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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.
Background: We reviewed numerous variables for ischemic stroke patients admitted to a rehabilitation unit to determine those that were statistically associated with discharge destination. Methods: A retrospective chart review of patients with ischemic stroke discharged from the rehabilitation unit between January 1, 2005 and December 31, 2015. Variables were examined for their association with discharge destination (home versus long-term care (LTC)). Univariable relationships with discharge destination were assessed, and a multivariable logistic regression model was built. Results: Univariate predictors of discharge to LTC: advanced age, decreasing admission and discharge functional independence measure (FIM) scores, increasing change in FIM score from admission to discharge, dependency, residence outside of home before the stroke, absence of a caregiver, urinary and bowel incontinence, low Berg balance score at admission and discharge, low Montreal Cognitive Assessment scores, smoking, chronic heart failure, and an inability to transfer. Multivariable logistic regression: five factors remained significant predictors with LTC disposition: advanced age, bowel incontinence, residence outside of the home prior to stroke, right hemisphere site of the stroke, and absence of a caregiver. Conclusions: Several easily measured variables were significantly associated with discharge to LTC versus home following stroke rehabilitation.
With the frequency of glyphosate-resistant waterhemp increasing throughout the Midwest, the identification of resistant populations has become important for managing this species. However, high-throughput screening for glyphosate resistance in the greenhouse is tedious and inefficient. Research was conducted to document the occurrence of glyphosate-resistant waterhemp throughout the state of Illinois, and to determine whether a molecular assay for 5-enolypyruvyl-shikimate-3-phosphate synthase (EPSPS) gene amplification can be used as an alternative means to detect resistant populations. Populations throughout the state of Illinois were collected in 2010 and screened for glyphosate resistance using a whole-plant assay in a greenhouse, and survivors were examined for EPSPS gene amplification. Of 80 populations investigated, 22 were glyphosate resistant based on the greenhouse screen, and gene amplification was identified in 20 (91%) of the resistant populations. Although there are multiple mechanisms for glyphosate resistance in waterhemp, a molecular test for EPSPS gene amplification provides a rapid alternative for identification of glyphosate resistance in most populations.
Field studies were conducted at 35 sites throughout the north-central United States in 1998 and 1999 to determine the effect of postemergence glyphosate application timing on weed control and grain yield in glyphosate-resistant corn. Glyphosate was applied at various timings based on the height of the most dominant weed species. Weed control and corn grain yields were considerably more variable when glyphosate was applied only once. The most effective and consistent season-long annual grass and broadleaf weed control occurred when a single glyphosate application was delayed until weeds were 15 cm or taller. Two glyphosate applications provided more consistent weed control when weeds were 10 cm tall or less and higher corn grain yields when weeds were 5 cm tall or less, compared with a single application. Weed control averaged at least 94 and 97% across all sites in 1998 and 1999, respectively, with two glyphosate applications but was occasionally less than 70% because of late emergence of annual grass and Amaranthus spp. or reduced control of Ipomoea spp. With a single application of glyphosate, corn grain yield was most often reduced when the application was delayed until weeds were 23 cm or taller. Averaged across all sites in 1998 and 1999, corn grain yields from a single glyphosate application at the 5-, 10-, 15-, 23-, and 30-cm timings were 93, 94, 93, 91, and 79% of the weed-free control, respectively. There was a significant effect of herbicide treatment on corn grain yield in 23 of the 35 sites when weed reinfestation was prevented with a second glyphosate application. When weed reinfestation was prevented, corn grain yield at the 5-, 10-, and 15-cm application timings was 101, 97, and 93% of the weed-free control, respectively, averaged across all sites. Results of this study suggested that the optimum timing for initial glyphosate application to avoid corn grain yield loss was when weeds were less than 10 cm in height, no more than 23 d after corn planting, and when corn growth was not more advanced than the V4 stage.
