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Adding another antipsychotic to a treatment regimen was previously used in evaluating the medication's efficacy. Supplementation of depot antipsychotics with oral antipsychotics is particularly meaningful because depot formulations are typically chosen for patients struggling with adherence to oral antipsychotics. This post-hoc analysis assessed supplementation of olanzapine long-acting injection (olanzapine-LAI) with oral olanzapine.
Subjects and methods
We used 12 months of data from an open-label, single-arm extension study of patients with schizophrenia or schizoaffective disorder (N = 931) treated with olanzapine-LAI. The prevalence, duration, time to first supplementation, and best predictors of oral supplementation were assessed.
Oral supplementation occurred in 21% of patients for a median of 31 days with mean modal dose of 10.8 mg/day. Mean time to first supplementation was shorter for patients who were at least moderately ill at baseline compared to less ill patients (47 vs. 97 days, p < 0.001). Best predictors of oral supplementation included a more severe illness profile at baseline, lower olanzapine-LAI dose prior to oral supplementation, supervised living arrangements, and being African-American.
Supplementation of olanzapine-LAI appears to be infrequent, of relatively short duration, and reserved for more severely ill patients who may require a targeted rescue medication due to signs of impending relapse.
Rehabilitation of memory after stroke remains an unmet need. Telehealth delivery may overcome barriers to accessing rehabilitation services.
We conducted a non-randomized intervention trial to investigate feasibility and effectiveness of individual telehealth (internet videoconferencing) and face-to-face delivery methods for a six-week compensatory memory rehabilitation program. Supplementary analyses investigated non-inferiority to an existing group-based intervention, and the role of booster sessions in maintaining functional gains. The primary outcome measure was functional attainment of participants’ goals. Secondary measures included subjective reports of lapses in everyday memory and prospective memory, reported use of internal and external memory strategies, and objective measures of memory functioning.
Forty-six stroke survivors were allocated to telehealth and face-to-face intervention delivery conditions. Feasibility of delivery methods was supported, and participants in both conditions demonstrated treatment-related improvements in goal attainment, and key subjective outcomes of everyday memory, and prospective memory. Gains on these measures were maintained at six-week follow-up. Short-term gains in use of internal strategies were also seen. Non-inferiority to group-based delivery was established only on the primary measure for the telehealth delivery condition. Booster sessions were associated with greater maintenance of gains on subjective measures of everyday memory and prospective memory.
This exploratory study supports the feasibility and potential effectiveness of telehealth options for remote delivery of compensatory memory skills training after a stroke. These results are also encouraging of a role for booster sessions in prolonging functional gains over time.
Variation in parental care by child's sex is evident across cultures. Evolutionary theory provides a functional explanation for this phenomenon, predicting that parents will favour specific children if this results in greater fitness payoffs. Here, we explore evidence for sex-biased parental care in a high-fertility, patriarchal and polygynous population in Tanzania, predicting that both mothers and fathers will favour sons in this cultural setting. Our data come from a cross-sectional study in rural northwestern Tanzania, which included surveys with mothers/guardians of 808 children under age 5. We focus on early childhood, a period with high mortality risk which is fundamental in establishing later-life physical and cognitive development. Examining multiple measures of direct/physical care provision (washing, feeding, playing with, supervising, co-sleeping and caring when sick), we demonstrate that fathers favour sons for washing, feeding and supervising, while maternal care is both more intensive and unrelated to child sex. We find no difference in parental care between girls and boys regarding the allocation of material resources and the duration of breastfeeding; or in terms of parental marital and co-residence status. This bias towards sons may result from higher returns to investment for fathers than mothers, and local gender norms about physical care provision.
The Darwin–Hatherton Glacial system (DHGS) connects the East Antarctic Ice Sheet (EAIS) with the Ross Ice Shelf and is a key area for understanding past variations in ice thickness of surrounding ice masses. Here we present the first detailed measurements of ice thickness and grounding zone characteristics of the DHGS as well as new measurements of ice velocity. The results illustrate the changes that occur in glacier geometry and ice flux as ice flows from the polar plateau and into the Ross Ice Shelf. The ice discharge and the mean basal ice shelf melt for the first 8.5 km downstream of the grounding line amount to 0.24 ± 0.05 km3 a−1 and 0.3 ± 0.1 m a−1, respectively. As the ice begins to float, ice thickness decreases rapidly and basal terraces develop. Constructed maps of glacier geometry suggest that ice drainage from the EAIS into the Darwin Glacier occurs primarily through a deep subglacial canyon. By contrast, ice thins to <200 m at the head of the much slower flowing Hatherton Glacier. The glaciological field study establishes an improved basis for the interpretation of glacial drift sheets at the link between the EAIS and the Ross Ice Sheet.
