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Chronic psychotic disorders (CPDs) occur worldwide and cause significant burden. Poor medication adherence is pervasive, but has not been well studied in sub-Saharan Africa.
This cross-sectional survey of 100 poorly adherent Tanzanian patients with CPD characterised clinical features associated with poor adherence.
Descriptive statistics characterised demographic and clinical variables, including barriers to adherence, adherence behaviours and attitudes, and psychiatric symptoms. Measures included the Tablets Routine Questionnaire, Drug Attitudes Inventory, the Brief Psychiatric Rating Scale, the Clinical Global Impressions scale, the Alcohol Use Disorders Identification Test and Alcohol, Smoking and Substance Involvement Screening Test. The relationship between adherence and other clinical variables was evaluated.
Mean age was 35.7 years (s.d. 8.8), 61% were male and 80% had schizophrenia, with a mean age at onset of 22.4 (s.d. 7.6) years. Mean proportion of missed CPD medication was 64%. One in ten had alcohol dependence. Most individuals had multiple adherence barriers. Most clinical variables were not significantly associated with the Tablets Routine Questionnaire; however, in-patients with CPD were more likely to have worse adherence (P ≤ 0.01), as were individuals with worse medication attitudes (Drug Attitudes Inventory, P < 0.01), higher CPD symptom severity levels (Brief Psychiatric Rating Scale, P < 0.001) and higher-risk use of alcohol (Alcohol Use Disorders Identification Test, P < 0.001).
Poorly adherent patients had multiple barriers to adherence, including poor attitudes toward medication and treatment, high illness acuity and substance use comorbidity. Treatments need to address adherence barriers, and consider family supports and challenges from an intergenerational perspective.
Parasitism can affect every aspect of wildlife ecology, from predator avoidance and competition for food to migrations and reproduction. In the wild, these ecological effects can have implications for host fitness and parasite dynamics. In contrast, domestic environments are typically characterised by high host densities, low host diversity, and veterinary interventions, and are not subject to processes like predation, competition, and migration. When wild and domesticated hosts interact via shared parasite populations, understanding and predicting the outcomes of parasite ecology and evolution for wildlife conservation and sustainable farming can be a challenge. We describe the ecology and evolution of ectoparasitic sea lice that are shared by farmed and wild salmon and the insights that experiments, fieldwork, and mathematical modelling have generated for theory and applied problems of host–parasite interactions over the course of a long-term study in Pacific Canada. The salmon–sea lice host–parasite system provides a rich case study to examine the ecological context of host–parasite interactions and to shed light on the principal challenges of parasite management for wildlife health and conservation.
Introduction: Optimizing naloxone dosing in the context of increasing fentanyl and ultra-potent opioid (UPO) prevalence is an important consideration for emergency health care providers. The goal of this systematic review was to evaluate the association between initial and cumulative naloxone doses on effective reversal and adverse events in undifferentiated and fentanyl/UPO overdoses. Methods: We searched Embase, MEDLINE, Cochrane Central Register of Controlled Trials, DARE, CINAHL, Science Citation Index, reference lists, toxicology websites, and conference proceedings from July to October 2018 and back to 1972. Our search included pertinent indexing terms for UPOs. We included interventional and observational studies reporting on naloxone administration for opioid toxicity reversal in people ≥12 years old. Additionally, we accessed non-traditional evidence sources (case reports and series) given this rapidly changing field. We conducted inclusion screens, data extraction and quality assessments in duplicate. We summarized study characteristics and where reported, analyzed number of patients with clinical response. Response was defined as not receiving further naloxone doses and remaining alive. Results: We included 174 studies (108 case reports and series, 55 observational, 9 interventional) with 26,660 subjects (median age 35.1; 74.2% male). We observed lower response among patients exposed to fentanyl/UPO versus heroin for initial naloxone doses ≤0.4mg (56.8% versus 80.2%) and > 0.4mg (27.0% versus 82.1%). Mean cumulative doses were higher for fentanyl/UPO (2.10 mg, SD 1.80 mg) versus heroin (1.48 mg, SD 1.68 mg) overdoses. In North American studies the median cumulative dose used was higher for fentanyl/UPO versus heroin overdoses. A dose-response curve for fentanyl/UPO studies showed marked variability in doses among responders, indicating heterogeneity. Adverse events reporting was inconsistent; 10% of subjects experienced withdrawal based on studies in which they were reported. Conclusion: This is the first systematic review to summarize proportion of patients with clinical response by naloxone dose provided. While variable reporting, study quality, heterogeneity, and our outcome definitions limit the conclusions we can draw, it appears that higher initial doses and in some cases, higher cumulative naloxone doses were used and may be necessary to reverse toxicity due to fentanyl/UPO compared to other opioids. High-quality prospective studies assessing effectiveness and safety are needed.
