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To investigate the percentage of patients who commenced smoking after transferring out of a non-smoking forensic psychiatric unit, the corresponding clozapine dose adjustments, the effects on plasma clozapine/norclozapine concentrations and observed changes in mental state. We reviewed the notes and plasma clozapine/norclozapine concentrations of 46 patients transferred to medium secure units between July 2008 and December 2013.
Thirty-five patients commenced smoking. Their median clozapine dose was increased by 50 mg/d. In the non-smokers, the median clozapine dose remained unchanged. Plasma clozapine/norclozapine concentrations were significantly reduced in smokers despite dosage adjustment. Eighteen patients experienced deterioration in mental state after transfer; almost all these patients were smokers.
Approximately three-quarters of patients who were non-smokers by virtue of being in a secure non-smoking environment commenced smoking after transfer. Monitoring of clozapine serum levels and assessment of mental state in the immediate period after a change in smoking status is indicated.
OBJECTIVES/SPECIFIC AIMS: The objective of this project is to determine whether HRV, collected peri-operatively, is predictive of cognitive decline among older adults who undergo elective surgery/anesthesia. METHODS/STUDY POPULATION: This project is a part of the ongoing INTUIT/PRIME study, which is collecting pre- and post-operative cognitive testing, fMRI imaging, CSF samples, and EEG recordings from 200 older adults (age ≥ 60) undergoing elective non-cardiac/non-neurologic surgery scheduled to last > 2 hours at Duke University Medical Center and Duke Regional Hospital. This project utilizes data from the first 60 INTUIT participants who contributed continuous heart rate data before and during surgery. Participants undergo cognitive testing prior to surgery (baseline) and at 6 weeks after surgery. Our primary dependent variable is the change in the composite score from baseline to 6-weeks. Delirium is assessed in the hospital with the twice daily 3D-CAM tool, so we will report the proportion of individuals with 6-week cognitive decline who exhibited delirium in the days following surgery. Participants’ echocardiogram (ECG) recordings are extracted pre- and intraoperatively from B650/B850 patient monitors with VSCapture software. HRV is defined as the variability between successive R-spikes or inter-beat-intervals on ECG. RESULTS/ANTICIPATED RESULTS: We anticipate that lower intraoperative HRV is associated with worse cognitive decline at 6 weeks after surgery. As secondary objectives, we will determine whether pre-operative HRV or change in HRV (from pre-operative to intra-operative measures) are predictive of cognitive decline after surgery. We expect that in-hospital delirium will be detected in a higher proportion of those with 6-week cognitive decline, compared to those with stable or improved cognition at 6 weeks. DISCUSSION/SIGNIFICANCE OF IMPACT: HRV may address the present need for pre- and intra-operative cognitive risk stratification in the elderly. Physiological indices like HRV have the potential to dramatically change our understanding of CI in older adults undergoing surgery, as they offer an accessible, cost-effective, and non-invasive means whereby clinicians, particularly those unfamiliar with the nuances of geriatric and CI/dementia-related care, can monitor patients and refer those at high-risk of CI after surgery for early intervention.
