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Antipsychotics are commonly used, and the rate of use is highest, among those aged 65 years or over, where the risk of adverse events is also high. Up to 20% of younger adults use more than one antipsychotic concurrently; however there are few studies on the prevalence of antipsychotic polypharmacy in older people. We aimed to analyze antipsychotic use in elderly Australians, focusing on the prevalence of antipsychotic polypharmacy and the use of medicines to manage adverse events associated with antipsychotics.
A cross-sectional study was conducted using Australian Department of Veterans’ Affairs (DVA) administrative claims data for the period 1 March 2014 to 30 June 2014. Veterans dispensed at least one antipsychotic medicine during the study period was included. We determined the number of participants dispensed antipsychotic polypharmacy and the number of participants dispensed medicines to manage antipsychotic side effects.
There were 7,412 participants with a median age of 86 years. Fifty-one percent (n=3,784) were women and 48% (n=3,569) lived in residential aged-care. Fifty one participants (0.7%) were dispensed anticholinergic medicines indicated for the management of antipsychotic-associated extrapyramidal movement disorders and eight (0.1%) were dispensed medicines for the management of hyperprolactinemia. Five percent of participants (n=365) received dual antipsychotics. Dual antipsychotic users were more likely to be under the care of a psychiatrist or to have had a mental health hospitalization than those using a single antipsychotic.
Antipsychotic polypharmacy occurred in one in 20 elderly persons, indicating that there is room for improvement in antipsychotic use in elderly patients.
The purpose of this paper is to describe the development and initial accomplishments of a training program of young leaders in community mental health research as part of a Latin American initiative known as RedeAmericas. RedeAmericas was one of five regional ‘Hubs’ funded by the National Institute of Mental Health (NIMH) to improve community mental health care and build mental health research capacity in low- and middle-income countries. It included investigators in six Latin American cities – Santiago, Chile; Medellín, Colombia; Rio de Janeiro, Brazil; and Córdoba, Neuquén, and Buenos Aires in Argentina – working together with a team affiliated with the Global Mental Health program at Columbia University in New York City. One component of RedeAmericas was a capacity-building effort that included an Awardee program for early career researchers in the mental health field. We review the aims of this component, how it developed, and what was learned that would be useful for future capacity-building efforts, and also comment on future prospects for maintaining this type of effort.
Lower and middle income countries (LMICs) are home to >80% of the global population, but mental health researchers and LMIC investigator led publications are concentrated in 10% of LMICs. Increasing research and research outputs, such as in the form of peer reviewed publications, require increased capacity building (CB) opportunities in LMICs. The National Institute of Mental Health (NIMH) initiative, Collaborative Hubs for International Research on Mental Health reaches across five regional ‘hubs’ established in LMICs, to provide training and support for emerging researchers through hub-specific CB activities. This paper describes the range of CB activities, the process of monitoring, and the early outcomes of CB activities conducted by the five research hubs.
The indicators used to describe the nature, the monitoring, and the early outcomes of CB activities were developed collectively by the members of an inter-hub CB workgroup representing all five hubs. These indicators included but were not limited to courses, publications, and grants.
Results for all indicators demonstrate a wide range of feasible CB activities. The five hubs were successful in providing at least one and the majority several courses; 13 CB recipient-led articles were accepted for publication; and nine grant applications were successful.
The hubs were successful in providing CB recipients with a wide range of CB activities. The challenge remains to ensure ongoing CB of mental health researchers in LMICs, and in particular, to sustain the CB efforts of the five hubs after the termination of NIMH funding.
Fontan survivors have depressed cardiac index that worsens over time. Serum biomarker measurement is minimally invasive, rapid, widely available, and may be useful for serial monitoring. The purpose of this study was to identify biomarkers that correlate with lower cardiac index in Fontan patients.
Methods and results
This study was a multi-centre case series assessing the correlations between biomarkers and cardiac magnetic resonance-derived cardiac index in Fontan patients ⩾6 years of age with biochemical and haematopoietic biomarkers obtained ±12 months from cardiac magnetic resonance. Medical history and biomarker values were obtained by chart review. Spearman’s Rank correlation assessed associations between biomarker z-scores and cardiac index. Biomarkers with significant correlations had receiver operating characteristic curves and area under the curve estimated. In total, 97 cardiac magnetic resonances in 87 patients met inclusion criteria: median age at cardiac magnetic resonance was 15 (6–33) years. Significant correlations were found between cardiac index and total alkaline phosphatase (−0.26, p=0.04), estimated creatinine clearance (0.26, p=0.02), and mean corpuscular volume (−0.32, p<0.01). Area under the curve for the three individual biomarkers was 0.63–0.69. Area under the curve for the three-biomarker panel was 0.75. Comparison of cardiac index above and below the receiver operating characteristic curve-identified cut-off points revealed significant differences for each biomarker (p<0.01) and for the composite panel [median cardiac index for higher-risk group=2.17 L/minute/m2 versus lower-risk group=2.96 L/minute/m2, (p<0.01)].
