinations at the α = 0.05 level; however, at P = 0.06, corn yield was greater for atrazine applied PRE at 1.1 kg ha−1 than for atrazine applied PRE at 0.5 kg ha−1, POST at 1.1 kg ha−1, or not at all. In summary, higher rates of atrazine applied PRE may improve yield, as reported by others, but this study concludes reduced rates of atrazine (i.e., ≤ 1.1 kg ha−1) applied to corn in a POST tank mixture combination provided more consistent control of giant ragweed, velvetleaf, and common lambsquarters compared with atrazine applied PRE. This information should help direct atrazine application timing applied POST when applied at low rates to improve proactive herbicide resistance management.
This paper describes the system architecture of a newly constructed radio telescope – the Boolardy engineering test array, which is a prototype of the Australian square kilometre array pathfinder telescope. Phased array feed technology is used to form multiple simultaneous beams per antenna, providing astronomers with unprecedented survey speed. The test array described here is a six-antenna interferometer, fitted with prototype signal processing hardware capable of forming at least nine dual-polarisation beams simultaneously, allowing several square degrees to be imaged in a single pointed observation. The main purpose of the test array is to develop beamforming and wide-field calibration methods for use with the full telescope, but it will also be capable of limited early science demonstrations.