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This greatly expanded third edition provides a comprehensive overview of clinical psychopharmacology, incorporating the major advances in the field since the previous edition's publication. Renowned experts from psychiatry, pharmacy, and nursing have integrated basic science, psychopharmacology, and clinical practice throughout the book in order to provide a thorough basis for prescribing. It covers all key psychiatric drugs and disorders and includes the latest data on efficacy, safety and tolerability. Adopting a pragmatic approach to drug nomenclature, both Neuroscience-based Nomenclature (NbN) and older generic terminology are included in the text reflecting that clinicians are likely to use both systems. Many chapters refer to current National Institute of Health and Care Excellence (NICE) guidelines, making this a crucial resource. Edited by leading authorities in the field, Professor Peter M. Haddad and Professor David J. Nutt, Seminars in Clinical Psychopharmacology emphasises evidence-based prescribing with the aim of achieving better clinical outcomes for patients.
The purpose of this study was to assess the associations of comorbid opioid use disorders and psychiatric disorders with suicide attempts among veterans seeking pain care.
The cohort (N = 226 444) was selected by identifying pain care initiation from 2012 to 2014 using national Veterans Health Administration (VHA) data. Data on opioid use disorders (OUD), psychiatric disorders, medical comorbidity, demographics at baseline, and suicide attempts in the year following the initiation of pain care were extracted from VHA databases. Relative excess risk due to interaction (RERI) was used to assess departure from additivity of effects.
Adjusted models indicated that both comorbid OUD and depression (RERI = 1.07) and comorbid OUD and AUD (RERI = 1.23) were significantly associated with additive risk of suicide attempt. In adjusted multiplicative interaction models, only comorbid OUD and bipolar disorder was significantly associated with suicide attempts; however, this association was protective (HR = 0.54).
The current findings highlight the importance of addressing opioid use disorders and alcohol use disorders and depression together to mitigate the risk of suicidal behavior.
Limited availability of fish oils (FO), rich in omega-3 long-chain (≥C20) polyunsaturated fatty acids (FA), is a major constraint for further growth of the aquaculture industry. Long-chain omega-3 rich oils from crops genetically modified with algal genes are promising new sources for the industry. This project studied the use of a newly developed omega-3 canola oil (DHA-CA) in diets of Atlantic salmon fingerlings in freshwater. The DHA-CA oil has high proportions of the omega-3 FA 18:3n-3 and DHA and lower proportions of omega-6 FA than conventional plant oils. Levels of phytosterols, vitamin E, and minerals in the DHA-CA were within the natural variation of commercial canola oils. Pesticides, mycotoxins, polyaromatic hydrocarbons, and heavy metals were below lowest qualifiable concentration. Two feeding trials were conducted to evaluate effects of two dietary levels of DHA-CA compared to two dietary levels of FO at two water temperatures. Fish increased their weight approximately 20-fold at 16 °C and 12-fold at 12 °C during the experimental periods, with equal growth in salmon fed the FO diets compared to DHA-CA diets. Salmon fed DHA-CA diets had approximately the same EPA+DHA content in whole body as salmon fed FO diets. Gene expression, lipid composition, and oxidative stress related enzyme activities showed only minor differences between the dietary groups and the effects were mostly a result of dietary oil level, rather than the oil source. The results demonstrated that DHA-CA is a safe and effective replacement for FO in diets of Atlantic salmon during the sensitive fingerling life-stage.
This study analyses the interplay between classical acoustic modes and intrinsic thermoacoustic (ITA) modes in a simple thermoacoustic system. The analysis is performed using a frequency-domain low-order network model as well as a time-domain spatially discretised model. Anti-correlated modal sensitivities are found to arise due to a pairwise interplay between acoustic and ITA modes. The magnitude of the sensitivities increases as the interplay between the modes grows stronger. The results show a global behaviour of the modes linked to the presence of exceptional points in the spectrum. The time-domain analysis results in a delay-differential equation and allows the investigation of non-normal behaviour and its consequences. Pseudospectral analysis reveals that energy amplification is crucially linked to an interplay between acoustic and ITA modes. While higher non-orthogonality between two modes is correlated with peaks in modal sensitivity, transient energy growth does not necessarily involve the most sensitive modes. In particular, growth estimates based on the Kreiss constant demonstrate that transient amplification relies critically on the proximity of the non-normal modes to the imaginary axis. The time scale for transient amplification is identified as the flame time delay, which is further corroborated by determining the optimal initial conditions responsible for the bulk of the non-modal energy growth. The flame is identified as an active and dominant contributor to energy gain. The frequency of the optimal perturbation matches the acoustic time scale, once more confirming an interplay between acoustic and ITA structures. Flame-based amplification factors of two to five are found, which are significant when feeding into the acoustic dynamics and eventually triggering nonlinear limit-cycle behaviour.
