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Agitated patients constitute 10% of all emergency psychiatric treatment. Management guidelines, the preferred treatment of clinicians differ in opinion and practice. In Lebanon, the use of the triple therapy haloperidol plus promethazine plus chlorpromazine (HPC) is frequently used but no studies involving this combination exists.
A pragmatic randomised open trial (September 2018–July 2019) in the Lebanese Psychiatric Hospital of the Cross in Beirut Lebanon involving 100 people requiring urgent intramuscular sedation due to aggressive behaviour were given intramuscular chlorpromazine 100 mg plus haloperidol 5 mg plus promethazine 25 mg (HPC) or intramuscular haloperidol 5 mg plus promethazine 25 mg
Primary outcome data were available for 94 (94%) people. People allocated to the haloperidol plus promethazine (HP) group showed no clear difference at 20 min compared with patients allocated to the HPC group [relative risk (RR) 0.84, 95% confidence interval (CI) 0.47–1.50].
Neither intervention consistently impacted the outcome of ‘calm’, or ‘asleep’ and had no discernible effect on the use of restraints, use of additional drugs or recurrence. If clinicians are faced with uncertainty on which of the two intervention combinations to use, the simpler HP is much more widely tested and the addition of chlorpromazine adds no clear benefit with a risk of additional adverse effects.
This article explores the causes of authoritarian durability. Why do some authoritarian regimes survive for decades, often despite severe crises, while others collapse quickly, even absent significant challenges? Based on an analysis of all authoritarian regimes between 1900 and 2015, the authors argue that regimes founded in violent social revolution are especially durable. Revolutionary regimes, such as those in Russia, China, Cuba, and Vietnam, endured for more than half a century in the face of strong external pressure, poor economic performance, and large-scale policy failures. The authors develop and test a theory that accounts for such durability using a novel data set of revolutionary regimes since 1900. The authors contend that autocracies that emerge out of violent social revolution tend to confront extraordinary military threats, which lead to the development of cohesive ruling parties and powerful and loyal security apparatuses, as well as to the destruction of alternative power centers. These characteristics account for revolutionary regimes’ unusual longevity.
To estimate food insecurity (FI) prevalence among UK adults and investigate associations with socio-demographic characteristics, diet and health.
Weighted cross-sectional survey data. FI was measured using the USDA Adult Food Security Survey Module. Data were analysed using adjusted logistic regression models.
2551 participants (aged 18–64 years); sub-sample (n 1949) used to investigate association between FI and overweight.
FI prevalence was 24·3 %. Higher odds of FI were observed among participants who reported that making ends meet was difficult v. easy (OR 19·76, 95 % CI 13·78, 28·34), were full-time students v. non-students (OR 3·23, 95 % CI 2·01, 5·18), had low v. high education (OR 2·30, 95 % CI 1·66, 3·17), were male v. female (OR 1·36, 95 % CI 1·01, 1·83) and reported their ethnicity as mixed (OR 2·32, 95 % CI 1·02, 5·27) and white other (OR 2·04, 95 % CI 1·04, 3·99) v. white British. Odds of FI were higher in participants living with children v. alone, especially in single-parent households (OR 2·10, 95 % CI 1·19, 3·70). Odds of FI decreased per year of increase in age (OR 0·95, 95 % CI 0·94, 0·96) and were lower in participants not looking for work v. full-time employed (OR 0·60, 95 % CI 0·42, 0·87). Food insecure v. food secure adults had lower odds of consuming fruits (OR 0·59, 95 % CI 0·47, 0·74) and vegetables (OR 0·68, 95 % CI 0·54, 0·86) above the median frequency, and higher odds for fruit juice (OR 1·39, 95 % CI 1·10, 1·75). Food insecure v. food secure adults had higher odds of reporting unhealthy diets (OR 1·65, 95 % CI 1·31, 2·10), poor general health, (OR 1·90, 95 % CI 1·50, 2·41), poor mental health (OR 2·10, 95 % CI 1·64, 2·69), high stress (OR 3·15, 95 % CI 2·42, 4·11) and overweight (OR 1·32, 95 % CI 1·00, 1·75).
FI prevalence was high and varied by socio-demographic characteristics. FI was associated with poorer diet and health.