Field experiments were conducted across the north-central United States to determine the benefits of various weed control strategies in corn. Weed control, corn yield, and economic return increased when a preemergence (PRE) broad-spectrum herbicide was followed by (fb) postemergence (POST) herbicides. Weed control decisions based on field scouting after a PRE broad-spectrum herbicide application increased weed control and economic return. Application of a PRE grass herbicide fb a POST herbicide based on field scouting resulted in less control of velvetleaf and morningglory species, corn yield, and economic return compared with a PRE broad-spectrum herbicide application fb scouting. Cultivation after a PRE broad-spectrum herbicide application increased weed control and corn yield compared with the herbicide applied alone, but economic return was not increased. An early-postemergence herbicide application fb cultivation resulted in the highest level of broadleaf weed control, the highest corn yield, and the greatest economic return compared with all other strategies. Weed control based on scouting proved to be useful in reducing the effect of weed escapes on corn yield and increased economic return compared with PRE herbicide application alone. However, economic return was not greater than the PRE fb planned POST or total POST strategies.
Fifty-four per cent of 41 chronically institutionalized adult patients with epilepsy had ataxia of gait (wide mean stride width). None of the following correlated with stride width: serum phenytoin, previous phenytoin toxicity, seizure frequency, or status epilepticus. Seventeen of the 41 patients had computed tomographic head scans. Patients with radiological evidence of cerebellar atrophy had a wider mean stride width, later age of onset of seizures, greater peak serum concentrations of phenytoin than did those without cerebellar atrophy. Ataxia of gait was inconsistently associated with cerebellar atrophy. Elevated serum/plasma concentrations of phenytoin may be a risk factor for cerebellar atrophy, but seizure frequency or status epilepticus are not independently related to this complication.
To study stimulation-related facial electromyographic (FEMG) activity in intensive care unit (ICU) patients, develop an algorithm for quantifying the FEMG activity, and to optimize the algorithm for monitoring the sedation state of ICU patients.
First, the characteristics of FEMG response patterns related to vocal stimulation of 17 ICU patients were studied. Second, we collected continuous FEMG data from 30 ICU patients. Based on these data, we developed the Responsiveness Index (RI) algorithm that quantifies FEMG responses. Third, we compared the RI values with clinical sedation level assessments and adjusted algorithm parameters for best performance.
In patients who produced a clinically observed response to the vocal stimulus, the poststimulus FEMG power was 0.33 µV higher than the prestimulus power. In nonresponding patients, there was no difference. The sensitivity and specificity of the developed RI for detecting deep sedation in the subgroup with low probability of encephalopathy were 0.90 and 0.79, respectively.
Consistent FEMG patterns were found related to standard stimulation of ICU patients. A simple and robust algorithm was developed and good correlation with clinical sedation scores achieved in the development data.
Eggs (24–28 h old) of Delia radicum (L.) were treated with the same doses of diflubenzuron, methoprene, juvenile hormone I, or precocene II. Diflubenzuron significantly reduced egg hatching compared with untreated and solvent-treated controls. Methoprene had a delayed effect, preventing eclosion of adults from pupae that subsequently developed from treated eggs. A commercial formulation of diflubenzuron, Dimilin®, significantly suppressed and delayed hatching of eggs treated when 3–7 h old but not of eggs treated when 24–48 h old. Diflubenzuron may be as effective as the commercial insecticide carbofuran in protecting rutabaga slices from damage, as all larvae that did hatch died shortly afterwards.
Psychiatric phenotypes are currently defined according to sets of
descriptive criteria. Although many of these phenotypes are heritable, it
would be useful to know whether any of the various diagnostic categories
in current use identify cases that are particularly helpful for
To use genome-wide genetic association data to explore the relative
genetic utility of seven different descriptive operational diagnostic
categories relevant to bipolar illness within a large UK case–control
bipolar disorder sample.
We analysed our previously published Wellcome Trust Case Control
Consortium (WTCCC) bipolar disorder genome-wide association data-set,
comprising 1868 individuals with bipolar disorder and 2938 controls
genotyped for 276 122 single nucleotide polymorphisms (SNPs) that met
stringent criteria for genotype quality. For each SNP we performed a test
of association (bipolar disorder group v. control group) and used the
number of associated independent SNPs statistically significant at
P<0.00001 as a metric for the overall genetic
signal in the sample. We next compared this metric with that obtained
using each of seven diagnostic subsets of the group with bipolar
disorder: Research Diagnostic Criteria (RDC): bipolar I disorder; manic
disorder; bipolar II disorder; schizoaffective disorder, bipolar type;
DSM–IV: bipolar I disorder; bipolar II disorder; schizoaffective
disorder, bipolar type.
