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Electroconvulsive therapy (ECT) is recommended in treatment guidelines as an efficacious therapy for treatment-resistant depression. However, it has been associated with loss of autobiographical memory and short-term reduction in new learning.
To provide clinically useful guidelines to aid clinicians in informing patients regarding the cognitive side-effects of ECT and in monitoring these during a course of ECT, using complex data.
A Committee of clinical and academic experts from Australia and New Zealand met to the discuss the key issues pertaining to ECT and cognitive side-effects. Evidence regarding cognitive side-effects was reviewed, as was the limited evidence regarding how to monitor them. Both issues were supplemented by the clinical experience of the authors.
Meta-analyses suggest that new learning is impaired immediately following ECT but that group mean scores return at least to baseline by 14 days after ECT. Other cognitive functions are generally unaffected. However, the finding of a mean score that is not reduced from baseline cannot be taken to indicate that impairment, particularly of new learning, cannot occur in individuals, particularly those who are at greater risk. Therefore, monitoring is still important. Evidence suggests that ECT does cause deficits in autobiographical memory. The evidence for schedules of testing to monitor cognitive side-effects is currently limited. We therefore make practical recommendations based on clinical experience.
Despite modern ECT techniques, cognitive side-effects remain an important issue, although their nature and degree remains to be clarified fully. In these circumstances it is useful for clinicians to have guidance regarding what to tell patients and how to monitor these side-effects clinically.
The term ‘mood stabiliser’ is ill-defined and lacks clinical utility. We propose a framework to evaluate medications and effectively communicate their mood stabilising properties – their acute and prophylactic efficacy across the domains of mania and depression. The standardised framework provides a common definition to facilitate research and clinical practice.
Declaration of interest
The Treatment Algorithm Group (TAG) was supported logistically by Servier who provided financial assistance with travel and accommodation for those TAG members travelling interstate or overseas to attend the meeting in Sydney (held on 18 November 2017). None of the committee were paid to participate in this project and Servier have not had any input into the content, format or outputs from this project.
Studies using acute tryptophan depletion (ATD) to examine the effects of a rapid reduction in serotonin function have shown a reduction in global cognitive status during ATD in Alzheimer's disease (AD) and Parkinson's disease (PD). Based on the severe cholinergic loss evident in dementia with Lewy bodies (DLB) and Parkinson's disease and dementia (PDD), we predicted that a reduction of global cognitive status during ATD would be greater in these conditions than in AD.
Patients having DLB or PDD underwent ATD in a double-blind, placebo-controlled, randomized, counterbalanced, crossover design.
While the study intended to test 20 patients, the protocol was poorly tolerated and terminated after six patients attempted, but only four patients – three with DLB and one with PDD – completed the protocol. The Modified Mini-Mental State Examination (3MSE) score was reduced in all three DLB patients and unchanged in the PDD and dementia patient during ATD compared with placebo.
This reduction in global cognitive function and the poor tolerability may fit with the hypothesis that people with dementia with Lewy bodies have sensitivity to the effects of reduced serotonin function.
Embedded piezoresistive microcantilever (EPM) sensors were used to detect the presence of the compound estrogen in water samples. The sensor was fabricated with a host material hydrogel (Hypol) functionalized with estrogen antibody. This sensor was able to detect 1 ppm of estrogen in water, responding almost immediately to the estrogen addition, with a full sensor response (saturation) occurring after two minutes of exposure.
We have constructed a low cost, portable, battery-powered quadrupole mass spectrometer for use in the analysis of gaseous, liquid or solid field samples. The system may be configured for continuous sampling of ambient gas samples, or for the analysis of small solid, liquid or gas samples in sealed glass vials. The system is capable of measuring partial pressures down to the 10-10 Torr range, and may be operated on battery power for several hours in a field deployment. In this paper, we present information on the design and testing of the instrument, as well as data taken on chlorinated hydrocarbons and other contaminants in water.