OBJECTIVES/SPECIFIC AIMS: In an effort to elucidate the role of potentially cancer chemopreventive drugs, we leveraged the Mayo Clinic-Karolinska Institute collaboration to create a multidisciplinary team that included an epidemiologist, statisticians, and physicians. We performed a population-based cohort study to examine the association between low dose aspirin, non-aspirin NSAIDs, statins, metformin, other risk factors and the risk of biliary tract cancer (BTC), while assessing confounding by sex. METHODS/STUDY POPULATION: We conducted a nationwide Swedish population-based cohort study using the Swedish Prescribed Drug Registry, which virtually completely enumerates use of prescribed medications nationwide since 2005. BTC diagnosis (intrahepatic cholangiocarcinoma [iCCA], extrahepatic cholangiocarcinoma [eCCA] or gallbladder cancer [GBC]) was ascertained from the Swedish Cancer Registry. Age-scaled Cox models, with exposure as time-varying covariates, were used to calculate hazard ratios (HRs), separately for men and women. RESULTS/ANTICIPATED RESULTS: In the 5.7 million person cohort, the risk of iCCA was significantly lower in men using statins (HR 0.62,95%CI 0.39-1.00, p = 0.05), with a non-significant reduction in women. Statin use was associated with a significantly decreased risk of eCCA in both women (HR 0.60,0.38-0.94, p = 0.03) and men (HR 0.47,0.28-0.80, p = 0.01). Low dose aspirin (HR 0.76,0.60-0.97, p = 0.03) was associated with a lower risk of GBC only in women, while statins (HR 0.72,0.55-0.93, p = 0.01) showed a significantly decreased risk of GBC in women and a non-significant reduction in men. For all BTC subtypes, combined use of low dose aspirin and statins did not confer additional risk reductions beyond those achieved by statins alone. Male and female users of non-aspirin NSAIDs appeared to be at increased risk of BTC and its subtypes. Metformin did not significantly affect risk of BTC. DISCUSSION/SIGNIFICANCE OF IMPACT: Our collaborative efforts allowed us to develop the largest population-based cohort evaluating risk and protective factors for BTC. Our results provide strong evidence in favor of the chemopreventive roles of low dose aspirin and statins in a subtype- and sex-specific manner. Individual risk factors contribute to development of BTC subtypes in different magnitudes. The next steps to translate these findings into clinical practice require randomized clinical trials that validate our results and provide a more complete picture of the risk-benefit ratio.
One of the major problems facing independence movements in the USSR is that significant and increasing numbers of people reside outside their national homelands and, therefore, are considered aliens in the national homelands of others. The ancestral homeland is intimately enmeshed with nationalism, and the deep emotional attachment to and the sense of exclusive ownership of the sacred soil of the homeland should not be underestimated. Most ethnic conflict involves alien in-migration or disputes over the control of the homeland. Significant numbers of nonindigenous groups within the national homelands undermine the nation's exclusive claim to the homeland, dilute the national homogeneity of the homeland, and increase interethnic interaction within the homeland. Thus, throughout the world, nations strive to maximize national homogeneity within their homelands, and migration that results in alien incursions into the national homeland is viewed with alarm and frequently results in violence. In the Baltic republics, for example, alien in-migration is of intense public and political concern and is frequently cited as a major justification for political independence. Differential natural increase among the nationalities in a homeland is also a vital concern when it significantly affects the ethnic composition of a homeland. Assimilation through intermarriage is another development frequently viewed as a threat to national homogeneity, although in the Soviet Union offspring of intermarriage in national homeland most often identify with the indigenous nationality.
A dramatic population increase coupled with a reduction in per capita investment is producing a “demographic cauldron” in Soviet Central Asia. This was the focus of Professor Lewis's December 7 lecture. In his presentation, Professor Lewis outlined the political, economic and social conditions that frame a grim picture for Central Asia. The region is plagued by an unfavorable convergence of factors: a rapidly growing rural population, especially the indigenous population which is concentrated in rural areas, labor surpluses, relatively little rural or northward out-migration, deteriorating economic conditions especially in rural areas and environmental degradation, along with significant social development and, thus, rising expectations and national awareness. At current growth rates, the indigenous, the rural, the total, and the rural working-age populations will double about every generation or less. Besides, there has been little effort on the part of the central government to shift investment and resource allocation priorities to accommodate the demographic changes.
The migration and settlement of Russians throughout the former Soviet Union in combination with rising nationalism have resulted in a set of conditions that will probably result in considerable national conflict. From an operational perspective, the subjective definition of a nation is the most useful. A nation is a self-defining community whose members claim a common ancestry and a common destiny. They also claim a common geographic origin, the national homeland, over which they claim an exclusive, proprietary right. In fact, nations seek to ensure their destiny by controlling the national homeland for the benefit of their nation, and by promoting the indigeneous nation to a dominant, preferential position. A primordial connection between nation and homeland—blood and soil—is claimed, which results in a geographic or spatial identity, imbued with great emotion as the sacred ancestral land. The national homeland is delimited and justified by either history, demography, or both. Although demographic dominance can generally be claimed by only one nation, the historical claim can be made by more than one, and frequently the demographic claim is reinforced by the historical argument. Most national and ethnic conflict is provoked by conflicting claims to the homeland or aliens residing in the national homeland. Thus, as a rule, the more ethnically homogeneous the homeland, the less the conflict among nations. Of course, this is not always the case. A major national goal is ethnic homogeneity in the national homeland, as various restrictive language, citizenship, and immigration laws demonstrate. Yet this aim will not be sought at the expense of control over ancestral territory.
