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To explore the relationships between dose changes to antipsychotic and/or benzodiazepine medications and resident outcomes, including variations in neuropsychiatric symptoms, quality of life (QoL), and social withdrawal, within a multicomponent, interdisciplinary antipsychotic and benzodiazepine dose reduction program.
Prospective, observational, longitudinal study.
The Reducing Use of Sedatives (RedUSe) project involved 150 Australian Long-Term Care Facilities (LTCFs) incorporating auditing and benchmarking of prescribing, education, and multidisciplinary sedative reviews.
A convenience sample of LTCFs (n = 28) involved in RedUSe between January 2015 and March 2016.
Permanent residents (n = 206) of LTCFs involved in RedUSe taking an antipsychotic and/or benzodiazepine daily. Residents were excluded if they had a severe psychiatric condition where antipsychotic therapy should generally be maintained long-term (e.g., bipolar disorder, schizophrenia) or were considered end-stage palliative.
Neuropsychiatric symptoms (Neuropsychiatric Inventory, Cohen-Mansfield Agitation Inventory (CMAI)), QoL (Assessment of Quality of Life-4D), and social withdrawal (Multidimensional Observation Scale for Elderly Subjects-withdrawal subscale) were measured at baseline and 4 months where nursing staff completed psychometric tests as proxy raters.
There was no evidence that psychometric measures were worsened following dose reductions. In fact, dose reduction was associated with small, albeit non-statistically significant, improvements in behavior, particularly less physically non-aggressive behavior with both drug groups (−0.36 points per 10% reduction in antipsychotic dose, −0.17 per 10% reduction in benzodiazepine dose) and verbally agitated behavior with benzodiazepine reduction (−0.16 per 10% dose reduction), as measured with the CMAI. Furthermore, antipsychotic reduction was associated with non-statistically significant improvements in QoL and social withdrawal.
Antipsychotic and benzodiazepine dose reduction in LTCFs was not associated with deterioration in neuropsychiatric symptoms, QoL, or social withdrawal. Trends toward improved agitation with antipsychotic and benzodiazepine dose reduction require further evaluation in larger, prospective, controlled studies.
The evolution of resistance to multiple herbicides in Palmer amaranth is a major challenge for its management. In this study, a Palmer amaranth population from Hutchinson, Kansas (HMR), was characterized for resistance to inhibitors of photosystem II (PSII) (e.g., atrazine), acetolactate synthase (ALS) (e.g., chlorsulfuron), and EPSP synthase (EPSPS) (e.g., glyphosate), and this resistance was investigated. About 100 HMR plants were treated with field-recommended doses (1×) of atrazine, chlorsulfuron, and glyphosate, separately along with Hutchinson multiple-herbicide (atrazine, chlorsulfuron, and glyphosate)–susceptible (HMS) Palmer amaranth as control. The mechanism of resistance to these herbicides was investigated by sequencing or amplifying the psbA, ALS, and EPSPS genes, the molecular targets of atrazine, chlorsulfuron, and glyphosate, respectively. Fifty-two percent of plants survived a 1× (2,240 g ai ha−1) atrazine application with no known psbA gene mutation, indicating the predominance of a non–target site resistance mechanism to this herbicide. Forty-two percent of plants survived a 1× (18 g ai ha−1) dose of chlorsulfuron with proline197serine, proline197threonine, proline197alanine, and proline197asparagine, or tryptophan574leucine mutations in the ALS gene. About 40% of the plants survived a 1× (840 g ae ha−1) dose of glyphosate with no known mutations in the EPSPS gene. Quantitative PCR results revealed increased EPSPS copy number (50 to 140) as the mechanism of glyphosate resistance in the survivors. The most important finding of this study was the evolution of resistance to at least two sites of action (SOAs) (~50% of plants) and to all three herbicides due to target site as well as non–target site mechanisms. The high incidence of individual plants with resistance to multiple SOAs poses a challenge for effective management of this weed.
For children with normal hearing (NH), early communication skills predict vocabulary, a precursor to grammar. Growth in early communication skills of infants with cochlear implants (CIs) was investigated using the Early Communication Indicator (ECI), a play-based observation measure. Multilevel linear growth modelling on data from six ECI sessions held at three-monthly intervals revealed significant growth overall, with a non-significant slower growth rate than that of children with NH (comparison age centred at 18 months). Analyses of gesture use and of nonword vocalisations revealed the CI group used significantly more of each, with more rapid growth. In contrast, the CI group used significantly fewer single words and multiword utterances, and with slower growth. Maternal education and time to achieve consistent CI use impacted significantly on growth for the CI sample. The results indicate that progression to vocabulary by young CI users can be supported by encouraging their use of prelinguistic communication.
High-resolution digital elevation models of Finland and Sweden based on LiDAR (Light Detection and Ranging) reveal subglacial landforms in great detail. We describe the ice-sheet scale distribution and morphometric characteristics of a glacial landform that is distinctive in morphology and occurs commonly in the central parts of the former Scandinavian Ice Sheet, especially up-ice of the Younger Dryas end moraine zone. We refer to these triangular or V-shaped landforms as murtoos (singular, ‘murtoo’). Murtoos are typically 30–200 m in length and 30–200 m in width with a relief of commonly <5 m. Murtoos have straight and steep edges, a triangular tip oriented parallel to ice-flow direction, and an asymmetric longitudinal profile with a shorter, but steeper down-ice slope. The spatial distribution of murtoos and their geomorphic relation to other landforms indicate that they formed subglacially during times of climate warming and rapid retreat of the Scandinavian Ice Sheet when large amounts of meltwater were delivered to the bed. Murtoos are formed under warm-based ice and may be associated with a non-channelized subglacial hydraulic system that evacuated large discharges of subglacial water.
Germ plasm, a cytoplasmic factor of germline cell differentiation, is suggested to be a perspective tool for in vitro meiotic differentiation. To discriminate between the: (1) germ plasm-related structures (GPRS) involved in meiosis triggering; and (2) GPRS involved in the germ plasm storage phase, we investigated gametogenesis in the marine medaka Oryzias melastigma. The GPRS of the mitosis-to-meiosis period are similar in males and females. In both sexes, five events typically occur: (1) turning of the primary Vasa-positive germ plasm granules into the Vasa-positive intermitochondrial cement (IMC); (2) aggregation of some mitochondria by IMC followed by arising of mitochondrial clusters; (3) intramitochondrial localization of IMC-originated Vasa; followed by (4) mitochondrial cluster degradation; and (5) intranuclear localization of Vasa followed by this protein entering the nuclei (gonial cells) and synaptonemal complexes (zygotene–pachytene meiotic cells). In post-zygotene/pachytene gametogenesis, the GPRS are sex specific; the Vasa-positive chromatoid bodies are found during spermatogenesis, but oogenesis is characterized by secondary arising of Vasa-positive germ plasm granules followed by secondary formation and degradation of mitochondrial clusters. A complex type of germ plasm generation, ‘the follicle cell assigned germ plasm formation’, was found in late oogenesis. The mechanisms discovered are recommended to be taken into account for possible reconstruction of those under in vitro conditions.