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The atypical antipsychotics (AAPs) are associated with a recognized class effect of glucose and lipid dysregulation. The use of these medications is rapidly increasing in elderly patients with, and without, dementia. However, the metabolic risks specific to elderly remain poorly studied.
Design: A case-control study.
Setting: Psychogeriatric service in Auckland, New Zealand.
Participants: Elderly patients either receiving AAP treatment (cases) or not (controls) between 1 Jan 2008 and 1 Jan 2014.
Main outcome measures: metabolic data of glucose, HbA1c, lipids, and cardiovascular events and death. The data were analyzed using t-tests and linear regression models for each metabolic outcome.
There were 330 eligible cases and 301 controls from a total study population of 5,307. There was a statistically significant change in the HbA1c over time, within the cases group of −1.14 mmol/mol (p = 0.018, 95% CI −0.19 to −2.09). Also statistically significant was the reduction in total cholesterol of −0.13 mmol/L (p = 0.036, 95% CI −0.008 to −0.245). The only significant difference found between cases and controls was in the change in cholesterol ratio of 0.16 mmol/L between groups (95%CI 0.01–0.31, p = 0.036).
AAP use was not associated with any clinically significant change in metabolic outcomes in this study population.
Screening for organ and tissue donation is an essential skill for emergency physicians. In 2015, 4,631 Canadians were on a waiting list for a transplant, and 262 died while waiting. Canada’s donation rates are less than half of comparable countries, so it is essential to explore strategies to improve the referral of donors. Poisoned patients may be one such underutilized source for donation. This study explores physician practices and perceptions regarding the referral of poisoned patients as donors.
In this cross-sectional unidirectional survey, 1,471 physician members of the Canadian Association of Emergency Physicians were invited to participate. Physicians were presented with 20 scenarios and asked whether they would refer the patient as a potential organ or tissue donor. Results were reported descriptively, and associations between demographics and referral patterns were assessed.
Physicians totalling 208 participated in the organ or tissue donation scenarios (14.1%); 75% of scenarios involving poisoning were referred for organ or tissue donation, compared with 92% in a non-poisoning scenario. Poisons associated with lower referrals included sedatives, acetaminophen, chemical exposure, and organophosphates. A total of 175 physicians completed the demographic survey (11.9%). Characteristics associated with increased referrals included previous referral experience, donation training, donation support, >10 years of service, urban practice, emergency medicine certification, and male gender.
Scenarios involving poisoning were referred less often when compared with an ideal scenario. Because poisoning is not a contraindication for referral, this represents a potential source of donors. Targeted training and referral support may help improve donation rates in this demographic.
In the early 1830s and 1840s, a British colonial official by the name of Colonel James Low uncovered evidence for an early culture with Indic traits in a river system known as the Bujang Valley. On the west coast of the Thai-Malay peninsula, the Bujang Valley is today located in the Malaysian state of Kedah. However, it wasn't until just before World War II that excavations took place, conducted by H. G. Quaritch Wales and his wife Dorothy. Their discoveries and subsequent publications led to the first real attempts to explain the origins and extent of this civilisation and its place within the larger South and Southeast Asian world. In the intervening years between Quaritch Wales's excavations and the present day, considerably more research has taken place within the Bujang Valley, though this has not been without controversy. Recently claims and counter-claims regarding the antiquity of Hinduism and Buddhism at the site have arisen in some quarters within Malaysia. It therefore seems pertinent that this material be re-evaluated in light of new scholarship and discoveries as well as the prevailing paradigms of interactions between South and Southeast Asia. This paper presents an updated reading of this material and argues that the Bujang Valley should be seen as a cosmopolitan trading port with substantive evidence for the presence of Hinduism and Buddhism.