Higher total alkaline phosphatase and mean corpuscular volume as well as lower estimated creatinine clearance identify Fontan patients with lower cardiac index. Using biomarkers to monitor haemodynamics and organ-specific effects warrants prospective investigation.
Real-time detection of microlensing has moved from proof of concept in 1994 (Udalski et al. 1994a, Alcock et al. 1994) to a steady stream of events this year. Global dissemination of these events by the MACHO and OGLE collaborations has made possible intensive photometric and spectroscopic follow up from widely dispersed sites confirming the microlensing hypothesis (Benetti 1995). Improved photometry and increased temporal resolution from follow up observations greatly increases the possibility of detecting deviations from the standard point-source, point-lens, inertial motion microlensing model. These deviations are crucial in understanding individual lensing systems by breaking the degeneracy between lens mass, position and velocity. We report here on GMAN (Global Microlensing Alert Network), the coordinated follow up of MACHO alerts.
Gravitational microlensing is the most straightforward interpretation of the stellar brightenings that have been observed by our team and other experiments. These data have provided some of the most stringent limits to date on the nature of the Galaxy's dark matter halo. The number of events seen towards the LMC indicate that our Galaxy is not surrounded by a “standard” halo of MACHOs in the mass range of 10–6 to 0.3 solar masses. The observed optical depth towards the Galactic Center is an important constraint on the distribution of mass in the plane of the Galaxy.
We have analyzed a sample of 1150 type ab, and 550 type c RR Lyrae stars found in 24 of 94 bulge fields of the MACHO database. These fields cover a range in Galactocentric distances from 0.3 to 1.6 kpc. In combination with the data on the outer bulge fields of Alard (1997) and Wesselink (1987), here we present the surface density distribution of bulge RR Lyrae between 0.3 and 3 kpc.
The MACHO microlensing experiment's time-sampled photometry database contains blue and red lightcurves for nearly 9 million stars in the central bar region of the Large Magellanic Cloud (LMC). We have identified known LMC Planetary Nebulae (PN) in the database and find one, Jacoby 5, to be variable. We additionally present data on the “parent populations” of LMC PN, and discuss the star formation history of the LMC bar.
A review of the properties of Type II Cepheids and RV Tauri stars in the Magellanic Clouds is presented. In the behaviour of their light and colour curves, the RV Tauri stars appear to be a direct extension of the Type II Cepheids to longer periods. A single P – L – C relationship describes both the Type II Cepheids and RV Tauri stars in the LMC. The derived high intrinsic magnitudes for the RV Tauri variables supports the proposition that these objects are luminous stars evolving off the AGB. Preliminary analysis of the long time-series MACHO photometry indicates one star (MACHO*05:37:45.0–69:54:16) has an obvious ‘period-quadrupled’ periodicity, which is supporting evidence for a period-doubling bifurcation transition to chaotic pulsations.
In order to calculate bremsstrahlung cross sections in plasmas, an atomic potential which includes the effects of the surrounding plasma is required. For the high ρ - T conditions we are considering (ne = 1025 cm−3, T = 500 ev), plasma correlative effects are important. In these strongly coupled plasmas, the Debye-Huckel potential is irrelevant and not considered here. The statistical Thomas-Fermi (TF) potential (Feynmann, Metropolis, and Teller, 1949) is known to be correct at very high densities but does not contain correlation information. A semiclassical treatment of correlations that accurately reproduces results of numerical simulations of strongly coupled plasmas is the hypernetted chain (HNC) approximation to the hierarchy of equations describing density distributions (Hansen and McDonald, 1981). The method generates many-body distributions using an analytic two-body interaction that successfully approximates quantum effects at short distances. These distributions are used in the Poisson equation to find the effective potential (Cauble, Blaha, and Davis, 1984). An alternative method (Gupta and Rajagopal, 1982) of including correlations is to treat them in a quantum mechanical manner, taking into account ion correlations as well as electron exchange and correlation; this is done in density functional theory (DFT), where electron wavefunctions and the effective potential which is used here are obtained self-consistently (Dharma-wardana and Perrot, 1982; Perrot and Dharma-wardana, 1984). Comparison of these methods can be found elsewhere (Cauble, Gupta, and Davis, 1984). These potentials for aluminum at 1025 cm−3 and 500 eV are displayed in Fig. 1.