Embedded piezoresistive microcantilever (EPM) sensors provide a small, simple and robust platform for the detection of many different types of analytes. These inexpensive sensors may be deployed in battery-powered handheld units, or interfaced to small, battery-powered radio transmitter-receivers (motes), for deployment in mesh networks of many sensors. Previously, we have demonstrated the use of EPM sensors in the detection of hydrogen fluoride gas, organophosphate nerve agents, volatile organic compounds (VOC’s), chlorinated hydrocarbons in water, and others. Here, we report on the design of EPM sensors functionalized for the detection of chlorine gas, or Cl2. We have constructed EPM sensors using composite materials consisting of a polymer or hydrogel matrix loaded with agents specific for the detection of Cl2 such as NaI. These materials were tested in both controlled laboratory conditions and in outdoor releases. Stability of the sensing materials under conditions of high temperature were also studied. Results are presented for gas exposures ranging from 1000 ppm to 20 ppm.
Embedded piezoresistive microcantilever (EPM) sensors have been used in the detection of a variety of analyte species. EPM sensors utilize a tiny piezoresistive microcantilever partially embedded into a sensing material to produce a sensing element that is compact, simple, resistant to movement and shock, and suitable for remote sensing applications. In the current project, we have used sensing materials comprised of an immobilizing polymer functionalized with either target enzymes or antibodies to detect two biological agents, Bacillus subtilis and Diisopropyl fluorophosphate (DFP). DFP is used as a simulant for organophosphate nerve agents, while BG is a large bacterial spore used as a simulant for other bacterial spores such as bacillus anthracis. Sensing results are presented for both types of EPM sensors.
Assertive community treatment (ACT) was developed in the early 1970s as a means of coordinating the care of people with severe mental illness in the community. A Cochrane review of the effectiveness of ACT for the general adult population found that people receiving ACT were more likely to engage with services, and were less likely to be admitted to hospital (Marshall & Lockwood, 2000). The National Service Framework for Mental Health (Department of Health, 1999) and the NHS Plan (Department of Health, 2000) called for a total of 220 assertive outreach teams by April 2003.
Embedded piezoresistive microcantilever (EPM) sensors provide a tiny, low-cost, and robust platform for the detection of chemical or biological analytes. New sensing applications become potentially available as the design or synthesis of new sensing materials for EPM instruments are studies. In this study, we report on the detection of hydrogen fluoride gas (HF) in air, and in a medical application, the measurement of human hydration levels. Two sensing materials characterize these applications, thiolated gold nanoparticles in a keratin matrix (HF), and a crosslinked PVA-based hydrogel in the hydration application.
A team of faculty at Northern Arizona University (a predominantly undergraduate institution) have joined forces to develop a cross-disciplinary course for sophomore level science students in nanotechnology and the associated instrumentation with an overarching theme centered around carbon nanotubes. Research laboratories with various analytical capabilities were utilized from the Departments of Biology, Chemistry, and Physics and Astronomy. Specifically, the techniques that were used included scanning electron microscopy, x-ray photoelectron spectroscopy, nuclear magnetic resonance, and micro-sensor technology. The course content, the student activities and the initial experience in developing and team-teaching the course are described.
We have used embedded piezoresistive microcantilever (EPM) sensors in the detection of hydrogen cyanide gas. EPM sensors are small, MEMS-based devices consisting of a tiny piezoresistive microcantilever partially embedded into a “sensing material” designed to respond volumetrically when exposed to the desired analyte. These EPM sensors may be very small, operate on simple and inexpensive support electronics, are highly resistant to movement or shock, may be operated by hardwire connection or wirelessly in large numbers, and are capable of detecting many different analytes. In this study, we have used EPM sensors to detect hydrogen cyanide gas. Preliminary results indicate that the EPM sensors provide a fast response (less than 5 seconds) to levels of HCN that may be lethal to humans.
Using simplicial methods developed in an earlier note, the paper
constructs topological quantum field
theories using an algebraic model of a homotopy n-type as initial
data, generalising constructions of Yetter
for n=1 and n=2.