Antipsychotic Drug Use: Managing Cardiometabolic and Cost Effects

Across the US, 30%, or approximately one third of people meet the criteria for at least one mental illness.1 Of those with severe mental illness (SMI), namely schizophrenia and bipolar disorder, the mortality rate is more than twofold compared to the general population.2 The cardiovascular risk factors that contribute to cardiovascular related deaths, including metabolic disease and type II diabetes, are not only modifiable, but staggeringly higher for those with SMI.3 Though antipsychotic drug prescription is the standard protocol for SMI treatment, such drug effects on cardiovascular risk factors and related deaths exacerbate the much higher mortality rate for the severely mentally ill population. Due to both the prevalence of SMI and the physical comorbidities that it entails, analysis of healthcare costs associated with this population are an essential part of general health and policy improvement for the U.S. Therefore, a breakdown of the healthcare costs of this population requires not only acknowledgment of the modes of treatment for mental illness specifically, but also the identification and cost-analysis of the commonly associated physical comorbidities. This is especially important considering SMI is almost always considered chronic, and many SMI patients qualify for either Medicare, Medicaid, or both. Certain gaps in coverage can lead to lack of preventive care, exacerbating the cost burden. From a clinician’s perspective, assessing relevant scientific studies and reviews to change the relationship between primary care and psychiatry is necessary to dampen the high mortality rate of the SMI population. From a policy-maker’s perspective, analyzing the cause and effect balance between managing costs of care directed at the SMI itself against the adjunct costs from physical comorbidity calls for a change in the structure of therapeutic care and how the SMI population accesses primary care. The Collaborative Care model is a health care model that unifies psychiatric, behavioral, and primary care to support the mental, behavioral, and physical health of patients. By supporting holistic healthcare, the high cost of care for the SMI population will be diminished. The model includes four parts: patient-centered care, populationbased care, measurement-based treatment to target, and evidence-based care. Swapping oral antipsychotics with injectable versions will be especially cost-effective by improving adherence rates, and thus, reducing institutionalization and other hospitalizations. By enforcing the Collaborative Care model through community health center interventions, clinicians and policy makers will be able to work together to effectively leverage the health of the SMI population while eroding the high health care expenditure that this population currently imposes on states

Evidence for a 304-day Orbital Period for GX 1+4

In this paper we report strong evidence for a ~304-day periodicity in the spin history of the accretion-powered pulsar GX 1+4 that is very likely to be a signature of the orbital period of the system. Using BATSE public-domain data, we show a highly-significant periodic modulation of the pulsar frequency from 1991 to date which is in excellent agreement with the ephemeris proposed by Cutler, Dennis & Dolan in 1986, which were based on a few events of enhanced spin-up that occurred during the pulsar's spin-up era in the 1970s. Our results indicate that the orbital period of GX 1+4 is 303.8+-1.1 days, making it by far the widest low-mass X-ray binary system known. A likely scenario for this system is an elliptical orbit in which the neutron star decreases its spin-down rate (or even exhibits a momentary spin-up behavior) at periastron passages due to the higher torque exerted by the accretion disk onto the magnetosphere of the neutron star.Comment: 5 pages, 2 figures, 1 single PS file, to appear in "Proceedings of the 5th Compton Symposium on Gamma-Ray Astrophysics", AI