Introduction: Opioid overdoses (OODs) have become a public health emergency, yet little is known about their long-term outcomes following an OD. We determined the one-year all-cause mortality and associated risk factors in a cohort of patients treated in an urban emergency department (ED) for an OOD. Methods: We reviewed records of all patients who visited St. Paul's Hospital ED from January 2013 to August 2017 and had a discharge diagnosis of OOD or had received naloxone in the ED as per pharmacy records. Patients with a suspected OOD were identified on structured chart review. A patient's first visit for an OOD during the study period was used as the index visit, with subsequent visits excluded. The primary outcome was mortality during the year after the index visit. Mortality was assessed by linking patient electronic medical records with Vital Statistics data. Deaths that occurred in the ED on the index visit were excluded. Patients admitted to hospital following ED treatment were included in this study. We described patient characteristics, calculated mortality rates, and used Cox regression to identify risk factors. Results: A total of 2239 patients visited the ED for an OOD during the study period, with a median patient age of 37 years (IQR 29, 49). Males comprised 73% of patients, while 28% had no fixed address, and 21% received take-home naloxone at the index visit. In total, 137 patients (6.1%) died within 1 year of the index visit. Eighty-one deaths (3.6%) occurred within 6 months, including 24 deaths (1.1%) that occurred within 1 month. The highest mortality rate occurred in 2017, with 8.0% of patients entering the cohort that year dying within 1 year. Gender did not significantly impact mortality risk. A Cox regression analysis controlled for gender, housing status, and whether take-home naloxone was provided at the index visit indicated that advancing age (adjusted hazards ratio [AHR] 1.03; 95%CI: 1.01-1.04 for each year increase in age) and the index visit calendar year (AHR 1.30; 95%CI: 1.10-1.54 for each yearly increase in the study period) were significant factors for mortality within 1 year. Conclusion: The mortality rate following an opioid OD treated in the ED is high, with over 6% of patients in our study dying within 1 year. The rising mortality risk with increasing calendar year may reflect the growing harms of fentanyl-related OODs. Patients visiting the ED for an OOD should be considered high risk and offered preventative treatment and referrals prior to discharge.
Grassland silage management is generally ad hoc resulting in soil compaction damage. Literature suggests grass yield reductions of 5 to 74% through compaction (UK mean 13%), while a 2015 study, reported here, comparing grass dry matter (DM) yield between controlled traffic farming (CTF) and normal management (N), found a 13.5% (0.80 t ha−1) increase for CTF. Commercially available grass forage equipment with widths of 3 to 12 m set up for CTF reduced trafficked areas from 80%–90% for N to 40%–13%. Economic analysis based on 13% increase in DM for 2 and 3 cut systems, gave an increased grass value between £38 ha−1 and £98 ha−1. CTF for multi-cut grass silage effectively increases yields by reducing compaction and sward damage.
Introduction: The following adverse outcomes have been described in patients treated in hospital for opioid overdose: pulmonary edema, cardiac dysrhythmias, neurologic injury secondary to hypoxia, prolonged opioid toxicity, recurrent opioid toxicity. In addition, patients who take an overdose of fentanyl may develop fentanyl induced chest rigidity, a life-threatening complication that appears to be uniquely related to fentanyl. The prevalence of adverse outcomes and the clinical course of patients that develop these complications have been described in patients who have taken an overdose of heroin. However, in British Columbia there has been a dramatic increase in the number of patients who overdose on fentanyl and other ultrapotent opioids. The proportion of illicit drug overdose deaths in British Columbia for which fentanyl was detected was only 5% in 2012 but, by 2016, this proportion had increased to 62%. It is very important to know the prevalence of adverse outcomes and the clinical course of patients that develop these adverse outcomes in patients with an overdose of fentanyl or another ultrapotent opioid. Methods: We are completing a retrospective cohort study to evaluate the prevalence of the following adverse outcomes for patients treated in hospital for an opioid overdose: i) pulmonary edema, ii) cardiac dysrhythmias, iii) fentanyl induced chest rigidity, iv) neurologic injury secondary to hypoxia, v) prolonged opioid toxicity, vi) recurrent opioid toxicity. Health records of patients treated for opioid overdose in the emergency departments of six greater Vancouver hospitals from Jan 1, 2014 to Dec 31, 2016 are being reviewed. Results: All Institutional approvals have been obtained. The dataset of 3600 ED visits for opioid overdose has been obtained and 160 health records have now been reviewed as of January 8, 2017. We will describe the type and prevalence (with 95% confidence intervals) of complications sustained by these patients. Conclusion: The results of this study will guide management of opioid overdose in a setting were ultrapotent opioids are commonly ingested. All health records will have been reviewed and the data analysis completed by May 2017.
