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Depression is a highly prevalent psychiatric disorder. Furthermore, it is one of the most common neuropsychiatric presentations in Alzheimer's disease (AD). Common underlying neuropathological processes appear to exist between these conditions. Synaptic degeneration has been implicated in AD pathogenesis, while its role in depression is not well understood.
This study aims to investigate synaptic degeneration as a possible underlying mechanism for depression and whether antidepressants could alleviate the stated pathology.
Primary rodent hippocampal neurons treated with corticosterone were used as an in vitro model of depression. Toxicity of corticosterone was determined through the lactate dehydrogenase and caspase-3 activity assays. Immunocytochemical analysis of synaptic proteins was employed to investigate effects of corticosterone on synapses.
Neurotoxicity was observed in hippocampal neurons after treatment with corticosterone (10μM) for 24 hours. Aggregations of synaptotagmin and synaptophysin were observed 24 hours after treatment with corticosterone (10μM). Similar effects were observed after sub-lethal treatments with corticosterone (0.5μM and 1μM) for 48 and 72 hours. Pre-treatment for 1 hour with imipramine and escitalopram (20μM and 40μM for both agents) were able to alleviate these toxic effects.
These results suggest the involvement of synaptic degeneration in corticosterone-induced toxicity and that commonly used antidepressants are able to alleviate synaptic derangements. Taken together, synaptic degeneration could be a common pathway for neuronal demise occurring in AD and depression, which can be attenuated by antidepressant administration. Future research to elucidate the precise mechanism for the synaptic protective effect of antidepressants is warranted.
Currently there is no consensus regarding how long anti-psychotics medication should be continued following a first/single psychotic episode. Clinically patients often request discontinuation after a period of remission. This is one of the first double-blind randomized-controlled studies designed to address the issue.
Patients with DSM-IV schizophrenia and related psychoses (excluding substance induced psychosis) who remitted well following a first/single-episode, and had remained well on maintenance medication for one year, were randomized to receive either maintenance therapy with quetiapine (400 mg/day), or placebo for 12 months. Relapse was defined by the presence of (i) an increase in at least one of the following PANSS psychotic symptom items to a threshold score (delusion, hallucinatory behaviour, conceptual disorganization, unusual thought content, suspiciousness); (ii) CGI Severity of Illness 3 or above; and (iii) CGI Improvement 5 or above.
178 patients were randomized. 144 patients completed the study (80.9%). The relapse rate was 33.7% (30/89) for the maintenance group and 66.3% (59/89) for the placebo group (log-rank test, chi-square=13.328, p<0.001). Relapse was not related to age or gender. Other significant predictors of relapse include medication status, pre-morbid schizotypal traits, verbal memory and soft neurological signs.
There is a substantial risk of relapse if medication is discontinued in remitted first-episode psychosis patients following one year of maintenance therapy. On the contrary 33.7% of patients discontinued medication and remained well.
Medication discontinuation in remitted single episode patients after a period of maintenance therapy is a major clinical decision and thus the identification of risk factors controlling for medication status is important.
Following a first/single episode with DSM-IV schizophrenia and related psychoses, remitted patients who had remained well on maintenance medication for at least one year were randomized to receive either maintenance therapy (with quetiapine 400 mg/day), or placebo for 12 months.
178 patients were randomized. Relapse rates were 33.7% (30/89) in maintenance group and 66.3% (59/89) in placebo group. Potential predictors were initially identified in univariate Cox regression models (p<0.1) and were subsequently entered into a multivariate Cox regression model for measuring the relapse risk. Significant predictors included patients on placebo (hazard ratio, 0.41; CI, 0.25 – 0.68; p=0.001); having more pre-morbid schizotypal traits (hazard ratio, 2.32; CI, 1.33 – 4.04; p=0.003); scoring lower in the logical memory test (hazard ratio, 0.94; CI, 0.9 – 0.99; p=0.028); and having more soft neurological signs (disinhibition) (hazard ratio, 1.33; CI, 1.02 – 1.74; p=0.039).
Relapse predictors may help to inform clinical decisions about discontinuation of maintenance therapy specifically for patients with a first/single episode psychosis following at least one year of maintenance therapy.
We are grateful to Dr TJ Yao at the Clinical Trials Center, University of Hong Kong, for statistical advice. The study was supported by investigator initiated trial award from AstraZeneca and the Research Grants Council Hong Kong (Project number: 765505).