To evaluate the feasibility and acceptability of the Takeaway Masterclass, a three-hour training session delivered to staff of independent takeaway food outlets that promoted healthy cooking practices and menu options.
A mixed-methods study design. All participating food outlets provided progress feedback at 6 weeks post-intervention. Baseline and 6-week post-intervention observational and self-reported data were collected in half of participating takeaway food outlets.
North East England.
Independent takeaway food outlet owners and managers.
Staff from eighteen (10 % of invited) takeaway food outlets attended the training; attendance did not appear to be associated with the level of deprivation of food outlet location. Changes made by staff that required minimal effort or cost to the business were the most likely to be implemented and sustained. Less popular changes included using products that are difficult (or expensive) to source from suppliers, or changes perceived to be unpopular with customers.
The Takeaway Masterclass appears to be a feasible and acceptable intervention for improving cooking practices and menu options in takeaway food outlets for those who attended the training. Further work is required to increase participation and retention and explore effectiveness, paying particular attention to minimising adverse inequality effects.
To determine if voluntary policies on supermarket checkout foods are associated with a difference in the healthfulness of foods displayed at, or near, supermarket checkout areas.
Cross-sectional survey of foods at, or near, supermarket checkouts categorised as less healthy or not according to the Food Standards Agency’s Nutrient Profiling Model.
One city in Eastern England (population about 125 000).
All stores in nine supermarket groups open for business in June–July 2017 in the study city. Supermarket checkout food policies were categorised as clear and consistent, vague or inconsistent, or none.
In thirty-three stores, 11 434 checkout food exposures were recorded, of which 8010 (70·1 %) were less healthy; and 2558 foods in areas near checkouts, of which 1769 (69·2 %) were less healthy. After adjusting for a marker of store size, the odds of a checkout food exposure being ‘less healthy’ was lower in stores with vague or inconsistent checkout policies (OR=0·63; 95 % CI 0·49, 0·80) and in stores with clear and consistent checkout policies (OR=0·33; 95 % CI 0·24, 0·45), compared with no policy. There was no difference in the odds of foods near, but not at, checkouts being less healthy according to checkout food policy.
Supermarket checkout food policies were associated with lower odds of checkout foods but not foods near, but not at, checkouts being less healthy. Further research is required to explore impacts on purchasing and consumption.
As the IAU heads towards its second century, many changes have simultaneously transformed Astronomy and the human condition world-wide. Amid the amazing recent discoveries of exoplanets, primeval galaxies, and gravitational radiation, the human condition on Earth has become blazingly interconnected, yet beset with ever-increasing problems of over-population, pollution, and never-ending wars. Fossil-fueled global climate change has begun to yield perilous consequences. And the displacement of people from war-torn nations has reached levels not seen since World War II.
The deep subsurface of other planetary bodies is of special interest for robotic and human exploration. The subsurface provides access to planetary interior processes, thus yielding insights into planetary formation and evolution. On Mars, the subsurface might harbour the most habitable conditions. In the context of human exploration, the subsurface can provide refugia for habitation from extreme surface conditions. We describe the fifth Mine Analogue Research (MINAR 5) programme at 1 km depth in the Boulby Mine, UK in collaboration with Spaceward Bound NASA and the Kalam Centre, India, to test instruments and methods for the robotic and human exploration of deep environments on the Moon and Mars. The geological context in Permian evaporites provides an analogue to evaporitic materials on other planetary bodies such as Mars. A wide range of sample acquisition instruments (NASA drills, Small Planetary Impulse Tool (SPLIT) robotic hammer, universal sampling bags), analytical instruments (Raman spectroscopy, Close-Up Imager, Minion DNA sequencing technology, methane stable isotope analysis, biomolecule and metabolic life detection instruments) and environmental monitoring equipment (passive air particle sampler, particle detectors and environmental monitoring equipment) was deployed in an integrated campaign. Investigations included studying the geochemical signatures of chloride and sulphate evaporitic minerals, testing methods for life detection and planetary protection around human-tended operations, and investigations on the radiation environment of the deep subsurface. The MINAR analogue activity occurs in an active mine, showing how the development of space exploration technology can be used to contribute to addressing immediate Earth-based challenges. During the campaign, in collaboration with European Space Agency (ESA), MINAR was used for astronaut familiarization with future exploration tools and techniques. The campaign was used to develop primary and secondary school and primary to secondary transition curriculum materials on-site during the campaign which was focused on a classroom extra vehicular activity simulation.