Electropolymerization is a promising approach to produce thin films of active organic conjugated materials on a desired conducting substrate. In this work, an electropolymerization study has been carried out on two diketopyrrolopyrrole (DPP)-based monomers 2,5-bis(2-butyloctyl)-3,6-di(furan-2-yl)pyrrolo[3,4-c]pyrrole-1,4(2H,5H)-dione (BO-DPPF) and 2,5-bis(2-butyloctyl)-3,6-di(thiophen-2-yl)pyrrolo[3,4-c]pyrrole-1,4(2H,5H)-dione (BO-DPPT). These monomers consist of thiophene and furan heterocyclic moieties attached to a DPP core with a common solubilizing alkyl chain (butyl-octyl). The properties of these monomers were analyzed via differential scanning calorimetry, thermogravimetric analysis, UV–Vis spectrometry (UV) and photoluminescence. Cyclic voltammetry (CV) studies indicate the presence of irreversible oxidation and reduction reactions. The electropolymerization of BO-DPPF and BO-DPPT electron-deficient monomers to form polymer films on a glassy carbon electrode is achieved by applying a potential between −2 V and 2 V versus ferrocene for up to 50 cycles. The properties of the polymers were investigated using the cyclic voltammetry (CV) technique.
The Functional Visual Field (FVF) offers explanatory power. To us, it relates to existing literature on the flexibility of attentional focus in visual search and reading (Eriksen & St. James 1986; McConkie & Rayner 1975). The target article promotes reflection on existing findings. Here we consider the FVF as a mechanism in the Prevalence Effect (PE) in visual search.
As improvements in neuroscience have enabled a better understanding of disorders of consciousness as well as methods to treat them, a hurdle that has become all too prevalent is the denial of coverage for treatment and rehabilitation services. In 2011, a settlement emerged from a Vermont District Court case, Jimmo v. Sebelius, which was brought to stop the use of an “improvement standard” that required tangible progress over an identifiable period of time for Medicare coverage of services. While the use of this standard can have deleterious effects on those with many chronic conditions, it is especially burdensome for those in the minimally conscious state (MCS), where improvements are unpredictable and often not manifested through repeatable overt behaviors. Though the focus of this paper is on the challenges of brain injury and the minimally conscious state, which an estimated 100,000 to 200,000 individuals suffer from in the United States, the post-Jimmo arguments presented can and should have a broad impact as envisioned by the plaintiffs who brought the case on behalf of multiple advocacy groups representing patients with a range of chronic care conditions.
Determination of optimum sperm requirement in artificial breeding helps to improve the fertilization efficiency, sperm economy and minimize the sacrificing of males for milt. Quantification of sperm cells was done by spectrophotometer at 420 nm followed by haemocytometer counting. Best correlation (r2 = 0.97) was recorded. The minimum number of sperm required for optimal fertilization success in Heteropneustes fossilis was determined. An average fertilization success of 78–93% was recorded at 8 × 103 to 8 × 107 sperm per egg. The optimum contact duration of gametes was 5 minutes. The highest fertilization rate of 98.18% was recorded at 8 × 107 spermatozoa.egg−1.
The translocation of C and N in a maize-Striga hermonthica association was investigated at three rates of nitrogen application in a glasshouse experiment. The objectives were to measure the transfer of C and N from maize to S. hermonthica and to determine whether the amount of N in the growing medium affected the proportions of C and N transferred. Young plants of maize were labelled in a 13CO2 atmosphere and leaf tips were immersed in (15NH4)2SO4 solution. The Striga×N interaction was not significant for any of the responses measured. Total dry matter for infected maize was significantly smaller than for uninfected maize from 43 to 99 days after planting, but N application increased total dry matter at all sampling times. Infected maize plants partitioned 39–45% of their total dry matter to the roots compared with 28–31% for uninfected maize. Dry matter of S. hermonthica was not affected by the rate of N applied. S. hermonthica derived 100% of its carbon from maize before emergence, decreasing to 22–59% thereafter; the corresponding values for nitrogen were up to 59% pre-emergence and up to 100% after emergence. The relative proportions of nitrogen depleted from the host (up to 10%) were greater than those of carbon (maximum 1.2%) at all times of sampling after emergence of the parasite. The results show that the parasite was more dependent on the host for nitrogen than for carbon.
A quick glance at any major western media source will reveal the extent of Africa's problems today. Although they exist everywhere, poverty, crime, unemployment, and disease are rampant in parts of many of Africa's overcrowded and underdeveloped cities. The rapid urbanization that followed the Second World War highlighted severe problems that extended into the independence era. Many of these problems, however, find historical roots in an earlier time. The chapters in this section look at the problems of urban development today and reveal that the causes of contemporary urban impoverishment are many.
