Commentary on strategies for switching antipsychotics

Both the new generation of antipsychotics and the more traditional antipsychotic drugs produce an important and meaningful improvement in patients with schizophrenia, but most patients are neither cured nor free of symptoms. As a consequence, it is common to switch from one drug to another in the hope of obtaining a better response. All antipsychotic drugs produce some side effects, so switching can also be a tolerance issue. There are reports in the literature on the tactics of switching: abrupt discontinuation, cross tapering, starting a patient on a new drug while continuing with the old drug until the new drug has reached a steady state, or some variation on these tactics. In this issue, Ganguli et al. have carried out a randomized switching study, the data from which indicates the tactics that might be optimal. We put this paper into context, provide a critique and describe indications for switching

A New Approach to Evaluate and Reduce Uncertainty of Model-Based Biodiversity Projections for Conservation Policy Formulation

Biodiversity projections with uncertainty estimates under different climate, land-use, and policy scenarios are essential to setting and achieving international targets to mitigate biodiversity loss. Evaluating and improving biodiversity predictions to better inform policy decisions remains a central conservation goal and challenge. A comprehensive strategy to evaluate and reduce uncertainty of model outputs against observed measurements and multiple models would help to produce more robust biodiversity predictions. We propose an approach that integrates biodiversity models and emerging remote sensing and in-situ data streams to evaluate and reduce uncertainty with the goal of improving policy-relevant biodiversity predictions. In this article, we describe a multivariate approach to directly and indirectly evaluate and constrain model uncertainty, demonstrate a proof of concept of this approach, embed the concept within the broader context of model evaluation and scenario analysis for conservation policy, and highlight lessons from other modeling communities

A self-organized model for cell-differentiation based on variations of molecular decay rates

Systemic properties of living cells are the result of molecular dynamics governed by so-called genetic regulatory networks (GRN). These networks capture all possible features of cells and are responsible for the immense levels of adaptation characteristic to living systems. At any point in time only small subsets of these networks are active. Any active subset of the GRN leads to the expression of particular sets of molecules (expression modes). The subsets of active networks change over time, leading to the observed complex dynamics of expression patterns. Understanding of this dynamics becomes increasingly important in systems biology and medicine. While the importance of transcription rates and catalytic interactions has been widely recognized in modeling genetic regulatory systems, the understanding of the role of degradation of biochemical agents (mRNA, protein) in regulatory dynamics remains limited. Recent experimental data suggests that there exists a functional relation between mRNA and protein decay rates and expression modes. In this paper we propose a model for the dynamics of successions of sequences of active subnetworks of the GRN. The model is able to reproduce key characteristics of molecular dynamics, including homeostasis, multi-stability, periodic dynamics, alternating activity, differentiability, and self-organized critical dynamics. Moreover the model allows to naturally understand the mechanism behind the relation between decay rates and expression modes. The model explains recent experimental observations that decay-rates (or turnovers) vary between differentiated tissue-classes at a general systemic level and highlights the role of intracellular decay rate control mechanisms in cell differentiation.Comment: 16 pages, 5 figure

Enhanced chlorhexidine skin penetration with 1,8-cineole

BACKGROUND: Chlorhexidine (CHG) penetrates poorly into skin. The purpose of this study was to compare the depth of CHG skin permeation from solutions containing either 2% (w/v) CHG and 70% (v/v) isopropyl alcohol (IPA) or 2% (w/v) CHG, 70% (v/v) IPA and 2% (v/v) 1,8-cineole. METHODS: An ex-vivo study using Franz diffusion cells was carried out. Full thickness human skin was mounted onto the cells and a CHG solution, with or without 2% (v/v) 1,8-cineole was applied to the skin surface. After twenty-four hours the skin was sectioned horizontally in 100 μm slices to a depth of 2000 μm and the concentration of CHG in each section quantified using high performance liquid chromatography (HPLC). The data were analysed with repeated measures analysis of variance. RESULTS: The concentration of CHG in the skin on average was significantly higher (33.3% [95%, CI 1.5% - 74.9%]) when a CHG solution which contained 1,8-cineole was applied to the skin compared to a CHG solution which did not contain this terpene (P = 0.042). CONCLUSIONS: Enhanced delivery of CHG can be achieved in the presence of 1,8-cineole, which is the major component of eucalyptus oil. This may reduce the numbers of microorganisms located in the deeper layers of the skin which potentially could decrease the risk of surgical site infection