Previous studies have identified risk factors for femoral arterial thrombosis after paediatric cardiac catheterisation, but none of them have evaluated the clinical and economic significance of this complication at the population level. Therefore, we examined the national prevalence and economic impact of femoral arterial thrombosis after cardiac catheterisation in children.
Patients⩽18 years of age who underwent cardiac catheterisation were identified in the 2003–2009 Kids’ Inpatient Database. Patients were stratified by age as follows: <1 year of age or 1–18 years of age. The primary outcome was arterial thrombosis of the lower extremity during the same hospitalisation as cardiac catheterisation. Propensity score matching was used to determine the impact of femoral arterial thrombosis on hospital length of stay, cost, and mortality.
Among the 11,497 paediatric cardiac catheterisations identified, 4558 catheterisations (39.6%) were performed in children <1 year of age. This age group experienced a higher prevalence of reported femoral arterial thrombosis, compared with children aged 1–18 years (1.3 versus 0.3%, p<0.001). After matching, femoral arterial thrombosis in children <1 year of age was associated with similar mortality (5.4 versus 1.8%, p=0.28), length of stay (8 versus 5 days, p=0.11), and total hospital cost ($27,135 versus $28,311, p=0.61), compared with absence of thrombosis.
Femoral arterial thrombosis is especially prevalent in children <1 year of age undergoing cardiac catheterisation. Clinicians should be vigilant in monitoring femoral arterial patency in neonates and infants after cardiac catheterisation.
A photometric and spectroscopic survey of many of the cool H-deficient Carbon (HdC) stars, including the R Coronae Borealis (RCB) stars, has been undertaken. For the RCB stars we have data on both the low amplitude photometric variations at maximum light and the major declines, the latter being the most distinguishing feature between the RCB and HdC stars.
The photometric data at maximum light have been analysed using the Lomb-Scargle Fourier method, which has revealed many significant periodicities. From estimates of the temperature of these stars, an observational period-temperature diagram can be compared with theoretical models. These models have also enabled us to determine the evolutionary lifetime of these stars for comparison with observational parameters, e.g., period changes.
Over the last several years we have photoelectrically covered the declines (and the recovery from some of these declines) of a number of RCB stars, from which we have been able to characterise two extreme types of decline behaviour. In addition, we have for the very first time spectroscopically recorded the initial decline phase of one (the prototype, R CrB) of these stars.
This study represents the first comprehensive examination of the distribution and abundance of killer whales (Orcinus orca) in the north-west Atlantic. Based on a collation of sightings data and a multi-year photographic catalogue of killer whales, 836 sighting events have been recorded between 1758 and 2012, with most occurring in the last ten years. Killer whales were most commonly observed during June–September in Newfoundland/Labrador, Canada. Most sightings were made close to shore, although many occurred beyond coastal shelf areas and in water depths in excess of 3000 m. Relatively fewer sightings were recorded on the Scotian Shelf, in the Gulf of St Lawrence or the north-eastern USA, despite appreciable aerial and vessel-based cetacean survey effort. In the north-west Atlantic, killer whales have been sighted both alone and in groups, with group sizes ranging from 2 to 30 whales (rarely more than 15, although an aggregation of 100 was reported 43 years ago). Groups usually comprised 2–6 individuals. Based on photographic records, there are at least 67 identified killer whales in the northwest Atlantic; this is an underestimate, since a large portion of our image collection was not of sufficient quality to be considered in the analysis, and many of the whales do not have easily discernible markings. The discovery curve of newly-identified whales has not plateaued, suggesting that there are more whales to identify. These data allow us to better understand the ecology of these killer whales, and provide a baseline against which population changes and distribution patterns can be assessed.
Paterson showed how to construct an étale groupoid from an inverse semigroup using ideas from functional analysis. This construction was later simplified by Lenz. We show that Lenz’s construction can itself be further simplified by using filters: the topological groupoid associated with an inverse semigroup is precisely a groupoid of filters. In addition, idempotent filters are closed inverse subsemigroups and so determine transitive representations by means of partial bijections. This connection between filters and representations by partial bijections is exploited to show how linear representations of inverse semigroups can be constructed from the groups occurring in the associated topological groupoid.
