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This systematic review aims to identify published randomized controlled trials (RCTs) that evaluated the use of anticonvulsants for the prevention and/or treatment of delirium among older adults.
A comprehensive search of databases: MEDLINE ALL (Ovid), Embase (Ovid), PsycINFO (Ovid), Web of Science Core Collection and Cochrane Central Register of Controlled was conducted.
The search identified four RCTs that evaluated the use of anticonvulsants among older adults with delirium. One RCT evaluated the perioperative use of gabapentin among individuals undergoing spinal surgery and the development of postoperative delirium. One RCT evaluated the relationship between the use of perioperative gabapentin and the development of postoperative delirium among individuals undergoing spinal surgery and hip and knee arthroplasty. Two post-hoc analyses of RCTs evaluated the use of gabapentin and pregabalin among individuals undergoing total knee arthroplasty (TKA) and total hip arthroplasty (THA). The perioperative use of gabapentin reduced the incidence of postoperative delirium among older adults undergoing spinal surgery. The perioperative use of gabapentin did not reduce the rates, severity or duration of postoperative delirium among older adults who were undergoing spine and hip and knee arthroplasty. The perioperative use of gabapentin did not reduce the incidence or duration of postoperative delirium among older adults undergoing elective TKA. The perioperative use of pregabalin did not reduce the incidence of postoperative delirium among older adults undergoing elective THA. Gabapentin and pregabalin were well tolerated among the individuals enrolled in these trials. There were no RCTs identified that evaluated the use of other anticonvulsants for the prevention and/or treatment of delirium among older adults.
Based on current evidence, the routine use of anticonvulsants for the prevention and/or treatment of delirium among older adults cannot be recommended.
Although it is now axiomatic that global biodiversity is threatened and that species are going extinct at an accelerating rate (Ceballos et al. 2015), remarkably little is known about the distribution dynamics of many threatened taxa (Brook et al. 2006; Fahrig 2003; Grenouillet & Comte 2014; Guisan et al. 2013). This conservation crisis has spurred the development of new fields of applied research, such as conservation biogeography. Conservation biogeography applies novel conceptual approaches to classic biogeographic models to determine how environmental and anthropogenic changes influence biodiversity (Whittaker et al. 2005). At its core, conservation biogeography focuses on the theory and statistical analyses of spatial dynamics of taxa within a changing environment (Franklin 2010). These dynamic processes include critical questions on how plants and animals respond to changes in habitat availability and use, due to the effects of global warming, forest loss and fragmentation, and anthropogenic pressures (Malcolm et al. 2006; Riitters et al. 2000; Woodroffe & Ginsberg 1998).
Low-frequency, high-acuity emergency events can and do occur within health care settings. Having a strong sense of daily situational and operational awareness is the first step in responding to any emergency event. To maintain high reliability, hospital leaders and staff must understand the full impact to the organization as the emergency event evolves. The Medical University of South Carolina health system has implemented the common practice of a daily operations safety briefing, called the Daily Check-In, to communicate any issues that could impact the operational ability of the hospitals within the enterprise, or any other associated resources during a disaster or emergency. Throughout various emergency events, including extreme weather, the Daily Check-In has evolved as a standard process for use during emergencies that is open to all staff and uses highly reliable systems.
A feminist analysis of Bavli Yoma draws our attention to one of the ways the rabbis reflect on their relationship with the priesthood, which is through the lens of the physical body. The Temple procedure detailed in the first seven chapters of the tractate, focused as it is on the priest's body, is entirely different from the bodily self-denial discussed in the eighth chapter, where eating, washing, anointing, sandal wearing, and sexual relations are prohibited. Continuities between the observance of Yom Kippur in the Temple and the prohibitions that define the rabbinic Yom Kippur are surprisingly lacking, given the extent to which the rabbis controlled both the Temple accounts in Yoma and the discussions about Yom Kippur in the eighth chapter of this tractate. Focusing on references to feet, a part of both the Temple rite and the rabbinic observance of Yom Kippur, this article will present one perspective on how the Bavli offers insight into the rabbinic departure from the Temple Yom Kippur.
The following group of essays emerged out of a seminar held at the Association for Jewish Studies conference in 2015. As section heads of Jewish History and Culture in Antiquity and Rabbinic Literature and Culture, tasked to think about how to address gaps in our fields, we recognized that despite a large amount of scholarship available on the Jerusalem Temple and its priesthood, there was a dearth of cross-disciplinary scholarly exchange, especially between ancient Jewish historians and those of us who engage in literary analysis of rabbinic sources. As a result, our divisions joined together to create “The Jerusalem Temple in History, Memory, and Ritual,” taking advantage of the “seminar” format at the conference. Twelve scholars, each working with different source material and employing different methodological approaches, participated.