Professor Liu, President of Shenzhen Kangning Hospital, came to Canada in 2008 and learned that Assertive Community Treatment Team (hospital without walls) might be one of the solutions to the shortage of inpatient beds. I was invited to conduct site visits, consultations, training sessions and workshops for the mental health professionals in Shenzhen since 2009. Doctors and administrative staff from Shenzhen were sent to Toronto, Canada to learn about the program implementation. Finally the Shenzhen ACT in China was established in November 2012.
To describe the development and adaptation of ACT model in Shenzhen China. To report the success and challenges of ACTT development in China.
To define the history and the purpose, its principles, its internal structure, the team composition, team dynamics, the target population, its characteristics of Shenzhen ACT within the demographic context. I will share my subjective experience regarding my observation, my perspectives and a brief comparison with ACT Teams in Toronto, Canada will be highlighted.
The China Shenzhen ACT Team was born in an institutional context where the community mental health care was still novel and not having enough infrastructures to support the work.
The Shenzhen ACT Team is the first ACT in China to experience the effectiveness and efficiency in taking care of severe mentally ill patients in the community. They have successfully implemented ACT service with the support from the hospital, municipal government and the neighbourhood community.
This paper investigates the recidivism of Mount Sinai Hospital mental health court support program in Toronto, Canada among patients involved in the criminal justice system. It also looks to find relationships between recidivism and factors including gender, age and ethnicity.
Follow up periods of up to 48 months after the time of initial admission to the program was conducted and the frequency of re-offense was observed. Comparisons for the significance of risk factors were analyzed using t-tests and Chisquare tests.
191 clients were admitted to the Mount Sinai Hospital Court Support Program between September 2001 and June 2007. At first admission, the mean ± s.d. age was 35.8 ± 9.8 years (range=18-74 years; n=184). The median age was 35 years. The modal age was 34 years. Of the 191 clients, 16 (8.4%) reoffended. Two of them (12.5%) had a third offense; and 1 (6.3%) had a total of four offenses within this tracking period. it appears that re-offense is more likely between 13 and 24 months. No re-offense was noted beyond the 48 months. The gender distribution was not significantly different between reoffenders and non-reoffenders. The mean age at first admission also did not differ between reoffenders and non-reoffenders. The distribution of ethnic groups among reoffenders and non-reoffenders did not differ.
The findings seem to indicate that recidivism has no relationship with gender, age and ethnic groups. The comprehensive and length of support services seem more important in preventing recidivism.
Cardiac Fibromas are primary cardiac tumours more common in children than in adults. Surgical intervention is often not required except in the case of limited cardiac output or significant arrhythmia burden. We present a symptomatic 3-month-old infant who had successful surgical intervention for a giant right ventricle fibroma found on prenatal imaging.
Official counts of deaths attributed to disasters are often under-reported, thus adversely affecting public health messaging designed to prevent further mortality. During the Oklahoma (USA) May 2013 tornadoes, Oklahoma State Health Department Division of Vital Records (VR; Oklahoma City, Oklahoma USA) piloted a flagging procedure to track tornado-attributed deaths within its Electronic Death Registration System (EDRS). To determine if the EDRS was capturing all tornado-attributed deaths, the Centers for Disease Control and Prevention (CDC; Atlanta, Georgia USA) evaluated three event fatality markers (EFM), which are used to collate information about deaths for immediate response and retrospective research efforts.
Oklahoma identified 48 tornado-attributed deaths through a retrospective review of hospital morbidity and mortality records. The Centers for Disease Control and Prevention (CDC; Atlanta, Georgia USA) analyzed the sensitivity, timeliness, and validity for three EFMs, which included: (1) a tornado-specific flag on the death record; (2) a tornado-related term in the death certificate; and (3) X37, the International Classification of Diseases, 10th Revision (ICD-10) code in the death record for Victim of a Cataclysmic Storm, which includes tornadoes.
The flag was the most sensitive EFM (89.6%; 43/48), followed by the tornado term (75.0%; 36/48), and the X37 code (56.2%; 27/48). The most-timely EFM was the flag, which took 2.0 median days to report (range 0-10 days), followed by the tornado term (median 3.5 days; range 1-21), and the X37 code (median >10 days; range 2-122). Over one-half (52.1%; 25/48) of the tornado-attributed deaths were missing at least one EFM. Twenty-six percent (11/43) of flagged records had no tornado term, and 44.1% (19/43) had no X37 code. Eleven percent (4/36) of records with a tornado term did not have a flag.