On the Impact of Helium Content on the RR Lyrae Distance Scale

Indexación: Scopus.We constructed new sets of He-enhanced (Y = 0.30, Y = 0.40) nonlinear, time-dependent convective hydrodynamical models of RR Lyrae (RRL) stars covering a broad range in metal abundances (Z = 0.0001-0.02). The increase in He content from the canonical value (Y = 0.245) to Y = 0.30-0.40 causes a simultaneous increase in stellar luminosity and in pulsation period. To investigate the dependence of the RRL distance scale on the He abundance, we computed new optical (RI) and near-infrared (JHK) Period-luminosity-metallicity-helium relations. Interestingly enough, the increase in He content causes a minimal change in the coefficients of both period and metallicity terms, since canonical and He-enhanced models obey similar PLZ relations. On the contrary, the classical B-And V-band mean magnitude metallicity relations and the R-band PLZ relation display a significant dependence on the He content. The He-enhanced models are, at fixed metal content, 0.2-0.5 mag brighter than canonical ones. This variation is only marginally affected by evolutionary effects. The quoted distance diagnostics once calibrated with trigonometric parallaxes (Gaia) will provide the opportunity to estimate the He content of field and cluster RRLs. Moreover, the use of either spectroscopic or photometric metal abundances will pave the way to new empirical constraints on the universality of the helium-To-metal enrichment ratio in old (t10 Gyr) stellar tracers. © 2018. The American Astronomical Society. All rights reserved.https://iopscience.iop.org/article/10.3847/2041-8213/aada1

Characterization of the CBC2 readout ASIC for the CMS strip-tracker high-luminosity upgrade

The CMS Binary Chip 2 (CBC2) is a full-scale prototype ASIC developed for the front-end readout of the high-luminosity upgrade of the CMS silicon strip tracker. The 254-channel, 130 nm CMOS ASIC is designed for the binary readout of double-layer modules, and features cluster-width discrimination and coincidence logic for detecting high-PT track candidates. The chip was delivered in January 2013 and has since been bump-bonded to a dual-chip hybrid and extensively tested. The CBC2 is fully functional and working to specification: we present the result of electrical characterization of the chip, including gain, noise, threshold scan and power consumption, together with the performance of the stub finding logic. Finally we will outline the plan for future developments towards the production version

Massive stellar systems: observational challenges and perspectives in the E-ELT era

We introduce the empirical framework concerning optical and near-infrared (NIR) photometry of crowded stellar fields. In particular, we address the impact that linear detectors and analytical PSF played in improving the accuracy and the precision of multi-band color-magnitude diagrams (CMDs). We focus our attention on recent findings based on deep NIR images collected with Adaptive Optics (AO) systems at the 8-10m class telescopes and discuss pros and cons of the different approaches. We also discuss the estimate of the absolute age of globular clusters using a well defined knee along the lower main sequence. We mention the role which the current AO-assisted instruments will have in addressing longstanding astrophysical problems of the Galactic center. Finally, we outline the role of first generation of E-ELT instruments upon photometry and spectroscopy of crowded stellar fields

Optical and Near-Infrared UBVRIJHK Photometry for the RR Lyrae stars in the Nearby Globular Cluster M4 (NGC 6121)

We present optical and near-infrared UBVRIJHK photometry of stars in the Galactic globular cluster M4 (NGC 6121) based upon a large corpus of observations obtained mainly from public astronomical archives. We concentrate on the RR Lyrae variable stars in the cluster, and make a particular effort to accurately reidentify the previously discovered variables. We have also discovered two new probable RR Lyrae variables in the M4 field: one of them by its position on the sky and its photometric properties is a probable member of the cluster, and the second is a probable background (bulge?) object. We provide accurate equatorial coordinates for all 47 stars identified as RR Lyraes, new photometric measurements for 46 of them, and new period estimates for 45. We have also derived accurate positions and mean photometry for 34 more stars previously identified as variable stars of other types, and for an additional five non-RR Lyrae variable stars identified for the first time here. We present optical and near-infrared color-magnitude diagrams for the cluster and show the locations of the variable stars in them. We present the Bailey (period-amplitude) diagrams and the period-frequency histogram for the RR Lyrae stars in M4 and compare them to the corresponding diagrams for M5 (NGC 5904). We conclude that the RR Lyrae populations in the two clusters are quite similar in all the relevant properties that we have considered. The mean periods, pulsation-mode ratios, and Bailey diagrams of these two clusters show support for the recently proposed "Oosterhoff-neutral" classification.Comment: 33 pages, 16 figures, 7 table