This article is a clinical guide which discusses the “state-of-the-art” usage of the classic monoamine oxidase inhibitor (MAOI) antidepressants (phenelzine, tranylcypromine, and isocarboxazid) in modern psychiatric practice. The guide is for all clinicians, including those who may not be experienced MAOI prescribers. It discusses indications, drug-drug interactions, side-effect management, and the safety of various augmentation strategies. There is a clear and broad consensus (more than 70 international expert endorsers), based on 6 decades of experience, for the recommendations herein exposited. They are based on empirical evidence and expert opinion—this guide is presented as a new specialist-consensus standard. The guide provides practical clinical advice, and is the basis for the rational use of these drugs, particularly because it improves and updates knowledge, and corrects the various misconceptions that have hitherto been prominent in the literature, partly due to insufficient knowledge of pharmacology. The guide suggests that MAOIs should always be considered in cases of treatment-resistant depression (including those melancholic in nature), and prior to electroconvulsive therapy—while taking into account of patient preference. In selected cases, they may be considered earlier in the treatment algorithm than has previously been customary, and should not be regarded as drugs of last resort; they may prove decisively effective when many other treatments have failed. The guide clarifies key points on the concomitant use of incorrectly proscribed drugs such as methylphenidate and some tricyclic antidepressants. It also illustrates the straightforward “bridging” methods that may be used to transition simply and safely from other antidepressants to MAOIs.

Various paleoclimatic records have been used to reconstruct the hydrologic history of the Altiplano, relating this history to past variability of the South American summer monsoon. Prior studies of the southern Altiplano, the location of the world’s largest salt flat, the Salar de Uyuni, and its neighbor, the Salar de Coipasa, generally agree in their reconstructions of the climate history of the past ∼24 ka. Some studies, however, have highly divergent climatic records and interpretations of earlier periods. In this study, lake-level variation was reconstructed from a ∼14-m-long sediment core from the Salar de Coipasa. These sediments span the last ∼40 ka. Lacustrine sediment accumulation was apparently continuous in the basin from ∼40 to 6 ka, with dry or very shallow conditions afterward. The fossil diatom stratigraphy and geochemical data (δ13C, δ15N, %Ca, C/N) indicate fluctuations in lake level from shallow to moderately deep, with the deepest conditions correlative with the Heinrich-1 and Younger Dryas events. The stratigraphy shows a continuous lake of variable depth and salinity during the last glacial maximum and latter stages of Marine Oxygen Isotope Stage 3 and is consistent with environmental inferences and the original chronology of a drill core from Salar de Uyuni.

People with dementia living in residential care often face the dual disadvantage of increasing difficulty with communication and reduced opportunities for conversation. Social interaction is central to wellbeing of residents with dementia, so it is important that care staff have the skills to engage in conversation with them. We studied conversations in 20 care staff–resident dyads, to examine conversation structure and content, patterns of engagement within conversations, including the topics around which engagement occurred, and communication behaviours by care staff that appeared to facilitate (or impede) participation by residents. The transcripts were analysed using Discursis, a computational information visualisation tool that allows interactive visual inspection, in context, of the contributions by each speaker, the turn-taking dynamics, and the content recurring within and between speakers. We present case examples (a) where care staff did most of the talking, initiated topics and were responsible for most recurrence of content; (b) where talk was more evenly shared between partners, with some topics initiated and/or elaborated by participants with dementia; and (c) where participants with dementia talked most, with care staff supporting the conversation. We identified accommodative strategies used by care staff, such as reflecting back the other person's responses to sustain engagement. We also noted care staff behaviours that impeded communication, such as not listening attentively and not allowing sufficient time for responses. The results from this study highlight aspects of social communication within the aged care context and suggest ways in which rewarding interactions between staff and residents with dementia might be encouraged.

Emergency Medical Services (EMS) providers face many ethical issues while providing prehospital care to children and adults. Although provider judgment plays a large role in the resolution of conflicts at the scene, it is important to establish protocols and policies, when possible, to address these high-risk and complex situations. This article describes some of the common situations with ethical underpinnings encountered by EMS personnel and managers including denying or delaying transport of patients with non-emergency conditions, use of lights and sirens for patient transport, determination of medical futility in the field, termination of resuscitation, restriction of EMS provider duty hours to prevent fatigue, substance abuse by EMS providers, disaster triage and difficulty in switching from individual care to mass-casualty care, and the challenges of child maltreatment recognition and reporting. A series of ethical questions are proposed, followed by a review of the literature and, when possible, recommendations for management.

BeckerTK, Gausche-HillM, AsweganAL, BakerEF, BookmanKJ, BradleyRN, De LorenzoRA, SchoenwetterDJ for the American College of Emergency Physicians’ EMS Committee. Ethical Challenges in Emergency Medical Services: Controversies and Recommendations. Prehosp Disaster Med. 2013;28(5):1-10.

We have obtained high-resolution F110W (~ J) and F160W (~ H) band observations of ten submillimeter galaxies (SMGs) with the Hubble Space Telescope's NICMOS camera, in order to resolve their rest-frame optical morphologies, determine the existence of multiple-component, merger-like configurations, and estimate their stellar masses. The selected targets have redshifts in the range 2.2≤ z ≤ 2.81 confirmed with millimeter or mid-IR spectroscopy, guaranteeing that the two bands sample the galaxies' rest-frame optical light with the Balmer break falling between them.

Previous studies of the molecular gas excitation in high-redshift galaxies have focused on galaxy-wide averages of CO line ratios. However, it is possible that these averages hide spatial variation on sub-galactic scales, disguising the true distribution and conditions of the molecular gas within star-forming galaxies. Even in the pre-ALMA era we have begun to see evidence for spatial variation of CO excitation in both rest-UV selected and submillimeter-selected galaxies at z > 2, aided both by the increased frequency coverage of the Jansky Very Large Array (allowing high-resolution observations of the CO(1–0) line, the best tracer for the coldest molecular gas) and by the benefits of gravitational lensing for spatially extended sources. We show new results for multiple high-redshift systems that reveal spatial and/or spectral variations in CO excitation, including an early-stage merger that has different conditions in its two components, thereby illustrating the need for high spatial and spectral resolution mapping in order to accurately characterize the molecular ISM in high-z galaxies.