The Gaia-ESO Survey: the selection function of the Milky Way field stars

The Gaia-ESO Survey was designed to target all major Galactic components (i.e. bulge, thin and thick discs, halo and clusters), with the goal of constraining the chemical and dynamical evolution of the Milky Way. This paper presents the methodology and considerations that drive the selection of the targeted, allocated and successfully observed Milky Way field stars. The detailed understanding of the survey construction, specifically the influence of target selection criteria on observed Milky Way field stars is required in order to analyse and interpret the survey data correctly. We present the target selection process for the Milky Way field stars observed with Very Large Telescope/Fibre Large Array Multi Element Spectrograph and provide the weights that characterize the survey target selection. The weights can be used to account for the selection effects in the Gaia-ESO Survey data for scientific studies. We provide a couple of simple examples to highlight the necessity of including such information in studies of the stellar populations in the Milky Way

Differences in trait impulsivity indicate diversification of dog breeds into working and show lines

Impulsiveness describes the inability to inhibit behaviour in the presence of salient cues. Trait-level impulsivity exists on a continuum and individual differences can be adaptive in different contexts. While breed related differences in behavioural tendency in the domestic dog (Canis familiaris) are well established, the phenomenon within lines of a breed which have been selected more recently is not well studied, although it may challenge the popular notion of breed-typical behaviour. We describe differences in impulsivity between and within two dog breeds with working and show lines selected for different levels of impulsivity: Border Collies (herding work) and Labrador Retrievers (gun work). Recent show line selection might have lessened differences in impulsivity between breeds. We tested this hypothesis on a dataset of 1161 individuals assessed using a validated psychometric tool (Dog Impulsivity Assessment Scale - DIAS). Collies were more impulsive on average, consistent with the original purpose of breed selection. Regarding line, working Collies differed from working Labradors, but show lines from the two breeds were not significantly different. Altered or relaxed artificial selection for behavioural traits when appearance rather than behaviour become the primary focus for breeders may reduce average differences in impulsivity between breeds in show lines

Implementation of Multigene Germline and Parallel Somatic Genetic Testing in Epithelial Ovarian Cancer: SIGNPOST Study

We present findings of a cancer multidisciplinary-team (MDT) coordinated mainstreaming pathway of unselected 5-panel germline BRCA1/BRCA2/RAD51C/RAD51D/BRIP1 and parallel somatic BRCA1/BRCA2 testing in all women with epithelial-OC and highlight the discordance between germline and somatic testing strategies across two cancer centres. Patients were counselled and consented by a cancer MDT member. The uptake of parallel multi-gene germline and somatic testing was 97.7%. Counselling by clinical-nurse-specialist more frequently needed >1 consultation (53.6% (30/56)) compared to a medical (15.0% (21/137)) or surgical oncologist (15.3% (17/110)) (p < 0.001). The median age was 54 (IQR = 51–62) years in germline pathogenic-variant (PV) versus 61 (IQR = 51–71) in BRCA wild-type (p = 0.001). There was no significant difference in distribution of PVs by ethnicity, stage, surgery timing or resection status. A total of 15.5% germline and 7.8% somatic BRCA1/BRCA2 PVs were identified. A total of 2.3% patients had RAD51C/RAD51D/BRIP1 PVs. A total of 11% germline PVs were large-genomic-rearrangements and missed by somatic testing. A total of 20% germline PVs are missed by somatic first BRCA-testing approach and 55.6% germline PVs missed by family history ascertainment. The somatic testing failure rate is higher (23%) for patients undergoing diagnostic biopsies. Our findings favour a prospective parallel somatic and germline panel testing approach as a clinically efficient strategy to maximise variant identification. UK Genomics test-directory criteria should be expanded to include a panel of OC genes

