The Influence of l- and dl-Tryptophane and Kynurenic Acid Administration on Bile Volume and Composition

We have undertaken to determine whether kynurenic acid production or excretion in the bile (as reported by Kotake and Ichihara) might be responsible, at least in part, for the choleretic effect of tryptophane. We have also studied the influence of optical configuration of tryptophane on bile volume and on bile salt output, both of which Whipple and Smith found were increased by l-tryptophane administration

Truss Assembly and Welding by Intelligent Precision Jigging Robots

This paper describes an Intelligent Precision Jigging Robot (IPJR) prototype that enables the precise alignment and welding of titanium space telescope optical benches. The IPJR, equipped with micron accuracy sensors and actuators, worked in tandem with a lower precision remote controlled manipulator. The combined system assembled and welded a 2 m truss from stock titanium components. The calibration of the IPJR, and the difference between the predicted and the truss dimensions as-built, identified additional sources of error that should be addressed in the next generation of IPJRs in 2D and 3D

Precise Truss Assembly using Commodity Parts and Low Precision Welding

We describe an Intelligent Precision Jigging Robot (IPJR), which allows high precision assembly of commodity parts with low-precision bonding. We present preliminary experiments in 2D that are motivated by the problem of assembling a space telescope optical bench on orbit using inexpensive, stock hardware and low-precision welding. An IPJR is a robot that acts as the precise "jigging", holding parts of a local assembly site in place while an external low precision assembly agent cuts and welds members. The prototype presented in this paper allows an assembly agent (in this case, a human using only low precision tools), to assemble a 2D truss made of wooden dowels to a precision on the order of millimeters over a span on the order of meters. We report the challenges of designing the IPJR hardware and software, analyze the error in assembly, document the test results over several experiments including a large-scale ring structure, and describe future work to implement the IPJR in 3D and with micron precision

An Efficient and Versatile Means for Assembling and Manufacturing Systems in Space

Within NASA Space Science, Exploration and the Office of Chief Technologist, there are Grand Challenges and advanced future exploration, science and commercial mission applications that could benefit significantly from large-span and large-area structural systems. Of particular and persistent interest to the Space Science community is the desire for large (in the 10- 50 meter range for main aperture diameter) space telescopes that would revolutionize space astronomy. Achieving these systems will likely require on-orbit assembly, but previous approaches for assembling large-scale telescope truss structures and systems in space have been perceived as very costly because they require high precision and custom components. These components rely on a large number of mechanical connections and supporting infrastructure that are unique to each application. In this paper, a new assembly paradigm that mitigates these concerns is proposed and described. A new assembly approach, developed to implement the paradigm, is developed incorporating: Intelligent Precision Jigging Robots, Electron-Beam welding, robotic handling/manipulation, operations assembly sequence and path planning, and low precision weldable structural elements. Key advantages of the new assembly paradigm, as well as concept descriptions and ongoing research and technology development efforts for each of the major elements are summarized

Cost-Effectiveness of Comprehensive, Integrated Care for First Episode Psychosis in the NIMH RAISE Early Treatment Program

This study compares the cost-effectiveness of Navigate (NAV), a comprehensive, multidisciplinary, team-based treatment approach for first episode psychosis (FEP) and usual Community Care (CC) in a cluster randomization trial. Patients at 34 community treatment clinics were randomly assigned to either NAV (N = 223) or CC (N = 181) for 2 years. Effectiveness was measured as a one standard deviation change on the Quality of Life Scale (QLS-SD). Incremental cost effectiveness ratios were evaluated with bootstrap distributions. The Net Health Benefits Approach was used to evaluate the probability that the value of NAV benefits exceeded its costs relative to CC from the perspective of the health care system. The NAV group improved significantly more on the QLS and had higher outpatient mental health and antipsychotic medication costs. The incremental cost-effectiveness ratio was $12 081/QLS-SD, with a .94 probability that NAV was more cost-effective than CC at$40 000/QLS-SD. When converted to monetized Quality Adjusted Life Years, NAV benefits exceeded costs, especially at future generic drug prices

Comprehensive Versus Usual Community Care for First-Episode Psychosis: 2-Year Outcomes From the NIMH RAISE Early Treatment Program

The primary aim was to compare the impact of NAVIGATE, a comprehensive, multidisciplinary, team-based treatment approach for first episode psychosis designed for implementation in the U.S. healthcare system, to Community Care on quality of life

Prescription Practices in the Treatment of First-Episode Schizophrenia Spectrum Disorders: Data From the National RAISE-ETP Study

Treatment guidelines suggest distinctive medication strategies for first episode and multi-episode patients with schizophrenia. How much community clinicians adjust their usual treatment regimens for first episode patients is unknown. We examined prescription patterns and factors associated with prescription choice within a national cohort of early phase patients

