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Patients with Parkinson’s disease psychosis (PDP) are often treated with an atypical antipsychotic, especially quetiapine or clozapine, but side effects, lack of sufficient efficacy, or both may motivate a switch to pimavanserin, the first medication approved for management of PDP. How best to implement a switch to pimavanserin has not been clear, as there are no controlled trials or case series in the literature to provide guidance. An abrupt switch may interrupt partially effective treatment or potentially trigger rebound effects from antipsychotic withdrawal, whereas cross-taper involves potential drug interactions. A panel of experts drew from published data, their experience treating PDP, lessons from switching antipsychotic drugs in other populations, and the pharmacology of the relevant drugs, to establish consensus recommendations. The panel concluded that patients with PDP can be safely and effectively switched from atypical antipsychotics used off label in PDP to the recently approved pimavanserin by considering each agent’s pharmacokinetics and pharmacodynamics, receptor interactions, and the clinical reason for switching (efficacy or adverse events). Final recommendations are that such a switch should aim to maintain adequate 5-HT2A antagonism during the switch, thus providing a stable transition so that efficacy is maintained. Specifically, the consensus recommendation is to add pimavanserin at the full recommended daily dose (34 mg) for 2–6 weeks in most patients before beginning to taper and discontinue quetiapine or clozapine over several days to weeks. Further details are provided for this recommendation, as well as for special clinical circumstances where switching may need to proceed more rapidly.
Systemic uptake of organic compounds from roots to leaves follows a Gaussian distribution in relation to the lipophilicity, as measured by the log Kow. Quantification of compound uptake with different lipophilicities, and applied as a seed treatment that diffuses through the seed coat into the embryo during imbibition, has not been reported. The aim of this investigation was to quantify the uptake of non-ionic compounds into seeds of soybean and corn. A series of fluorescent piperonyl amides were synthesized and a novel combinatorial pharmacodynamic technique was developed that provided a range of compounds from log Kow 0.02 to 5.7. Seeds were treated with a mixture of amides, imbibed and compounds chemically extracted and quantified by high-performance liquid chromatography using a fluorescence detector. The maximum uptake efficiency of the applied amide mixture from whole soybean and corn seeds was 67% at log Kow 2.9, and 43% at log Kow 3.4, respectively. The critical partition coefficient for uptake for both species was <4.2 log Kow. Seeds were dissected and separated as soybean embryo and testa, and corn internal tissues (embryo + endosperm) or seed covering layers (pericarp + testa), and >75% of the amides were found in the soybean embryo or corn internal tissues compared with the covering layers at log Kow <4.2. The distribution of amides showed that the corn seed covering layer had similar hydrophilic/lipophilic properties as internal tissues, while soybean tissues had different hydrophilic/lipophilic properties. Collectively, the Gaussian uptake pattern for systemic uptake into plants was not found for either seed species.
The accurate and precise collection of three-dimensional (3D) context and provenience data is of critical importance for archaeologists. Traditional square-hole methods are being augmented by new digital techniques to increase the accuracy and precision with which 3D data are collected. Structure from Motion (SfM) photogrammetry is an emerging digital technique that is becoming more widespread for collecting 3D data of archaeological sites and features. We are using handheld digital cameras and ground-based SfM to record accurate and precise 3D context and provenience data at the scale of the excavation unit and profile during rockshelter excavations in the Lower Pecos Canyonlands of Texas. By combining SfM with traditional excavation methods, we collect 3D data on excavation units, layers, features, and profiles without excavating in grid-bound square units. SfM provides a straightforward and flexible method to excavate based on the stratigraphy and logistical pragmatics, which further aids in assigning precise context and provenience to recovered artifacts and samples. This article describes how ground-based SfM serves as a basic recording tool during excavation and shows that, by applying ground-based SfM methods to excavation, archaeologists can collect more, and more accurate, data than with traditional square-hole methods.