The Gaia-ESO Survey: Pre-main-sequence stars in the young open cluster NGC 3293

© 2016 The Authors Published by Oxford University Press on behalf of the Royal Astronomical Society.The young open cluster NGC3293 is included in the observing program of the Gaia-ESO survey (GES). The radial velocity values provided have been used to assign cluster membership probabilities by means of a single-variable parametric analysis. These membership probabilities are compared to the results of the photometric membership assignment of NGC3293, based on UBVRI photometry. The agreement of the photometric and kinematic member samples amounts to 65 per cent, and could increase to 70 per cent as suggested by the analysis of the differences between both samples. A number of photometric PMS candidate members of spectral type F are found, which are confirmed by the results from VPHAS photometry and SED fitting for the stars in common with VPHAS and GES data sets. Excesses at mid- and near-infrared wavelengths, and signs of Hα emission, are investigated for them. Marginal presence of Hα emission or infilling is detected for the candidate members. Several of them exhibit moderate signs of U excess and weak excesses at mid-IR wavelengths. We suggest that these features originate from accretion discs in their last stages of evolution

Gaia-ESO Survey: Gas dynamics in the Carina nebula through optical emission lines

Aims. We present observations from the Gaia-ESO Survey in the lines of Hα, [N II], [S II] and He I of nebular emission in the central part of the Carina Nebula. Methods. We investigate the properties of the two already known kinematic components (approaching and receding, respectively), which account for the bulk of emission. Moreover, we investigate the features of the much less known low-intensity high-velocity (absolute RV >50 km/s) gas emission. Results. We show that gas giving rise to Hα and He I emission is dynamically well correlated, but not identical, to gas seen through forbidden-line emission. Gas temperatures are derived from line-width ratios, and densities from [S II] doublet ratios. The spatial variation of N ionization is also studied, and found to differ between the approaching and receding components. The main result is that the bulk of the emission lines in the central part of Carina arises from several distinct shell-like expanding regions, the most evident found around η Car, the Trumpler 14 core, and the starWR25. Such “shells" are non-spherical, and show distortions probably caused by collisions with other shells or colder, higher-density gas. Part of them is also obscured by foreground dust lanes, while only very little dust is found in their interior. Preferential directions, parallel to the dark dust lanes, are found in the shell geometries and physical properties, probably related to strong density gradients in the studied region. We also find evidence that the ionizing flux emerging from η Car and the surrounding Homunculus nebula varies with polar angle. The high-velocity components in the wings of Hα are found to arise from expanding dust reflecting the η Car spectrum

The CHIP-Family study to improve the psychosocial wellbeing of young children with congenital heart disease and their families: design of a randomized controlled trial

Background: Children with congenital heart disease (CHD) are at increased risk for behavioral, emotional, and cognitive problems. They often have reduced exercise capacity and participate less in sports, which is associated with a lower quality of life. Starting school may present more challenges for children with CHD and their families than for families with healthy children. Moreover, parents of children with CHD are at risk for psychosocial problems. Therefore, a family-centered psychosocial intervention for children with CHD when starting school is needed. Until now, the 'Congenital Heart Disease Intervention Program (CHIP) - School' is the only evidence-based intervention in this field. However, CHIP-School targeted parents only and resulted in non-significant, though positive, effects as to child psychosocial wellbeing. Hence, we expanded CHIP by adding a specific child module and including siblings, creating the CHIP-Family intervention. The CHIP-Family study aims to (1) test the effects of CHIP-Family on parental mental health and psychosocial wellbeing of CHD-children and to (2) identify baseline psychosocial and medical predictors for the e