Consumption of sugar sweetened beverages (SSBs) in infants and young children are less explored in Asian populations. The Growing in Singapore Towards healthy Outcomes (GUSTO) cohort study examined associations between SSB intakes at ages 18 months and 5 years with adiposity measures at age 6 years. We studied Singaporean infants/children with SSB intake assessed by food frequency questionnaires (FFQ) at ages 18 months (n=555) and 5 years (n=767). The median (interquartile range) for SSB intakes is 28(5.5-98) ml at age 18 months and 111 (57-198) ml at age 5 years. Associations between SSB intakes (100 ml/day increments and tertile categories) and adiposity measures (BMI standard deviation scores (s.d. unit), sum of skinfolds (SSFs)) and overweight/obesity status were examined using multivariable linear and Poisson regression models, respectively. After adjusting for confounders and additionally for energy intake, SSB intakes at age 18 months were not significantly associated with later adiposity measures and overweight/obesity outcomes. In contrast, at age 5 years, SSB intakes when modelled as 100ml/day increments were associated with higher BMI by 0.09 (95% CI: 0.02, 0.16) s.d. unit, higher SSF thickness by 0.68 (0.06, 1.44) mm, and increased risk for overweight/obesity by 1.2 times (1.07, 1.23) at age 6 years. Trends were consistent with SSB intakes modelled as categorical tertiles. In summary, SSB intake in young childhood is associated with higher risks of adiposity and risk for overweight/obesity. Public health policies working to reduce SSB consumption need to focus on prevention programs targeted at young children.
While echocardiographic parameters are used to quantify ventricular function in infants with single ventricle physiology, there are few data comparing these to invasive measurements. This study correlates echocardiographic measures of diastolic function with ventricular end-diastolic pressure in infants with single ventricle physiology prior to superior cavopulmonary anastomosis.
Data from 173 patients enrolled in the Pediatric Heart Network Infant Single Ventricle enalapril trial were analysed. Those with mixed ventricular types (n = 17) and one outlier (end-diastolic pressure = 32 mmHg) were excluded from the analysis, leaving a total sample size of 155 patients. Echocardiographic measurements were correlated to end-diastolic pressure using Spearman’s test.
Median age at echocardiogram was 4.6 (range 2.5–7.4) months. Median ventricular end-diastolic pressure was 7 (range 3–19) mmHg. Median time difference between the echocardiogram and catheterisation was 0 days (range −35 to 59 days). Examining the entire cohort of 155 patients, no echocardiographic diastolic function variable correlated with ventricular end-diastolic pressure. When the analysis was limited to the 86 patients who had similar sedation for both studies, the systolic:diastolic duration ratio had a significant but weak negative correlation with end-diastolic pressure (r = −0.3, p = 0.004). The remaining echocardiographic variables did not correlate with ventricular end-diastolic pressure.
In this cohort of infants with single ventricle physiology prior to superior cavopulmonary anastomosis, most conventional echocardiographic measures of diastolic function did not correlate with ventricular end-diastolic pressure at cardiac catheterisation. These limitations should be factored into the interpretation of quantitative echo data in this patient population.
Harbour (2016) argues for a parsimonious universal set of features for grammatical person distinctions, and suggests (ch. 7) that the same features may also form the basis for systems of deixis. We apply this proposal to an analysis of Heiltsuk, a Wakashan language with a particularly rich set of person-based deictic contrasts (Rath 1981). Heiltsuk demonstratives and third-person pronominal enclitics distinguish proximal-to-speaker, proximal-to-addressee, and distal (in addition to an orthogonal visibility contrast). There are no forms marking proximity to third persons (e.g., ‘near them’) or identifying the location of discourse participants (e.g., ‘you near me’ vs. ‘you over there’), nor does the deictic system make use of the clusivity contrast that appears in the pronoun paradigm (e.g., ‘this near you and me’ vs. ‘this near me and others’). We account for the pattern by implementing Harbour's spatial element χ as a function that yields proximity to its first- or second-person argument.