The diet of most adults is low in fish and, therefore, provides limited quantities of the long-chain, omega-3 fatty acids (LCn-3FAs), eicosapentaenoic and docosahexaenoic acids (EPA, DHA). Since these compounds serve important roles in the brain, we sought to determine if healthy adults with low-LCn-3FA consumption would exhibit improvements in neuropsychological performance and parallel changes in brain morphology following repletion through fish oil supplementation.
In a randomized, controlled trial, 271 mid-life adults (30–54 years of age, 118 men, 153 women) consuming ⩽300 mg/day of LCn-3FAs received 18 weeks of supplementation with fish oil capsules (1400 mg/day of EPA and DHA) or matching placebo. All participants completed a neuropsychological test battery examining four cognitive domains: psychomotor speed, executive function, learning/episodic memory, and fluid intelligence. A subset of 122 underwent neuroimaging before and after supplementation to measure whole-brain and subcortical tissue volumes.
Capsule adherence was over 95%, participant blinding was verified, and red blood cell EPA and DHA levels increased as expected. Supplementation did not affect performance in any of the four cognitive domains. Exploratory analyses revealed that, compared to placebo, fish oil supplementation improved executive function in participants with low-baseline DHA levels. No changes were observed in any indicator of brain morphology.
In healthy mid-life adults reporting low-dietary intake, supplementation with LCn-3FAs in moderate dose for moderate duration did not affect neuropsychological performance or brain morphology. Whether salutary effects occur in individuals with particularly low-DHA exposure requires further study.
Background: SMA is a neurodegenerative disease caused by biallelic deletion/mutation of the survival motor neuron (SMN1) gene. In the phase 1 trial (NCT02122952), SMN GRT onasemnogene abeparvovec (AVXS-101) improved outcomes of 15 symptomatic SMA1 patients (3 at a lower dose [cohort 1] and 12 at the proposed therapeutic dose [cohort 2]). This report describes long-term follow-up study design and data from the phase 1 study. Methods: Patients in the phase 1 study could rollover into a long-term follow-up study (NCT03421977). The primary objective is to collect long-term safety data (serious adverse events, hospitalizations, and adverse events of special interest). Annual follow-up will occur for 15 years. Additionally, patient record transfers from local clinician(s) will be requested. Safety assessments include medical history and record review, physical examination, clinical laboratory evaluation, and pulmonary assessments. Efficacy assessments include physical examination to assess developmental milestones. Results: As of September 27, 2018, the oldest patients are 59.2 (cohort 1) and 52.1 (cohort 2) months old and free of permanent ventilation. Preliminary data, including survival and developmental milestones, will be presented. Conclusions: Patients treated with a one-time dose of AVXS-101 continue to gain strength, develop, and achieve new milestones, demonstrating a long-term, durable response.
Spotted hyenas (Crocuta crocuta) are mammalian carnivores that occur throughout sub-Saharan Africa in a diverse array of habitats. Spotted hyenas primarily obtain food by hunting ungulates but also scavenge from carcasses using powerful jaws. They have extended juvenile periods and live in complex societies characterized by fission-fusion dynamics. Experimental assessments have been done using a variety of olfactory, visual, physical, and auditory stimuli. Studies suggest that spotted hyenas exhibit high levels of social intelligence, including recognition of third-party relationships. Innovation has been assessed in hyenas using a novel extractive foraging task, and numerosity using vocalization playback experiments. Major challenges during experimentation incude controlling olfactory, visual and auditory cues, building robust apparatuses and controlling motivation and neophobia. In the wild, cognitive assessment of individuals is influenced by complex group interactions as well as by specific testing conditions. However, testing in both captive and wild environments offers exciting opportunities to understand the evolution, mechanisms, and adaptive functions of cognition in this species.
