Use of antipsychotics and benzodiazepines in patients with psychiatric emergencies: Results of an observational trial

<p>Abstract</p> <p>Background</p> <p>Conventional antipsychotics augmented with benzodiazepines have been the standard acute treatment for psychiatric emergencies for more than 50 years. The inability of patients to give informed consent limits randomised, controlled studies. This observational study on immediate therapy for aggression and impulse control in acutely agitated patients (IMPULSE) evaluated the short-term effectiveness and tolerability of atypical and typical antipsychotic medications (AP) in a non-interventional setting.</p> <p>Methods</p> <p>This was a comparative, non-randomised, prospective, open-label, observational study. Treatment over the first 5 days was classified according to whether any olanzapine, risperidone, or haloperidol was included or not. Documentations (PANSS-excited component, CGI-aggression, CGI-suicidality, tranquilisation score) were at baseline (day 1) and days 2–6 after start of AP.</p> <p>Results</p> <p>During the short treatment-period, PANSS-EC and CGI-aggression scores improved in all cohorts. 68.7% of patients treated with olanzapine, 72.2% of patients treated with risperidone, and 83.3% of patients treated with haloperidol received concomitant benzodiazepines (haloperidol vs. non-haloperidol: p < 0.001). More patients treated with olanzapine (73.8%) were fully alert according to a tranquilisation score and active at day 2 than patients treated with risperidone (57.1%) or haloperidol (58.0%).</p> <p>Conclusion</p> <p>Current medication practices for immediate aggression control are effective with positive results present within a few days. In this study, concomitant benzodiazepine use was significantly more frequent in patients receiving haloperidol.</p

Comparison of resting egg gene expression with different hatchability related to salinity variations in the marine rotifer Brachionus manjavacas

Salinity is a significant factor in affecting resting egg hatching in the euryhaline rotifers. In order to clarify the effects of salinity on resting egg hatchability, this study investigated gene expressions of resting eggs subjected to two different incubation salinities (at 17 and 33 ppt) in the rotifer Brachionus manjavacas. The resting eggs formed at 17 ppt showed a higher hatching rate at 17 ppt incubation salinity, compared to those at 33 ppt. Related to these circumstances, the resting eggs incubated at 17 ppt expressed genes which have putative functions implying cellular differentiation and embryonic development: late embryogenesis abundant protein (LEAs-1), α-amylase, and deaminase. The resting eggs incubated at 33 ppt highly expressed the genes related to the environmental stresses: AP2 transcription factors (AP2TF), and ATP decomposition: ABC transporter permease (ABC-TP), NAD?+?synthase, copper-translocating P-type ATPase (CTP-ATPase). It is expected that the resting eggs incubated at 33 ppt may need more energy (ATP) to endure saline stress during incubation. The obtained results indicated that the resting eggs regulate their hatching by allocating energy between embryo development and self-defense against environmental conditions like salinity stresses

Medical treatment of primary sclerosing cholangitis: A role for novel bile acids and other (post-)transcriptional modulators?

Primary sclerosing cholangitis (PSC) is a rare chronic cholestatic disease of the liver and bile ducts that is associated with inflammatory bowel disease, generally leads to end-stage liver disease, and is complicated by malignancies of the biliary tree and the large intestine. The pathogenesis of PSC remains enigmatic, making the development of targeted therapeutic strategies difficult. Immunosuppressive and antifibrotic therapeutic agents were ineffective or accompanied by major side effects. Ursodeoxycholic acid (UDCA) has consistently been shown to improve serum liver tests and might lower the risk of colon carcinoma and cholangiocarcinoma by yet unknown mechanisms. Whether "high dose" UDCA improves the long-term prognosis in PSC as suggested by small pilot trials remains to be demonstrated. The present overview discusses potential therapeutic options aside of targeted immunological therapies and UDCA. The C23 bile acid norUDCA has been shown to markedly improve biochemical and histological features in a mouse model of sclerosing cholangitis without any toxic effects. Studies in humans are eagerly being awaited. Nuclear receptors like the farnesoid-X receptor (FXR), pregnane-X receptor (PXR), vitamin D receptor (VDR), and peroxisome-proliferator-activator receptors (PPARs) have been shown to induce expression of diverse carriers and biotransformation enzymes of the intestinal and hepatic detoxification machinery and/or to modulate fibrogenesis. Pros and cons of respective receptor agonists for the future treatment of PSC are discussed in detail. In our view, the novel bile acid norUDCA and agonists of PPARs, VDR, and PXR appear particularly attractive for further studies in PSC

Disaster resilience in a flood-impacted rural Australian town

This paper reports exploratory research conducted in a flood-impacted rural Australian town to identify the factors which residents perceived as supporting community resilience to disaster. There is a gap in this research area centred in the Australian disaster context. Since Australia is predicted to be highly impacted by the effects of climate change in the form of an increased incidence of flooding, an urgent need exists to examine the factors that confer resilience to disaster-impacted localities to inform suitable disaster mitigation and adaptation policies for the future. Because of the complexity of community resilience and its interrelationship with individual resilience, a multi-method approach was used: a demographic study to assess community stability and functioning before and after the flood disaster, focus group interviews to obtain from community members their views on what supported them and their community resilience and a survey to generalise the interview findings. Our operating hypothesis was that individuals remaining in the town post-flood were likely to be resilient to the flood disaster. The demographic study results pointed to a resilient community after the floods as they reflected stability in population numbers and socio-economic indicators. The interviews and survey showed that individual resilience was promoted by social connectedness and a sense of place, a factor that was also negatively linked to the desire to relocate from the community. The use of structural equation modelling of our results provided verification of prior research findings about the role of sense of place in supporting individuals' resilience. Results are discussed in the context of future climate change adaptation policy