Parallax measurements for 21 hydrogen-deficient carbon stars have been made by the Hipparcos satellite. These stars include most of the brighter R Coronae Borealis (RCB) variables, other cool hydrogen-deficient carbon (HdC) stars, and several higher-Teff extreme helium (eHe) stars. Most of these stars have either negative or statistically insignificant parallaxes, indicating that they lie beyond the detection capability of Hipparcos. Although the distances to the galactic hydrogen-deficient carbon stars remain unknown, at least the Hipparcos observations do confirm that these objects must have high luminosity like the LMC RCB stars, for which Mbol = −4 to −5. Based upon Hipparcos proper motions, we derive UVW velocities for the RCB and HdC stars, assuming Mbol = −3 and −5. The UW -velocity dispersion of the RCB/HdC stars is similar to that already reported for the eHe stars, further supporting the idea that these groups of stars have predominantly bulge distributions. However, UW Cen may be a second example of a halo RCB star currently seen transitting the Galactic plane.
The objective of this study was to demonstrate the presence of leptospires in equine urine, as evidence for a potential role of horses in transmission of this organism. Thoroughbred horses (aged 2–5 years, n = 276) from Rio de Janeiro, Brazil, were studied. After a severe storm, the premises of the animals remained flooded for 72 h. Blood samples for serology were collected on days 20 and 35 (day of storm = day 0). On day 20, 132 (47·8%) horses were seroreactive (titre ⩾200) and, of these, 23 (31·0%) had increased antibody titres on day 35. Furthermore, 34 urine samples (for PCR and culture) were collected from seroreactive horses on day 35. Copenhageni was the most frequent serovar (88·8% of reactive titres). Although none of the urine samples were culture positive, 12 (35·2%) were PCR positive. This is apparently the first report of evidence of leptospires in urban horses. Furthermore, we suggest that these animals can play a role in the transmission of leptospirosis in urban areas.
Early in the twenty-first century, a nexus of globalization, climate change, and geopolitics is shaping the future of the maritime Arctic. The implications of these forces have never been more compelling for Arctic marine transport. Exploration and development of the Arctic's vast natural resources, such as oil, gas, and hard minerals (e.g., nickel, copper, zinc), have been driven by high commodity prices and worldwide demand, and the result is that the Arctic is becoming much more integrated with the global economy. Importantly, most of these activities rely on marine transport systems. At the same time, the Arctic's sea ice cover is undergoing a historic transformation – thinning, extent reduction in all seasons, and reduction in the area of multiyear ice in the central Arctic Ocean. These changes allow for increases in marine access throughout the Arctic Ocean and for potential longer seasons of navigation and possibly transarctic voyages in the summer. Surface ships in recent years have also reached previously difficult coastal areas and remote regions of the central Arctic Ocean. In addition, the ongoing process for delimitation of the outer continental shelf in the Arctic Ocean under article 76 of the UN Convention on the Law of the Sea (UNCLOS) presents unique marine challenges for gathering data and adds to the already complex geopolitics influencing the future of the maritime Arctic. Taken together, these changes present very real challenges to the existing legal and regulatory structures governing marine safety and environmental protection, and to the general lack of adequate marine infrastructure in most of the Arctic. However, the evolving process of moving to an integrated system of rules and regulations for Arctic navigation will have to be sensitive to the basic principles of freedom of navigation and the overall security concerns of the Arctic states.
Pacific salmon (see Table 10–1 for more information about terms in bold) enjoy iconic status in northwestern North America. As key components of both freshwater (Schindler et al. 2003) and marine (Beamish 2005) ecosystems, salmon play an important biological role in community structure and function. But salmon are no less crucial to the fabric of human societies. They have provided important food resources to Native Americans for at least 10,000 years (Butler & O'Connor 2004) and figure prominently in cultural, social, and economic traditions. Over the last ~200 years following European settlement, Pacific salmon have supported substantial commercial and sport fisheries, as well as continuing tribal harvest. Renowned for their long migrations and strong homing instinct, salmon have long been symbolic of Northwestern beauty and culture for human inhabitants of the region.
However, Pacific salmon also face a wide range of challenges to their persistence, due largely to major anthropogenic changes to their ecosystems (National Research Council 1996; Lackey et al. 2006). Urbanization, dams, road construction, harvesting, logging, mining, ranching, hatcheries, agriculture, invasive species, and other forms of habitat modification have all taken their toll on salmon populations. As a consequence, approximately 30% of historic salmon populations in the contiguous United States have been extirpated (Gustafson et al. 2007), and half of those that remain are formally protected under the U.S. Endangered Species Act (ESA) (Table 10–2).