Habitat fragmentation creates habitat edges, and ecological edge effects can cause major changes in the ecology and distribution of many taxa. However, these ecological changes may in turn influence animal movements and lead to molecular edge effects and edge-related genetic structure, matters that are largely unexplored. This study aims to infer molecular edge effects and to test three possible underlying mechanisms in the Endangered golden-brown mouse lemur Microcebus ravelobensis, a nocturnal species in the dry deciduous forest of the Ankarafantsika National Park in north-western Madagascar. Mouse lemurs were sampled in one edge and two interior habitats in close proximity to each other (500–1,400 m) in a continuous forest. A total of 41 mouse lemur samples were genotyped with seven nuclear microsatellites, and a fragment of the mitochondrial control region was sequenced for all samples. The overall genetic diversity (allelic richness, heterozygosity, haplotype richness, nucleotide diversity) was lower in the edge habitat compared to the two interior sites and all subpopulations showed signals of relatively low genetic exchange and significant genetic differentiation between them despite the short geographical distances, supporting the local preference model. These findings can be interpreted as preliminary signals of a molecular edge effect and suggest the potential for local adaptation. They are highly relevant for the conservation of fragmented populations, because a further subdivision of already small populations may increase their vulnerability to stochastic demographic changes and collapse.
Although roads are often assumed to be barriers to the dispersal of arboreal species, there has been little empirical testing of this assumption. If arboreal animals are unable to cross roads, population subdivision may occur, or resources may become inaccessible. We tested the hypothesis that Route Nationale 4 (RN4), a paved highway, was a barrier to movement and dispersal of the Endangered golden-brown mouse lemur Microcebus ravelobensis in Ankarafantsika National Park, in north-west Madagascar. During June–August 2015 we conducted a capture–mark–recapture study at three sites: two adjacent to RN4 and one within intact forest without a potential barrier. During 2,294 trap nights we captured 120 golden-brown mouse lemurs 1,032 times. In roadside habitats we captured significantly more males than females, whereas the opposite was the case in interior forest habitat. We detected eighteen crossings of highway transects by nine individuals; however, all potential dispersal events involved males. In roadside habitat, movement was significantly inhibited in both males and females. We present some of the first data on the effects of roads on movement patterns in arboreal Malagasy mammals, showing species- and sex-biased effects of roads as dispersal barriers. Our findings indicate that roads may not be complete barriers to dispersal in lemurs. We recommend that conservation managers and scientists examine explicitly the effects of roads and natural arboreal bridges in Madagascar in future studies.
Watching the evening news on any given night should assure you that applied social psychologists have much to do. Societal problems abound. Epidemics such as obesity and game addiction, increasing levels of consumer debt, bullying and drugs in schools, vehicle collisions in traffic, and environmental degradation pose significant economic problems, as well as devastating costs in terms of human suffering and loss of life. Because human behaviour contributes to each of these societal problems, human behaviour can also be a critical part of the solution. As experts in the development and evaluation of behaviour-focused interventions, behavioural scientists and social psychologists are uniquely equipped to tackle these problems and make a difference in improving the quality of life in our societies.
This chapter provides an overview of techniques used for large-scale behaviour-based intervention. When it comes to applying psychological principles to change behaviour on a large scale, behavioural scientists have been at the forefront. We therefore begin by describing some of the fundamental assumptions of a behavioural-science approach to intervention design and evaluation. Next, we outline six intervention techniques, which have been successfully used by behavioural scientists to improve behaviour in various domains. Finally, we outline six social-psychological principles that can enhance the beneficial impact of these interventions. When you finish reading this chapter, you will understand the principles and procedures of a variety of interventions which can be used to address problem-relevant behaviour.
A behavioural-science approach to intervention
The applied behavioural-science approach to intervention is based on the scientific philosophy of B. F. Skinner. Instead of targeting internal events such as thoughts and attitudes – as is often the focus of contemporary awareness campaigns – Skinner believed psychologists should focus on behaviour because, unlike thoughts and feelings, behaviours can be reliably observed and measured. Thus, the behavioural-science approach to intervention seeks to measure and influence observable behaviour.
A second principle of Skinner's approach is ‘selection by consequences’. In other words, we do what we do because of the consequences that follow our behaviour. More specifically, we do what we do in order to gain positive consequences or to avoid or escape negative consequences.
This chapter provides clinicians, researchers, programme evaluators and administrators with current information on the assessment of quality-of-life (QOL) outcomes for persons with severe mental illnesses. Measures are summarised according to purpose, content, psychometric properties, patient subgroups with whom used and key references. A series of QOL measures are summarised and reflect considerable variability on the parameters examined. Comprehensive, reliable, and valid measures of QOL are available, although further development of QOL assessment methods is needed. More importantly, we must strive for a better understanding of how to interpret and use QOL outcome information.