The tornado-specific flag was the most sensitive and timely EFM. Using the flag to collate death records and identify additional deaths without the tornado term and X37 code may improve immediate response and retrospective investigations. Moreover, each of the EFMs can serve as quality controls for the others to maximize capture of all disaster-attributed deaths from vital statistics records in the EDRS.
Issa AN, Baker K, Pate D, Law R, Bayleyegn T, Noe RS. Evaluation of Oklahoma’s Electronic Death Registration System and event fatality markers for disaster-related mortality surveillance – Oklahoma USA, May 2013. Prehosp Disaster Med. 2019;34(2):125–131
The Pain Catastrophizing Scale (PCS) measures three aspects of catastrophic cognitions about pain—rumination, magnification, and helplessness. To facilitate assessment and clinical application, we aimed to (a) develop a short version on the basis of its factorial structure and the items’ correlations with key pain-related outcomes, and (b) identify the threshold on the short form indicative of risk for depression.
Social centers for older people.
664 Chinese older adults with chronic pain.
Besides the PCS, pain intensity, pain disability, and depressive symptoms were assessed.
For the full scale, confirmatory factor analysis showed that the hypothesized 3-factor model fit the data moderately well. On the basis of the factor loadings, two items were selected from each of the three dimensions. An additional item significantly associated with pain disability and depressive symptoms, over and above these six items, was identified through regression analyses. A short-PCS composed of seven items was formed, which correlated at r=0.97 with the full scale. Subsequently, receiver operating characteristic (ROC) curves were plotted against clinically significant depressive symptoms, defined as a score of ≥12 on a 10-item version of the Center for Epidemiologic Studies-Depression Scale. This analysis showed a score of ≥7 to be the optimal cutoff for the short-PCS, with sensitivity = 81.6% and specificity = 78.3% when predicting clinically significant depressive symptoms.
The short-PCS may be used in lieu of the full scale and as a brief screen to identify individuals with serious catastrophizing.
This study investigated the characteristics of subjective memory complaints (SMCs) and their association with current and future cognitive functions.
A cohort of 209 community-dwelling individuals without dementia aged 47–90 years old was recruited for this 3-year study. Participants underwent neuropsychological and clinical assessments annually. Participants were divided into SMCs and non-memory complainers (NMCs) using a single question at baseline and a memory complaints questionnaire following baseline, to evaluate differential patterns of complaints. In addition, comprehensive assessment of memory complaints was undertaken to evaluate whether severity and consistency of complaints differentially predicted cognitive function.
SMC and NMC individuals were significantly different on various features of SMCs. Greater overall severity (but not consistency) of complaints was significantly associated with current and future cognitive functioning.
SMC individuals present distinctive features of memory complaints as compared to NMCs. Further, the severity of complaints was a significant predictor of future cognition. However, SMC did not significantly predict change over time in this sample. These findings warrant further research into the specific features of SMCs that may portend subsequent neuropathological and cognitive changes when screening individuals at increased future risk of dementia.
We review progress studying unique plasmonics in topological insulators (TIs). First, we describe exfoliation and deposition synthesis approaches. TI materials have substantially improved: it is now possible to grow samples with few trivial electrons and controllable doping. We then describe the theory behind the unique behavior of the coupled, 2D Dirac plasmons. While reviewing experimental efforts, we note that Dirac plasmons have been conclusively demonstrated in TIs and they show remarkable properties including long lifetimes, large mode indices, and huge modulation depths. Finally, we describe the opportunities that are present now that high-quality materials can be obtained, including spin and nanoparticle plasmons.