We present the first results of the analysis of 22 Blazhko stars. We find: 1) Blazhko RRab stars that are nearly pure amplitude modulators; 2) Blazhko RRab stars that have both amplitude and phase modulation; 3) A Blazhko RRab star that has an abrupt period change; 4) Proof of the Blazhko effect in RRc stars. Our data show the character of the amplitude and phase modulations of the light curves over the Blazhko cycles far better than has been previously possible.
We present the preliminary results of a frequency analysis of 1457 fundamental mode RR Lyrae (RR0) stars in the Large Magellanic Cloud (LMC) from MACHO Project photometry. We find the same classes of pulsational behavior as were found in our earlier survey of first overtone RR Lyrae (RR1) stars. Variables whose prewhitened power spectra contain one or two peaks close to the main frequency component in the original power spectra are commonly known as Blazhko-type variables. The present analysis shows the overall frequency of Blazhko-type stars in the total RR0 population analysed to date to be ≈ 10%. This is lower than the often cited Galactic field/globular rate of 20-30% (Szeidl, 1988).
The incidence rate of Blazhko-type variability in the LMC appears to be about three times higher in RR0 stars than in RR1 stars. This puts important constraints on possible models of the Blazhko effect.
We present the first massive frequency analysis of the 1200 first overtone RR Lyrae stars in the Large Magellanic Cloud observed in the first 4.3 yr of the MACHO project. Besides the many new double-mode variables, we also discovered stars with closely spaced frequencies. These variables are most probably nonradial pulsators.
The new 48-in. Schmidt telescope of the U.K. Science Research Council is being commissioned at Siding Spring in Australia. Its potential both for extra-galactic and galactic research is enormous but this potential can only be fully exploited with an automatic measuring machine.
We investigate and quantify stirring due to chaotic advection within a steady, three-dimensional, Ekman-driven, rotating cylinder flow. The flow field has vertical overturning and horizontal swirling motion, and is an idealization of motion observed in some ocean eddies. The flow is characterized by strong background rotation, and we explore variations in Ekman and Rossby numbers,
, over ranges appropriate for the ocean mesoscale and submesoscale. A high-resolution spectral element model is used in conjunction with linear analytical theory, weakly nonlinear resonance analysis and a kinematic model in order to map out the barriers, manifolds, resonance layers and other objects that provide a template for chaotic stirring. As expected, chaos arises when a radially symmetric background state is perturbed by a symmetry-breaking disturbance. In the background state, each trajectory lives on a torus and some of the latter survive the perturbation and act as barriers to chaotic transport, a result consistent with an extension of the KAM theorem for three-dimensional, volume-preserving flow. For shallow eddies, where
, the flow is dominated by thin resonant layers sandwiched between KAM-type barriers, and the stirring rate is weak. On the other hand, eddies with moderately small
experience thicker resonant layers, wider-spread chaos and much more rapid stirring. This trend reverses for sufficiently small
, corresponding to deep eddies, where the vertical rigidity imposed by strong rotation limits the stirring. The bulk stirring rate, estimated from a passive tracer release, confirms the non-monotonic variation in stirring rate with
. This result is shown to be consistent with linear Ekman layer theory in conjunction with a resonant width calculation and the Taylor–Proudman theorem. The theory is able to roughly predict the value of
at which stirring is maximum. For large disturbances, the stirring rate becomes monotonic over the range of Ekman numbers explored. We also explore variation in the eddy aspect ratio.
It is now known that health benefits associated with diets rich in fruit and vegetables may be partly derived from intake of polyphenols. Berry polyphenols may influence carbohydrate metabolism and absorption and hence postprandial glycaemia. To date, studies related to polyphenol effects on the glycaemic response have been completed only in liquids using either monosaccharides or disaccharides. It remains to be determined whether berries known to be rich in polyphenols can reduce the glycaemic response (GR) to a solid polysaccharide meal. The aim of the present study was to investigate whether berries alter postprandial hyperglycaemia and consequently the GR to a starchy food. Blood glucose was tested on seven occasions, on three occasions using a reference food and on four occasions using pancakes supplemented with either raspberries or blueberries or control pancakes containing similar amounts of fructose and glucose. Results showed that there were no differences in GR (blueberry 51·3 (sem 5·7); raspberry 54·7 (sem 5·6); blueberry control 43·9 (sem 4·2); raspberry control 41·8 (sem 6·4)), GR area under the curve or satiety index between any of the tests. The present study indicates that the ability of berries to reduce blood glucose from starch-based foods is unsubstantiated.