The mid-first millennium CE represents a crucial period in the emergence of early polities in Southeast Asia. However, disagreement remains between archaeologists and art historians as to the precise dating of this shift from prehistory to history. This article focuses on the Dvāravatī period and re-evaluates evidence in Thai and Western language publications. A growing number of sites excavated over the past two decades in particular show occupation from c. the fourth to fifth century onwards while others provide a continual sequence stretching back well into the Iron Age. I argue that evidence from these sites makes a strong case for postulating a proto-Dvāravatī period spanning c. the fourth to fifth centuries. In doing so this article proposes this period as the timeframe within which the nascent traits and characteristics of what becomes Dvāravatī in the seventh to ninth centuries are present and gradually developing.
Studies of early Southeast Asia focus largely on its ‘classical states’, when rulers and their entourages from Sukhothai and Ayutthaya (Thailand), Angkor (Cambodia), Bagan (Myanmar), Champa and Dai Viet (Vietnam) clashed, conquered, and intermarried one another over an approximately six-century-long quest for legitimacy and political control. Scholarship on Southeast Asia has long held that such transformations were largely a response to outside intervention and external events, or at least that these occurred in interaction with a broader world system in which Southeast Asians played key roles. As research gathered pace on the prehistory of the region over the past five decades or so, it has become increasingly clear that indigenous Southeast Asian cultures grew in sophistication and complexity over the Iron Age in particular. This has led archaeologists to propose much greater agency in regard to the selective adaptation of incoming Indic beliefs and practices than was previously assumed under early scholarship of the nineteenth and early to mid-twentieth century.
Recent studies point to overlap between neuropsychiatric disorders in symptomatology and genetic aetiology.
To systematically investigate genomics overlap between childhood and adult attention-deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD) and major depressive disorder (MDD).
Analysis of whole-genome blood gene expression and genetic risk scores of 318 individuals. Participants included individuals affected with adult ADHD (n = 93), childhood ADHD (n = 17), MDD (n = 63), ASD (n = 51), childhood dual diagnosis of ADHD–ASD (n = 16) and healthy controls (n = 78).
Weighted gene co-expression analysis results reveal disorder-specific signatures for childhood ADHD and MDD, and also highlight two immune-related gene co-expression modules correlating inversely with MDD and adult ADHD disease status. We find no significant relationship between polygenic risk scores and gene expression signatures.
Our results reveal disorder overlap and specificity at the genetic and gene expression level. They suggest new pathways contributing to distinct pathophysiology in psychiatric disorders and shed light on potential shared genomic risk factors.
This article explores a number of ways in which to reconstruct the possible extent of monastic Buddhism in the Khorat Plateau during the Dvāravatī period. In an attempt to so, it is consequently multidisciplinary in its conception, being primarily archaeological while also drawing on areas of anthropology, art history, demographics and Buddhist studies. In doing so, it attempts to move beyond the sole analysis of archaeological and art historic objects in order to investigate the social, demographic and geographical factors that lie behind the production of these artefacts. It proposes to do so by a number of quantitative means: first, by giving hypothetical population estimates of urban centres/moated sites during the Dvāravatī period and consequently the number of monks these settlements could have supported. These estimates are then used to consider how many monks may have been sustained according to these figures. Second, by carrying out a quantitative analysis of sema stone numbers and their distribution throughout the Khorat Plateau this also provides a method to calculate the number of possible consecrated spaces (viz., sīma) in the region and their geographic extent. The analysis shows that institutional, monastic Buddhism primarily spread and settled along the major river systems throughout the region. Third, by plotting the distribution, quantity and quality of Buddhist narrative artwork on sema to pinpoint the locations of possible workshops and centres. This also allows for a number of conclusions to be drawn in terms of the socio-economic support needed to develop and maintain workshops and craftsmen and relates directly to population densities.
It should, however, be stated at the outset that this paper proposes nothing more than a possible scenario to aid in explaining and understanding the extent and spread of Buddhism during this period. I am here using the term “scenario” in reference to Donn Bayard's cautionary remarks regarding archaeology and the use of models. As Bayard explains, a model, strictly speaking should be based on reliable datasets which are testable and “ideally consists of a set of relationships between variables to which more or less precise numerical values may be assigned”. As will become clear in this paper, the assigning of such precise figures to the subject under investigation (viz. Buddhism) is unrealistic given the current incomplete state of the datasets from the region and time period in question.