Introduction: Bronchiolitis is a viral respiratory infection and the most common reason for hospitalization of infants. Despite evidence that few interventions are beneficial in patients with bronchiolitis, other studies would have shown that a significant proportion of patients undergo various forms of low value care. This objective of this project was to 1. establish baseline management of bronchiolitis in the Calgary Zone, and 2. deliver audit and feedback (A&F) reports to pediatric emergency physicians (PEP) to identify opportunities and strategies for practice improvement. Methods: This retrospective cohort study included all patients 12 months old that presented to a Calgary emergency department or urgent care center with a diagnosis of bronchiolitis from April 1, 2013 to March 31, 2017. Using data from various electronic health data sources, we captured age, vital signs, CTAS, common therapeutic interventions (bronchodilators, steroids, antibiotics) and investigations (chest x-ray (CXR), viral studies, antibiotics). Results were stratified by site and by admission status. Descriptive statistics were used to report baseline characteristics and interventions. Interhospital ranges (IHR) were provided to compare different hospitals in the zone. For the A&F component of the project, consenting PEP received a report of both their individual and peer comparator data and an in-person multi-disciplinary facilitated feedback session. Results: We included 4023 patients from all 6 sites (range from 28 to 3316 patients). Admission rates were 21.7% (IHR 0-29%). Mean age was 5.4 months old. Bronchodilator use was 27.0% (IHR 21-41%). 22.0% of patients received a CXR (IHR 0-57%) and 30.3% had viral studies done (IHR range 0.8-33%). PEP had higher usage of viral studies (30% vs 5.7%), whereas non-PEP had higher CXR usage (46.2% vs 23.4%). 41 of 66 PEP consented to receive their individual A&F reports (62%). In the facilitated feedback session PEP 1. identified two areas (bronchodilators and viral studies) where improvements could be made and 2. discussed specific strategies to decrease practice variation and minimize low value care including development of a multi-disciplinary care pathway, alignment with in-patient management, education and repeated A&F reports. Conclusion: Significant variability exists in management of patients with bronchiolitis across different hospitals in our zone. A facilitated feedback session identified areas for improvement and multi-disciplinary strategies to reduced low value care for patients with bronchiolitis. Future phases of this project include repeated data in 6 months and implementation of a provincial care pathway for the management of bronchiolitis.
Introduction: Prior research has shown that audit and feedback (A &F) can be an effective tool for practice change. However, questions remain about how to optimize A&F. The objectives of this project were to determine if: 1) there are differences in practice between physicians who do, and do not, consent to receive a confidential report on their practice and; 2) if there is a relationship between consenting physicians self-predicted and actual practice. Methods: This was a prospective, cross-sectional study embedded in a larger quality improvement (QI) initiative to align physician practice with best evidence in the emergency department (ED) care of infants with bronchiolitis. All physicians practicing in the ED of a tertiary care pediatric hospital were offered the opportunity to consent to receive an individual, confidential data report on their practice. Prior to receiving their data, consenting physicians completed a survey which asked them to predict the proportion of bronchiolitic patients for whom they ordered diagnostic tests or treatments. We used chi-squared testing to compare the proportion of consenting and non-consenting physicians whose diagnostic test (Chest X-ray (CXR), viral study) and treatment (steroid, Ventolin) ordering was above the median for all ED physicians. We used Pearsons correlation to assess the relationship between consenting physicians self -predicted and actual practice. Results: 56% (37/66) of physicians consented to receive a data report. The median proportion of patients with an x-ray ordered was 20%, 63% of non-consenters were above the median, compared to 36% of consenters (X2 (1, N=66)=4.91 p=0.03). For viral testing, 31% of patients had a test ordered, with 50% of non-consenters and 50% consenters above the median (( X2 (1, N=66) =0 p=1); 11% of patients had steroids ordered, with 53% of non-consenters and 47% of consenters above the median ( X2 (1, N=66)=0.24 p-0.621); and 18% of patients had Ventolin ordered, with 60% of non-consenters and 42% of consenters above the median ( X2 (1, N=66) =2.2 p=0.138). There was a moderate correlation between physicians predicted and actual practice with respect to viral testing (r=0.67), but minimal correlation for CXR (0.05), steroids (r=0.17) or Ventolin (r=0.33) ordering. Conclusion: The finding that physicians have a limited ability to accurately predict their own performance emphasizes the importance of providing physicians with feedback. However, our results suggest that the consent process may be a potential barrier to effective A &F.
In this paper, a control approach called Artificial Neural Tissue (ANT) is applied to multirobot excavation for lunar base preparation tasks including clearing landing pads and burying of habitat modules. We show for the first time, a team of autonomous robots excavating a terrain to match a given three-dimensional (3D) blueprint. Constructing mounds around landing pads will provide physical shielding from debris during launch/landing. Burying a human habitat modules under 0.5 m of lunar regolith is expected to provide both radiation shielding and maintain temperatures of −25 °C. This minimizes base life-support complexity and reduces launch mass. ANT is compelling for a lunar mission because it does not require a team of astronauts for excavation and it requires minimal supervision. The robot teams are shown to autonomously interpret blueprints, excavate and prepare sites for a lunar base. Because little pre-programmed knowledge is provided, the controllers discover creative techniques. ANT evolves techniques such as slot-dozing that would otherwise require excavation experts. This is critical in making an excavation mission feasible when it is prohibitively expensive to send astronauts. The controllers evolve elaborate negotiation behaviors to work in close quarters. These and other techniques such as concurrent evolution of the controller and team size are shown to tackle problem of antagonism, when too many robots interfere reducing the overall efficiency or worse, resulting in gridlock. Although many challenges remain with this technology, our work shows a compelling pathway for field testing this approach.