To identify sociodemographic characteristics associated with frequency of consuming home-cooked meals and meals from out-of-home sources.
Cross-sectional analysis of a population-based cohort study. Frequency of consuming home-cooked meals, ready meals, takeaways and meals out were derived from a participant questionnaire. Sociodemographic characteristics regarding sex, age, ethnicity, working overtime and socio-economic status (SES; measured by household income, educational attainment, occupational status and employment status) were self-reported. Sociodemographic differences in higher v. lower meal consumption frequency were explored using logistic regression, adjusted for other key sociodemographic variables.
Fenland Study participants (n 11 326), aged 29–64 years at baseline.
Eating home-cooked meals more frequently was associated with being female, older, of higher SES (measured by greater educational attainment and household income) and not working overtime. Being male was associated with a higher frequency of consumption for all out-of-home meal types. Consuming takeaways more frequently was associated with lower SES (measured by lower educational attainment and household income), whereas eating out more frequently was associated with higher SES (measured by greater educational attainment and household income) and working overtime.
Sociodemographic characteristics associated with frequency of eating meals from different out-of-home sources varied according to meal source. Findings may be used to target public health policies and interventions for promoting healthier diets and dietary-related health towards people consuming home-cooked meals less frequently, such as men, those with lower educational attainment and household income, and overtime workers.
“Low-agency” public health interventions do not rely on individuals using their personal resources to benefit. These help people enact the choices they wish to make and are likely to increase objective and perceived control. Lower-agency interventions have been criticised as constraining individual choice. Pepper & Nettle show that this is unlikely to be the case.
Many dietary assessment methods attempt to estimate total food and nutrient intake. If the intention is simply to determine whether participants achieve dietary recommendations, this leads to much redundant data. We used data mining techniques to explore the number of foods that intake information was required on to accurately predict achievement, or not, of key dietary recommendations.
We built decision trees for achievement of recommendations for fruit and vegetables, sodium, fat, saturated fat and free sugars using data from a national dietary surveillance data set. Decision trees describe complex relationships between potential predictor variables (age, sex and all foods listed in the database) and outcome variables (achievement of each of the recommendations).
UK National Diet and Nutrition Survey (NDNS, 2008–12).
The analysis included 4156 individuals.
Information on consumption of 113 out of 3911 (3 %) foods, plus age and sex was required to accurately categorize individuals according to all five recommendations. The best trade-off between decision tree accuracy and number of foods included occurred at between eleven (for fruit and vegetables) and thirty-two (for fat, plus age) foods, achieving an accuracy of 72 % (for fat) to 83 % (for fruit and vegetables), with similar values for sensitivity and specificity.
Using information on intake of 113 foods, it is possible to predict with 72–83 % accuracy whether individuals achieve key dietary recommendations. Substantial further research is required to make use of these findings for dietary assessment.
Bipolar disorder is a highly heritable polygenic disorder. Recent
enrichment analyses suggest that there may be true risk variants for
bipolar disorder in the expression quantitative trait loci (eQTL) in the
We sought to assess the impact of eQTL variants on bipolar disorder risk
by combining data from both bipolar disorder genome-wide association
studies (GWAS) and brain eQTL.
To detect single nucleotide polymorphisms (SNPs) that influence
expression levels of genes associated with bipolar disorder, we jointly
analysed data from a bipolar disorder GWAS (7481 cases and 9250 controls)
and a genome-wide brain (cortical) eQTL (193 healthy controls) using a
Bayesian statistical method, with independent follow-up replications. The
identified risk SNP was then further tested for association with
hippocampal volume (n = 5775) and cognitive performance
(n = 342) among healthy individuals.
Integrative analysis revealed a significant association between a brain
eQTL rs6088662 on chromosome 20q11.22 and bipolar disorder (log Bayes
factor = 5.48; bipolar disorder P =
5.85×10–5). Follow-up studies across multiple independent
samples confirmed the association of the risk SNP (rs6088662) with gene
expression and bipolar disorder susceptibility (P =
3.54×10–8). Further exploratory analysis revealed that
rs6088662 is also associated with hippocampal volume and cognitive
performance in healthy individuals.