Cardiometabolic Risk in Patients With First-Episode Schizophrenia Spectrum Disorders: Baseline Results From the RAISE-ETP Study

IMPORTANCE: The fact that individuals with schizophrenia have high cardiovascular morbidity and mortality is well established. However, risk status and moderators or mediators in the earliest stages of illness are less clear. OBJECTIVE: To assess cardiometabolic risk in first-episode schizophrenia spectrum disorders (FES) and its relationship to illness duration, antipsychotic treatment duration and type, sex, and race/ethnicity. DESIGN, SETTING, AND PARTICIPANTS: Baseline results of the Recovery After an Initial Schizophrenia Episode (RAISE) study, collected between July 22, 2010, and July 5, 2012, from 34 community mental health facilities without major research, teaching, or clinical FES programs. Patients were aged 15 to 40 years, had research-confirmed diagnoses of FES, and had less than 6 months of lifetime antipsychotic treatment. EXPOSURE: Prebaseline antipsychotic treatment was based on the community clinician's and/or patient's decision. MAIN OUTCOMES AND MEASURES: Body composition and fasting lipid, glucose, and insulin parameters. RESULTS: In 394 of 404 patients with cardiometabolic data (mean [SD] age, 23.6 [5.0] years; mean [SD] lifetime antipsychotic treatment, 47.3 [46.1] days), 48.3% were obese or overweight, 50.8% smoked, 56.5% had dyslipidemia, 39.9% had prehypertension, 10.0% had hypertension, and 13.2% had metabolic syndrome. Prediabetes (glucose based, 4.0%; hemoglobin A1c based, 15.4%) and diabetes (glucose based, 3.0%; hemoglobin A1c based, 2.9%) were less frequent. Total psychiatric illness duration correlated significantly with higher body mass index, fat mass, fat percentage, and waist circumference (all P<.01) but not elevated metabolic parameters (except triglycerides to HDL-C ratio [P=.04]). Conversely, antipsychotic treatment duration correlated significantly with higher non-HDL-C, triglycerides, and triglycerides to HDL-C ratio and lower HDL-C and systolic blood pressure (all P≤.01). In multivariable analyses, olanzapine was significantly associated with higher triglycerides, insulin, and insulin resistance, whereas quetiapine fumarate was associated with significantly higher triglycerides to HDL-C ratio (all P≤.02). CONCLUSIONS AND RELEVANCE: In patients with FES, cardiometabolic risk factors and abnormalities are present early in the illness and likely related to the underlying illness, unhealthy lifestyle, and antipsychotic medications, which interact with each other. Prevention of and early interventions for psychiatric illness and treatment with lower-risk agents, routine antipsychotic adverse effect monitoring, and smoking cessation interventions are needed from the earliest illness phases

Antipsychotic prescribing for vulnerable populations: a clinical audit at an acute Australian mental health unit at two-time points

Background: Antipsychotics are recognised as a critical intervention for schizophrenia and bipolar disorder. Guidelines globally endorse the routine practice of antipsychotic monotherapy, at the minimum effective dose. Even in treatmentresistant schizophrenia, clozapine use is endorsed before combining antipsychotics. This aim of this study was to review antipsychotic polytherapy alone, high-dose therapy alone, polytherapy and highdose prescribing patterns in adults discharged from an inpatient mental health unit at two time-points, and the alignment of this prescribing with clinical guideline recommendations. Additionally, associations with polytherapy and high-dose antipsychotic prescribing, including patient and clinical characteristics, were explored. Methods: A retrospective clinical audit of 400 adults (200 patients at two different time-points) discharged with at least one antipsychotic. Preliminary findings and education sessions were provided to physicians between Cohorts. Outcomes (polytherapy alone, high-dose therapy alone, polytherapy and high-dose therapy) were compared between study Cohorts using chi-squared and rank-sum tests. Associations between outcomes and covariates were assessed using multivariable logistic regression. Results: Most patients (62.5%) were discharged on a single antipsychotic within the recommended dose range. There was a clear preference for prescribing second generation antipsychotics, and in this respect, prescribing is aligned with current evidence-based guidelines. However, sub-optimal prescribing practices were identified for both Cohorts in relation to polytherapy and high-dose antipsychotic rates. Involuntary treatment, frequent hospitalisations and previous clozapine use significantly increased the risk of all three prescribing outcomes at discharge. Conclusions: In a significant minority, antipsychotic prescribing did not align with clinical guidelines despite increased training, indicating that the education program alone was ineffective at positively influencing antipsychotic prescribing practices. Further consideration should be given when prescribing antipsychotics for involuntary patients, people with frequent hospitalisations, and those who have previously trialled clozapine