We describe here the parallels in astronomy and earth science datasets, their analyses, and the opportunities for methodology transfer from astroinformatics to geoinformatics. Using example of hydrology, we emphasize how meta-data and ontologies are crucial in such an undertaking. Using the infrastructure being designed for EarthCube - the Virtual Observatory for the earth sciences - we discuss essential steps for better transfer of tools and techniques in the future e.g. domain adaptation. Finally we point out that it is never a one-way process and there is enough for astroinformatics to learn from geoinformatics as well.
Repeat rectal chlamydia infection is common in men who have sex with men (MSM) following treatment with 1 g azithromycin. This study describes the association between organism load and repeat rectal chlamydia infection, genovar distribution, and efficacy of azithromycin in asymptomatic MSM. Stored rectal chlamydia-positive samples from MSM were analysed for organism load and genotyped to assist differentiation between reinfection and treatment failure. Included men had follow-up tests within 100 days of index infection. Lymphogranuloma venereum and proctitis diagnosed symptomatically were excluded. Factors associated with repeat infection, treatment failure and reinfection were investigated. In total, 227 MSM were included – 64 with repeat infections [28·2%, 95% confidence interval (CI) 22·4–34·5]. Repeat positivity was associated with increased pre-treatment organism load [odds ratio (OR) 1·7, 95% CI 1·4–2·2]. Of 64 repeat infections, 29 (12·8%, 95% CI 8·7–17·8) were treatment failures and 35 (15·4%, 95% CI 11·0–20·8) were reinfections, 11 (17·2%, 95% CI 8·9–28·7) of which were definite reinfections. Treatment failure and reinfection were both associated with increased load (OR 2·0, 95% CI 1·4–2·7 and 1·6, 95% CI 1·2–2·2, respectively). The most prevalent genovars were G, D and J. Treatment efficacy for 1 g azithromycin was 83·6% (95% CI 77·2–88·8). Repeat positivity was associated with high pre-treatment organism load. Randomized controlled trials are urgently needed to evaluate azithromycin's efficacy and whether extended doses can overcome rectal infections with high organism load.
Despite appropriate antiepileptic drug treatment, approximately one-third of humans and dogs with epilepsy continue experiencing seizures, emphasising the importance for new treatment strategies to improve the quality of life of people or dogs with epilepsy. A 6-month prospective, randomised, double-blinded, placebo-controlled cross-over dietary trial was designed to compare a ketogenic medium-chain TAG diet (MCTD) with a standardised placebo diet in chronically antiepileptic drug-treated dogs with idiopathic epilepsy. Dogs were fed either MCTD or placebo diet for 3 months followed by a subsequent respective switch of diet for a further 3 months. Seizure frequency, clinical and laboratory data were collected and evaluated for twenty-one dogs completing the study. Seizure frequency was significantly lower when dogs were fed the MCTD (2·31/month, 0–9·89/month) in comparison with the placebo diet (2·67/month, 0·33–22·92/month, P=0·020); three dogs achieved seizure freedom, seven additional dogs had ≥50 % reduction in seizure frequency, five had an overall <50 % reduction in seizures (38·87 %, 35·68–43·27 %) and six showed no response. Seizure day frequency were also significantly lower when dogs were fed the MCTD (1·63/month, 0–7·58/month) in comparison with the placebo diet (1·69/month, 0·33–13·82/month, P=0·022). Consumption of the MCTD also resulted in significant elevation of blood β-hydroxybutyrate concentrations in comparison with placebo diet (0·041 (sd 0·004) v. 0·031 (sd 0·016) mmol/l, P=0·028). There were no significant changes in serum concentrations of glucose (P=0·903), phenobarbital (P=0·422), potassium bromide (P=0·404) and weight (P=0·300) between diet groups. In conclusion, the data show antiepileptic properties associated with ketogenic diets and provide evidence for the efficacy of the MCTD used in this study as a therapeutic option for epilepsy treatment.