The broad impact that severe mental illnesses have on people's lives and the resulting complexity of the needs generated by such illnesses pose a particular challenge in the assessment of the outcomes of services for these persons (Lehman et al, 1982; Ruggeri & Tansella, 1995). Relevant outcome domains include psychiatric symptoms, functional status, access to resources and opportunities, subjective well-being, family burden and community safety. Because of this broad array of relevant outcomes and because of a prevailing concern that outcome assessments should include the patient's perspective (Lasalvia & Ruggeri, 2007), there has been increased attention paid over the past decade to the development of measures of patients’ QOL.
This chapter summarises the measures of QOL that have been developed specifically for persons with severe mental illnesses. We do not consider generic health-related QOL measures, such as the WHOQOL–100 (WHOQOL Group, 1998a) or its abbreviated version, the WHOQOL–BREF (WHOQOL Group, 1998b), the Medical Outcome Study (MOS) 36-Item Short-Form Health Survey (SF–36) (Ware & Sherbourne, 1992) or the EQ–5D (Kind, 1996). Although these measures have been widely used for assessing QOL in studies conducted on psychiatric populations, they have been designed to asses it in a wide spectrum of physical disorders and in a variety of situations and population groups (e.g. cancer patients, refugees, the elderly and those with certain diseases, such as HIV/AIDS). ‘Quality of life’ is a broad term and conceptually could cover all outcome measures, including measures of clinical symptoms and functional status (Katschnig, 2000). However, many of these measures are reviewed elsewhere in this volume or have been reviewed previously. Therefore, they are not included in this review. Also excluded here are measures of client satisfaction with services and ‘family burden’, which are considered in detail in Chapters 6 and 7, respectively.
Combining atmospheric Δ14CO2 data sets from different networks or laboratories requires secure knowledge on their compatibility. In the present study, we compare Δ14CO2 results from the Heidelberg low-level counting (LLC) laboratory to 12 international accelerator mass spectrometry (AMS) laboratories using distributed aliquots of five pure CO2 samples. The averaged result of the LLC laboratory has a measurement bias of –0.3±0.5‰ with respect to the consensus value of the AMS laboratories for the investigated atmospheric Δ14C range of 9.6 to 40.4‰. Thus, the LLC measurements on average are not significantly different from the AMS laboratories, and the most likely measurement bias is smaller than the World Meteorological Organization (WMO) interlaboratory compatibility goal for Δ14CO2 of 0.5‰. The number of intercomparison samples was, however, too small to determine whether the measurement biases of the individual AMS laboratories fulfilled the WMO goal.
Plants vary in the mechanisms by which they disperse their seeds. Plant dispersal mechanisms are either abiotic (wind, water and ballistic dispersal), or biotic (endozoochory and epizoochory) (Howe and Smallwood, 1982). Epizoochory refers to dispersal of seeds via adhesion to animal fur, while endozoochory refers to the consumption of fleshy fruits and seeds by frugivores, and their subsequent deposition, through either spitting or defecation (Couvreur et al., 2005). While the latter mechanism is relatively rare in temperate forests, up to 90% of tropical tree species depend on endozoochory, relying on animals as dispersal vectors (Howe and Smallwood, 1982). Different animal dispersers affect seed dispersal and seed viability via seed handling (Lambert, 1999), gut passage (Knogge et al., 2003; Valenta and Fedigan, 2009) and the spatial location of seed deposition (Valenta and Fedigan, 2010).
The effect of gut passage on seeds is a potentially crucial determinant of plant reproductive success. In some cases, studies have shown that gut passage neither helps nor hinders a seed's chance of germinating (Smith, 2004). However, the majority of research on the effect of gut passage suggests that it increases the potential for germination for numerous species (Knogge et al., 2003). For some plant species, passage through a specific animal dispersal vector is necessary for successful seed germination (Temple, 1977; Chapman et al., 1992).
Other processes influencing the success of seed dispersal are secondary dispersal and predation (Nathan and Mueller-Landau, 2000; Valenta and Fedigan, 2009). The deposition of a seed is not necessarily the final step in the plant–animal interaction, because the forest floor is home to invertebrates and vertebrates that variously prey on, or safely redeposit, dispersed seeds. One study of primate-dispersed seeds in Costa Rica found that approximately 80% (N = 793) of seeds were removed from animal feces a mere week after initial deposition (Chapman, 1989). A study of howler monkey (Alouatta palliata)-dispersed seeds in Mexico found that a majority of the dung beetle species in the area were overwhelmingly attracted to howler dung, steering clear of the feces of other, more folivorous, herbivores, resulting in the massive redeposition of defecated seeds (Estrada and Coates-Estrada, 1991).