Our findings suggest that 20q11.22 is likely a risk region for bipolar
disorder; they also highlight the informative value of integrating
functional annotation of genetic variants for gene expression in
advancing our understanding of the biological basis underlying complex
disorders, such as bipolar disorder.
To investigate the display of food at non-food store checkouts; and to classify foods by type and nutrient content, presence of price promotions and whether food was at child height.
Cross-sectional survey of checkout displays at non-food stores. Foods were classified as ‘less healthy’ or healthier using the UK Food Standards Agency’s Nutrient Profile Model. Written price promotions were recorded. Child height was defined as the sight line of an 11-year-old approximated from UK growth charts.
A large indoor shopping mall, Gateshead, UK, February–March 2014.
Two hundred and five out of 219 non-food stores in the shopping mall directory which were open for trading.
Thirty-two (15·6 %) of 205 non-food stores displayed food at the checkout. All displayed less healthy foods, and fourteen (43·8 %) had healthier foods. Overall, 5911 checkout foods were identified. Of these, 4763 (80·6 %) were ‘less healthy’. No fruits, vegetables, nuts or seeds were found. Of 4763 less healthy foods displayed, 195 (4·1 %) were subject to price promotions, compared with twelve of 1148 (1·0 %) healthier foods (χ2(df=1)=25·4, P<0·0001). There was no difference in the proportion of less healthy (95·1 %) and healthier (96·2 %) foods displayed at child height.
Almost one-sixth of non-food stores displayed checkout food, the majority of which was ‘less healthy’ and displayed at child height. Less healthy food was more likely to be subject to a written price promotion than healthier food. Further research into the drivers and consequences of checkout food in non-food stores is needed. Public health regulation may be warranted.
Patients may present to Emergency Departments (ED) in shock for various reasons. Emergency medicine physicians may require the use of vasopressors or inotropes to manage these patients. The Critical Care Practice Committee of the Canadian Association of Emergency Physicians (C4) conducted an intensive literature search and guideline development process to help create an evidence based approach for use of these agents in the stabilization of shock.
Consider quasianalytic local rings of germs of smooth functions closed under composition, implicit equation, and monomial division. We show that if the Weierstrass Preparation Theoremholds in such a ring, then all elements of it are germs of analytic functions.
Childhood adversity has been associated with accelerated menarcheal and reproductive timing in females. The relationship between family- and neighbourhood-level measures of childhood adversity, menarcheal timing and intended reproductive timing was investigated in a sample of 354 English adolescent girls. The data were collected from March to June 2012. In total 90 of the participants had reached menarche. Frequent residential relocations increased the likelihood of reaching menarche (HR 1.11; 95%CI 1.02–1.22). Girls who had moved house one to four times or five or more times, were respectively, more than twice (HR 2.14; 95%CI 1.23–3.73) and more than three times (HR 3.20; 95%CI 1.44–7.10) as likely to have reached menarche than girls who had never moved house. Frequent residential relocations were associated with stepfather co-residence, increased number of half/stepsiblings and reduced feelings of family support. Menarche was also accelerated by the presence of half/stepsisters. There was no relationship between menarcheal timing and intended reproductive timing. Frequent residential relocations may indicate instability in a young person's life, which is often outside of their control. Extending childhood adversity measures to include residential relocations could be important in better understanding the role early life events play in accelerating menarche.
To examine the use of vitamin D supplements during infancy among the participants in an international infant feeding trial.
Information about vitamin D supplementation was collected through a validated FFQ at the age of 2 weeks and monthly between the ages of 1 month and 6 months.
Infants (n 2159) with a biological family member affected by type 1 diabetes and with increased human leucocyte antigen-conferred susceptibility to type 1 diabetes from twelve European countries, the USA, Canada and Australia.
Daily use of vitamin D supplements was common during the first 6 months of life in Northern and Central Europe (>80 % of the infants), with somewhat lower rates observed in Southern Europe (>60 %). In Canada, vitamin D supplementation was more common among exclusively breast-fed than other infants (e.g. 71 % v. 44 % at 6 months of age). Less than 2 % of infants in the USA and Australia received any vitamin D supplementation. Higher gestational age, older maternal age and longer maternal education were study-wide associated with greater use of vitamin D supplements.
Most of the infants received vitamin D supplements during the first 6 months of life in the European countries, whereas in Canada only half and in the USA and Australia very few were given supplementation.