Because individuals develop dementia as a manifestation of neurodegenerative or neurovascular disorder, there is a need to develop reliable approaches to their identification. We are undertaking an observational study (Ontario Neurodegenerative Disease Research Initiative [ONDRI]) that includes genomics, neuroimaging, and assessments of cognition as well as language, speech, gait, retinal imaging, and eye tracking. Disorders studied include Alzheimer’s disease, amyotrophic lateral sclerosis, frontotemporal dementia, Parkinson’s disease, and vascular cognitive impairment. Data from ONDRI will be collected into the Brain-CODE database to facilitate correlative analysis. ONDRI will provide a repertoire of endophenotyped individuals that will be a unique, publicly available resource.
The idea that private, covert information is subtly communicated in human facial expressions is popular in both the academic literature (e.g., the ‘micro-expression’) and the media (e.g., the television show ‘Lie to Me’). Yet, in 2005, when we began to scour the literature for evidence of involuntary aspects of emotional expression – and the contribution to identifying insincere emotional expressions – we found that it was surprisingly scarce. With the exception of genuine and false smiles (e.g., Ekman, Davidson and Friesen 1990; Frank, Ekman and Friesen 1993), little research had addressed even the most basic issues around involuntary aspects of emotional expression, including whether micro-expressions exist. In the decade since this realization, our research team has conducted the most comprehensive investigation of the manner in which emotional information is involuntarily communicated on the human face (e.g., Porter and ten Brinke 2008; ten Brinke and Porter 2012; ten Brinke et al. 2013), sometimes to the expresser's dismay. With the goal of solving some of the mysteries and resolving some of the controversies in this area, we have manually coded millions of frames of videotaped faces for both the presence of full expressions and specific, individual muscle movements. These tapes include expressions generated in both highly controlled, lab-based experiments and naturalistic ‘real-life’ emotional scenarios. Not only does this body of research represent our basic interest in this aspect of human communication, but also it was motivated by the practical implications of the results. Specifically, in observing the deleterious consequences that emotional deception can have in society, we hoped to learn how science might inform the practice of identifying insincere emotions. For example, in one study we found that psychopathic offenders are such good emotional actors that they successfully talk and cry their way out of parole hearings at a rate two and a half times higher than their more meritorious counterparts (Porter, ten Brinke and Wilson 2009). When we followed up on their performance in the community, they typically re-offended quickly and often in a heinous, violent fashion. The goal of this chapter is to explore the results of our and others’ research on the manifestations of voluntary and involuntary aspects of emotional expressions in everyday life and the manner in which they relate to the differentiation of sincere and insincere expressions.
To describe the development and application of the School Food Environment Assessment Tools and a novel scoring system to assess the integration of healthy and environmentally sustainable food initiatives in elementary and secondary schools.
The cross-sectional study included direct observations of physical food environments and interviews with key school personnel regarding food-related programmes and policies. A five-point scoring system was then developed to assess actions across six domains: (i) food gardens; (ii) composting systems; (iii) food preparation activities; (iv) food-related teaching and learning activities; and availability of (v) healthy food; and (vi) environmentally sustainable food.
A purposive sample of public schools (n 33) from all six sectors of the Vancouver Board of Education.
Schools scored highest in the areas of food garden and compost system development and use. Regular integration of food-related teaching and learning activities and hands-on food preparation experiences were also commonly reported. Most schools demonstrated rudimentary efforts to make healthy and environmentally sustainable food choices available, but in general scored lowest on these two domains. Moreover, no schools reported widespread initiatives fully supporting availability or integration of healthy or environmentally sustainable foods across campus.
More work is needed in all areas to fully integrate programmes and policies that support healthy, environmentally sustainable food systems in Vancouver schools. The assessment tools and proposed indicators offer a practical approach for researchers, policy makers and school stakeholders to assess school food system environments, identify priority areas for intervention and track relevant changes over time.