The RDC schizoaffective disorder, bipolar type (v.
controls) stood out from the other diagnostic subsets as having a
significant excess of independent association signals
(P<0.003) compared with that expected in samples of
the same size selected randomly from the total bipolar disorder group
data-set. The strongest association in this subset of participants with
bipolar disorder was at rs4818065 (P = 2.42 ×
10–7). Biological systems implicated included gamma
amniobutyric acid (GABA)A receptors. Genes having at least one
associated polymorphism at P<10–4 included
B3GALTS, A2BP1, GABRB1, AUTS2, BSN, PTPRG, GIRK2 and
Our findings show that individuals with broadly defined bipolar
schizoaffective features have either a particularly strong genetic
contribution or that, as a group, are genetically more homogeneous than
the other phenotypes tested. The results point to the importance of using
diagnostic approaches that recognise this group of individuals. Our
approach can be applied to similar data-sets for other psychiatric and
Obesity is considered a risk factor for laminitis, insulin resistance and other medical problems in horses. The objective of this study was to test the hypothesis that a feeding and exercise programme would induce weight loss and affect indices of health in overweight horses. Twenty-three overweight (BCS 6.5–9.0) QH and TB horses were assigned to three groups: calorie restriction (DIET), calorie restriction plus exercise (DIETX) and a control group at weight maintenance (CON). Measurements included body weight, body condition score, rump fat thickness, glucose, insulin, leptin, non-esterified fatty acids (NEFA) and triglycerides. Frequently sampled intravenous glucose tolerance tests measured insulin sensitivity (SI), glucose effectiveness and acute insulin response to glucose (AIRg). Disposition index (DI) was calculated. DIETX underwent a fitness test (graded exercise test) on a treadmill before and after the experimental period, and performed a standardized submaximal exercise regimen in an Equi-ciser™. Horses in the DIETX group lost more weight (P < 0.01) than DIET or CON. DIET also lost more weight versus CON (P < 0.05). All groups had decreases (P < 0.05) in BCS, with DIETX and DIET exhibiting the largest decreases. DIET and DIETX decreased (P < 0.05) in rump fat thickness. Cortisol decreased (P < 0.05) in DIET, and NEFA decreased in DIETX pre- versus post-weight loss. There were decreases (P < 0.05) in leptin and AIRg in DIET and DIETX pre- versus post-weight loss. DI was decreased (P < 0.05) in DIET and CON. SI was decreased (P < 0.05) only in CON. Calorie restriction and calorie restriction plus exercise programmes were successful in achieving weight loss in overweight horses. Indices of obesity, physiological stress and fat metabolism can be significantly altered with calorie control and exercise.
Damage to the occipital cortex in children can result in many complex disorders of cognitive visual function. A series of clinical questions, developed from the specific problems of a cohort of children with cortical visual impairment, was asked of the parents of 200 children with no history of cerebral pathology, aged 5 to 12 years. One hundred and ninety-two parents gave reliable consistent responses. The results show a progressive improvement in performance with age, culminating in few 11- and 12-year olds having frequent problems, apart from 8% having frequent difficulty with orientation in new surroundings and 2% having problems with simultaneous perception tasks. The parents of 52 children (aged 5 to 17 years) with shunted hydrocephalus were then asked the same set of questions. Evidence of cognitive visual problems was identified in 27 of these children of whom 16 manifested multiple difficulties. The disabilities identified by our study comprised problems with: shape recognition, simultaneous perception, perception of movement, colour perception, orientation, object recognition, and face recognition. The range, nature, and combinations of these disorders are presented in this paper.
After three or more decades of mainly positivistic readings of the economics of Adam Smith, there was a decided movement following the bicentennial of the publication of the Wealth of Nations to broaden the agenda of Smithian studies. The publication in 1978 of the Report of 1762–63 of Smith's lectures in jurisprudence added impetus to this movement. In particular, historians of ideas began to pay increased attention to Smith's concern with justice in economic life. That attention has evoked renewed interest in certain of Smith's intellectual antecedents who may have played a part in shaping his ideas, but whose influence has remained a matter of relative neglect in modern scholarship.
With the European settlement of Australia yet to reach its bi-centennial, historical archaeology in the country is young, both in what it studies and how long it has been established. A special interest, explored here, is the range of patterns of European settlement which results from the varied national traditions of the settlers.
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