One of the founding concepts of the high-entropy alloy (HEA) field was that the lattice structures of multicomponent solid solution phases are highly distorted. The displacement of the constituent atoms, away from their ideal locations (local lattice strain), has been widely cited as the reason for a number of the observed physical and mechanical properties. However, very little data directly characterizing these lattice distortions exist and, thus, the validity of this hypothesis remains an open question. Here, the concept is reviewed by considering the underlying principles of the lattice distortions, the suitability of different assessment methods, and the direct experimental data currently available. It is found that, at present, there is no clear evidence that the lattice distortions in HEAs are significantly greater than those of conventional alloys. However, so few alloys have been appropriately characterized that this conclusion cannot be considered overarching and further research is required.
Potentially modifiable risk factors for developing dementia have been identified. However, risk factors for increased mortality in patients with diagnosed dementia are not well understood. Identifying factors that influence prognosis would help clinicians plan care and address unmet needs.
To investigate diagnosed depression and sociodemographic factors as predictors of mortality in patients with dementia in UK secondary clinical care services.
We conducted a cohort study of patients with a dementia diagnosis in an electronic health records database in a UK National Health Service mental health trust.
In 3374 patients with 10 856 person-years of follow-up, comorbid depression was not associated with mortality (adjusted hazard ratio 0.94; 95% CI 0.71–1.24). Single patients had higher mortality than those who were married (adjusted hazard ratio 1.25; 95% CI 1.03–1.50). Patients of Asian ethnicity had lower mortality rates than White British patients (adjusted hazard ratio 0.50; 95% CI 0.34–0.73).
Clinically diagnosed depression does not increase mortality in patients with dementia. Patients who are single are a potential high-mortality risk group. Lower mortality rates in Asian patients with dementia that have been reported in the USA also apply in the UK.
Postpartum psychosis has recently been the focus of an in-depth storyline on a British television soap opera watched by millions of viewers.
This research explored how the storyline and concomitant increase in public awareness of postpartum psychosis have been received by women who have recovered from the condition.
Nine semistructured, one-to-one interviews were conducted with women who had experienced postpartum psychosis. Thematic analysis consistent with Braun and Clarke's six-step approach was used to generate themes from the data.
Public exposure provided by the postpartum psychosis portrayal was deemed highly valuable, and its mixed reception encompassed potentially therapeutic benefits in addition to harms.
Public awareness of postpartum psychosis strongly affects women who have experienced postpartum psychosis. This research highlights the complexity of using television drama for public education and may enable mental health organisations to better focus future practices of raising postpartum psychosis awareness.
Declaration of interest
GB is chair of action on Postpartum Psychosis. JH is director of action on Postpartum Psychosis. IJ is a trustee of action on Postpartum Psychosis and was a consultant to the BBC (television company) on the EastEnders storyline. CD is a trustee of action on Postpartum Psychosis, a trustee of BIPOLAR UK, vice chair of the Maternal Mental Health Alliance, and was a consultant to the BBC (television company) on the EastEnders storyline.
While the exchange of water through Yucatan Strait is reasonably well known, the age of the deep water in both the Caribbean Sea and Gulf of Mexico is not. We recently measured the radiocarbon (14C) concentrations in deep water in the Gulf of Mexico from a line of stations along 90°30′W. The mean apparent age of water below 900 m, the depth of the Florida Strait sill, was found to be about 740 yr relative to the 1950 14C standard. Depending on how the corrections for biological activity in the upper water are applied, this converts to a “true” age of between 231 ± 28 and 293 ± 74 yr. These ages agree with a previous estimate of the age of the deep water in the Gulf of Mexico based on heat flows, put upper limits on the age of the deep water in the Caribbean Sea, and provide constraints on modelers for the return of deep water from the Gulf of Mexico to the Caribbean. This might be important in the event of a future deep water oil or other chemical spill in the region.
To determine whether antimicrobial-impregnated textiles decrease the acquisition of pathogens by healthcare provider (HCP) clothing.
We completed a 3-arm randomized controlled trial to test the efficacy of 2 types of antimicrobial-impregnated clothing compared to standard HCP clothing. Cultures were obtained from each nurse participant, the healthcare environment, and patients during each shift. The primary outcome was the change in total contamination on nurse scrubs, measured as the sum of colony-forming units (CFU) of bacteria.