Remains of earth ovens with rock heating elements of various sizes and configurations are common at hunter-gatherer sites around the world. They span the last 30,000 years in the Old World and some 10,000 years in the New World. Although various foods were baked in these ovens, plants predominate. Earth ovens are ethnographically well documented as family-size and bulk cooking facilities, but related technology and its archaeological signatures remain poorly understood and understudied. These ubiquitous features are often mischaracterized as generic cooking facilities termed hearths. It is proposed that, in fact, most rock “hearths” are heating elements of earth ovens. Reliable identification and interpretation of earth ovens requires documentation of heating elements, pit structure, rock linings, and various remnants thereof. Fundamental technological concepts for investigating their archaeological signatures include thermodynamics, construction designs, and life cycles in systemic context, as informed by ethnographic, archaeological, and experimental data. Earth oven technology explains well the primary purpose of labor-intensive thermal storage for long-term cooking and conserving fuel. Information from the extensive archaeological record of earth ovens on the Edwards Plateau of south-central North America illustrates these points.
To describe the identification, management, and clinical characteristics of hospitalized patients with influenza-like illness (ILI) during the peak period of activity of the 2009 pandemic strain of influenza A virus subtype H1N1 (2009 H1N1).
Retrospective review of electronic medical records.
Patients and Setting.
Hospitalized patients who presented to the emergency department during the period October 18 through November 14, 2009, at 4 hospitals in Cook County, Illinois, with the capacity to perform real-time reverse-transcriptase polymerase chain reaction testing for influenza.
Vital signs and notes recorded within 1 calendar day after emergency department arrival were reviewed for signs and symptoms consistent with ILI. Cases of ILI were classified as recognized by healthcare providers if an influenza test was performed or if influenza was mentioned as a possible diagnosis in the physician notes. Logistic regression was used to determine the patient attributes and symptoms that were associated with ILI recognition and with influenza infection.
We identified 460 ILI case patients, of whom 412 (90%) had ILI recognized by healthcare providers, 389 (85%) were placed under airborne or droplet isolation precautions, and 243 (53%) were treated with antiviral medication. Of 401 ILI case patients tested for influenza, 91 (23%) had a positive result. Fourteen (3%) ILI case patients and none of the case patients who tested positive for influenza had sore throat in the absence of cough.
Healthcare providers identified a high proportion of hospitalized ILI case patients. Further improvements in disease detection can be made through the use of advanced electronic health records and efficient diagnostic tests. Future studies should evaluate the inclusion of sore throat in the ILI case definition.
Describe the clinical and molecular epidemiology of incident Clostridium difficile infection (CDI) cases in Chicago area acute healthcare facilities (HCFs).
Design and Setting.
Laboratory, clinical, and epidemiologic information was collected for patients with incident CDI who were admitted to acute HCFs in February 2009. Stool cultures and restriction endonuclease analysis typing of the recovered C. difficile isolates was performed.
Two hundred sixty-three patients from 25 acute HCFs.
Acute HCF rates ranged from 2 to 7 patients with CDI per 10,000 patient-days. The crude mortality rate was 8%, with 20 deaths occurring in patients with CDI. Forty-two (16%) patients had complications from CDI, including 4 patients who required partial, subtotal, or total colectomy, 3 of whom died. C. difficile was isolated and typed from 129 of 178 available stool specimens. The BI strain was identified in 79 (61%) isolates. Of patients discharged to long-term care who had their isolate typed, 36 (67%) had BI-associated CDI.
Severe disease was common and crude mortality was substantial among patients with CDI in Chicago area acute HCFs in February 2009. The outbreak-associated BI strain was the predominant endemic strain identified, accounting for nearly two-thirds of cases. Focal HCF outbreaks were not reported, despite the presence of the BI strain. Transfer of patients between acute and long-term HCFs may have contributed to the high incidence of BI cases in this investigation.