The Nigerian cities, Lagos and Ibadan, are vibrant and cosmopolitan, but they certainly have their share of what are often designated as urban problems. These cities demand that residents and visitors conscientiously emphasize personal security on a daily basis. Rising levels of poverty and crime in the independence era have been the focus of many social scientists. Laurent Fourchard, however, traces the roots of the problem to the period bounded by the economic crisis of 1929 and the end of the Second World War. The Great Depression, he argues, marked the development of new forms of urban poverty characterized by rapid growth in unemployment, prostitution, and delinquency. Growing poverty, as it does so frequently, led to a rise in criminal activities. Using administrative, police, and court records, Fourchard brings to light new information about the level of crime during the 1930s. The rapid growth in population from the start of the Second World War led to rising urban blight, but Fourchard uses the evidence to move the origins of these urban problems into the prewar period and attributes their legacy to colonial policies and practices.
Thomas Ngomba Ekali looks at the nature of urban problems today in Victoria, Cameroon, but traces their existence from the precolonial era to the present. Cameroon was unique because at various times it was under German, British, and French colonial rule, leaving a legacy of non-African ownership of urban economic social and economic systems that fostered urban underdevelopment. Economic stratification and residential segregation have long been features of Victoria. Africans were removed from particular areas and resettled elsewhere, away from European administrators and business people. Under early European rule, the Germans gave new names to streets and constructed new buildings that changed the architectural landscape, further alienating Africans from the urban space.
African Urban Spaces in Historical Perspective presents new and interdisciplinary approaches to the study of African urban history and culture. It presents original research and integrates historical methodologies with those of anthropology, geography, literature, art, and architecture. Moving between precolonial, colonial, and contemporary urban spaces, it covers the major regions, religions, and cultural influences of sub-Saharan Africa. The themes include Islam and Christianity, architecture, migration, globalization, social and physical decay, identity, race relations, politics, and development. This book elaborates on not only what makes the study of African urban spaces unique within urban historiography, it also offers an encompassing and up-to-date study of the subject and inserts Africa into the growing debate on urban history and culture throughout the world. The opportunities provided by the urban milieu are endless and each study opens new potential avenues ofresearch. This book explores some of those avenues and lays the groundwork on which new studies can build. Contributors: Maurice Nyamanga Amutabi, Catherine Coquery Vidrovitch, Mark Dike DeLancey, Thomas Ngomba Ekali, Omar A. Eno, Doug T. Feremenga, Laurent Fourchard, James Genova, Fatima Muller-Friedman, Godwin R. Murunga, Kefa M. Otiso, Michael Ralph, Jeremy Rich, Eric Ross, Corinne Sandwith, Wessel Visser.
Toyin Falola is the Jacob and Frances Sanger Mossiker Chair in the Humanities and University Distinguished Teaching Professor at the University of Texas at Austin; StevenJ. Salm is Assistant Professor of History, Xavier University of Louisiana.
Global influences have long had an effect on the development of African cities, but the degree of influence was enhanced by the increased frequency of contact with the outside world in the late nineteenth and twentieth centuries. African cities are home to Africans from throughout the continent as well as foreigners who came to the cities at different times and for various reasons. The hybrid nature of the urban environment was determined by immigration, religious factors, and the continuing conflict between “traditional” and “modern” space. Global influences, however, do not imply a lack of African agency. We must recognize the cultural and political synthesis that was undergoing continual transformation. The essays in this section reflect these themes and show that identities were also linked closely to these processes of change.
The early colonial era witnessed an increased flow of people and ideas between African areas and from abroad. Jeremy Rich looks at the connections that tied Libreville, Gabon, to the Atlantic and imperial worlds and attracted Africans from not only the interior but from the coastal regions of West Africa. Senegalese workers, sailors, soldiers, and religious clerics, for example, immigrated to Libreville during the early colonial era and helped shape the physical and social space of the city. Vietnamese laborers, brought into the region by French administrators to do menial labor, also contributed to the diverse character of the port community. Both groups faced difficulties in adapting to their new environment but were instrumental in determining the spatial development of the city. Rich calls for historians to pay greater heed to the level of global influences in the early colonial era and acknowledge their importance in the economic, social, and cultural development of coastal African cities.
For many years, the focus of urban scholarship in Africa was on the changes that rural-urban migrants underwent during their early adaptation to the urban environment. Too often, however, their histories stopped there. Maurice Amutabi looks not only at the problematic legacy of colonialism in Kenya, but also suggests a move away from migrationist histories toward an analysis of what happened to immigrant groups once they had settled in their new cities.