PARTICIPANTS AND SETTING
Nurses working in medical and surgical ICUs in a 936-bed tertiary-care hospital.
Nurse subjects wore standard cotton-polyester surgical scrubs (control), scrubs that contained a complex element compound with a silver-alloy embedded in its fibers (Scrub 1), or scrubs impregnated with an organosilane-based quaternary ammonium and a hydrophobic fluoroacrylate copolymer emulsion (Scrub 2). Nurse participants were blinded to scrub type and randomly participated in all 3 arms during 3 consecutive 12-hour shifts in the intensive care unit.
In total, 40 nurses were enrolled and completed 3 shifts. Analyses of 2,919 cultures from the environment and 2,185 from HCP clothing showed that scrub type was not associated with a change in HCP clothing contamination (P=.70). Mean difference estimates were 0.118 for the Scrub 1 arm (95% confidence interval [CI], −0.206 to 0.441; P=.48) and 0.009 for the Scrub 2 rm (95% CI, −0.323 to 0.342; P=.96) compared to the control. HCP became newly contaminated with important pathogens during 19 of the 120 shifts (16%).
Antimicrobial-impregnated scrubs were not effective at reducing HCP contamination. However, the environment is an important source of HCP clothing contamination.
After CQ Cep, the system CX Cep has the shortest orbital period known among Galactic WR+O binaries. However, no definitive spectroscopic study is yet available for CX Cep, probably because of its relatively faint magnitude (B ≈ 13). We have therefore obtained and analyzed some 60 CCD spectra (3700-4900 Å, S/N ⋍ 100, 5 Å/2 pixels) in August and October 1987.
There are multiple recent reports of an association between anxious/depressed (A/D) symptomatology and the rate of cerebral cortical thickness maturation in typically developing youths. We investigated the degree to which anxious/depressed symptoms are tied to age-related microstructural changes in cerebral fiber pathways. The participants were part of the NIH MRI Study of Normal Brain Development. Child Behavior Checklist A/D scores and diffusion imaging were available for 175 youths (84 males, 91 females; 241 magnetic resonance imagings) at up to three visits. The participants ranged from 5.7 to 18.4 years of age at the time of the scan. Alignment of fractional anisotropy data was implemented using FSL/Tract-Based Spatial Statistics, and linear mixed model regression was carried out using SPSS. Child Behavior Checklist A/D was associated with the rate of microstructural development in several white matter pathways, including the bilateral anterior thalamic radiation, bilateral inferior longitudinal fasciculus, left superior longitudinal fasciculus, and right cingulum. Across these pathways, greater age-related fractional anisotropy increases were observed at lower levels of A/D. The results suggest that subclinical A/D symptoms are associated with the rate of microstructural development within several white matter pathways that have been implicated in affect regulation, as well as mood and anxiety psychopathology.
This document is the final Phase A Science Report of the Australian LYMAN Science Working Group, and describes in detail the scientific objectives, technical feasibility, and engineering implementation of the LYMAN mission as developed in the Australian studies.
The emergency department (ED) of NYU Langone Medical Center was destroyed by Hurricane Sandy, contributing to a public health disaster in New York City. We evaluated hospital-based acute care provided through the establishment of an urgent care center with an associated ED-run observation service (EDOS) that operated in the absence of an ED during this disaster.
We conducted a retrospective cohort study of all patients placed in an EDOS following a visit to an urgent care center during the 18 months of ED closure. We reviewed diagnoses, clinical protocols, selection criteria, and performance metrics.
Of 55,723 urgent care center visits, 15,498 patients were hospitalized, and 3167 of all hospitalized patients (20.4%) were placed in the EDOS. A total of 2660 EDOS patients (84%) were discharged from the EDOS. The 8 most frequently utilized clinical protocols accounted for 76% of the EDOS volume.
A diverse group of patients presenting to an urgent care center following the destruction of an ED by natural disaster can be cared for in an EDOS, regardless of association with a physical ED. An urgent care center with an associated EDOS can be implemented to provide patient care in a disaster situation. This may be useful when existing ED or hospital resources are compromised. (Disaster Med Public Health Preparedness. 2016;10:405–410)