Jordan is currently one of the world's 10 water-poorest nations, a situation which has been exacerbated by a rapidly growing population. This chapter reviews the current status of the water resources in the Hashemite Kingdom of Jordan in the context of the global pattern of increasing demand for water linked to population growth which is increasingly urban-based, increasing economic progress and the potential impact of climate change. Jordan's climate ranges from Mediterranean to arid with approximately 80% of the country receiving less than 100 mm of rainfall annually. Evaporation ranges from 2,000 mm in the north to 5,000 mm in the south. Current demand for water exceeds available renewable water resources, with the shortfall met by exploiting non-renewable reserves and water rationing. An additional water supply available for agricultural use is treated wastewater, but there are concerns and limitations to the use of this resource. The demand for water is predicted to continue to grow, and current predictions of future climate in the region indicate no change or a reduction in the quantity of rainfall and changes in the distribution through the year. These predictions of growth in water demand and shifts in rainfall patterns highlight the need to make more efficient use of the available water and to use other sustainable sources such as treated wastewater in a more effective manner.
Epitaxial growth of the dilute magnetic semiconductors GaMnP and GaMnN has been investigated by Gas Source Molecular Beam Epitaxy (GSMBE). GaMnP films grown with < 4.5% Mn show the preferential formation of the second phases MnP and Mn5.64P3, resulting in only a slight deviation from purely diamagnetic behavior. GaMnN films grown on both Al2O3 and Metal-Organic Chemical Vapor Deposition (MOCVD) derived GaN surfaces show strong ferromagnetism when grown with either C codoping or at elevated temperatures to raise the concentration of n-type carriers. Comparable GaMnN films grown under conditions which produce highly resistive material show only paramagnetism, indicating the importance of carrier concentration on the resulting magnetic behavior. The formation of second phases was not observed in the GaMnN material for Mn concentrations less than 9%.
We developed a method for making 4-point contacts to Bi nanowires with a thick oxide coat using a combination of lithographic and focused ion beam (FIB) techniques. The resistivity of Bi nanowires with diameters in the range 70-200nm is found to increase with decreasing wire diameter. In contrast to bulk Bi, the temperature dependence of the resistivity is found to decrease monotonically with increasing temperature. The results are explained on the basis of increased scattering in the nanowire and the known temperature dependence of the electronic properties of bulk Bi. A large magneto-resistance was also measured, indicating a high crystalline quality of the nanowires. A large spread in the measured values of the resistivity indicates significant systematic error in the measurement technique. Possible sources for error are discussed.
The pressure filling of anodic alumina templates with molten bismuth has been used to synthesize single crystalline bismuth nanowires with diameters ranging from 7 to 200nm and lengths of 50μm. The nanowires are separated by dissolving the template, and electrodes are affixed to single Bi nanowires on Si substrates. A focused ion beam (FIB) technique is used first to sputter off the oxide from the nanowires with a Ga ion beam and then to deposit Pt without breaking vacuum. The resistivity of a 200nm diameter Bi nanowire is found to be only slightly greater than the bulk value, while preliminary measurements indicate that the resistivity of a 100nm diameter nanowire is significantly larger than bulk. The temperature dependence of the resistivity of a 100nm nanowire is modeled by considering the temperature dependent band parameters and the quantized band structure of the nanowires. This theoretical model is consistent with the experimental results.
We have synthesized single crystal bismuth nanowires by pressure injecting molten Bi into anodic alumina templates. By varying the template fabrication conditions, nanowires with diameters ranging from 10 to 200nm and lengths of ~50[.proportional]m can be produced. We present a scheme for measuring the resistance of a single Bi nanowire using a 4-point measurement technique. The nanowires are found to have a 7nm thick oxide layer which causes very high contact resistance when electrodes are patterned on top of the nanowires. The oxide is found to be resilient to acid etching, but can be successfully reduced in high temperature hydrogen and ammonia environments. The reformation time of the oxide in air is found to be less than 1 minute. Focused ion beam milling is attempted as an alternate solution to oxide removal.