822 research outputs found

    Utilization of care among drug resistant epilepsy patients with symptoms of anxiety and depression

    Get PDF
    AbstractPurposeEpilepsy patients have a significantly higher rate of anxiety and depression than the general population, and psychiatric disease is particularly prevalent among drug resistant epilepsy patients. Symptoms of anxiety and depression might serve as a barrier to appropriate epilepsy care.The aim of this study was to determine if drug resistant epilepsy patients with symptoms of anxiety and/or depression receive different epilepsy management than controls.MethodWe identified 83 patients with drug resistant focal epilepsy seen at the Penn Epilepsy Center. Upon enrollment, all patients completed 3 self-report scales and a neuropsychiatric inventory and were grouped into those with symptoms of anxiety and/or depression and controls. Each patient's medical records were retrospectively reviewed for 1–2 years, and objective measures of outpatient and inpatient epilepsy management were assessed.ResultsAt baseline, 53% (n=43) of patients screened positive for symptoms of anxiety and/or depression. The remaining 47% (n=38) served as controls. Patients with anxiety and/or depression symptoms had more missed outpatient visits per year compared to controls (median 0.84 vs. 0.48, p=0.02). Patients with symptoms of both anxiety and depression were more likely to undergo an inpatient admission or procedure (56% vs. 24%, p=0.02).ConclusionFor most measures of epilepsy management, symptoms of anxiety and/or depression do not alter epilepsy care; however, drug resistant epilepsy patients with anxiety and/or depression symptoms may be more likely to miss outpatient appointments, and those with the highest burden of psychiatric symptoms may be admitted more frequently for inpatient services compared to controls

    Evaluating a microalga (Schizochytrium sp.) as an alternative to fish oil in fish-free feeds for sablefish (Anoplopoma fimbria)

    Get PDF
    Alternative feeds are critical for the sustainable expansion of the marine finfish aquaculture industry. The industry uses wild-caught forage fish as a primary ingredient in farmed fish feeds. Alternative ingredients are needed to safeguard fisheries\u27 sustainability and future aquaculture development. While there have been successes in alternative feeds, it is necessary to improve the existing options and identify alternative ingredients with higher concentrations of omega-3 polyunsaturated fatty acids (PUFAs). This study was designed to test a microalga, Schizochytrium sp., as a feed ingredient for sablefish (Anoplopoma fimbria) using six test diets. There were two fish-ingredient control diets: +FM+FO, which contained both fishmeal and fish oil, and −FM+FO, which contained fish oil, but no fishmeal. The remaining four diets contained alternative lipids and were completely fish-free. FF Flax contained flax oil as the only lipid source replacing fish oil. FF LowSc, FF ModSc, and FF HighSc contained a low, moderate, and high level of Schizochytrium sp. to replace fish oil, with flax oil content decreasing as the microalga increased. After a 20-week trial, sablefish growth differed across the feed treatments, with fish fed the high microalga-inclusion diet (FF HighSc) performing similarly to fish fed the fish-ingredient controls. Fulton\u27s K condition factor, dry feed intake (DFI), and lipid productive value (LPV) were also influenced by treatment. For the four fish-free diets, specific growth rate increased with increasing inclusion of Schizochytrium sp. in the feed. Fillet fatty acid profiles were similarly influenced by diet treatment, generally reflecting the fatty acid profiles of the feed. Total fillet PUFAs were higher in sablefish from the fish-free treatments than the control treatments, with DHA increasing with increasing inclusion of dietary Schizochytrium. In contrast, EPA was higher in fillets from both fish-ingredient control treatments compared to fillets from the fish-free treatments, yet EPA remained higher than expected in sablefish fed the fish-free diets. Histologic evaluation of sablefish distal intestine and liver demonstrated that the microalga-inclusion diets were well tolerated and did not cause histomorphological changes in the tissues. These results suggest Schizochytrium sp. can increase PUFA concentrations in fish fillets without compromising fish health and growth, making it a viable ingredient for alternative sablefish feeds

    Imported Lassa Fever, Pennsylvania, USA, 2010

    Get PDF
    We report a case of Lassa fever in a US traveler who visited rural Liberia, became ill while in country, sought medical care upon return to the United States, and subsequently had his illness laboratory confirmed. The patient recovered with supportive therapy. No secondary cases occurred

    Development of an intervention to expedite cancer diagnosis through primary care: a protocol.

    Get PDF
    BACKGROUND: GPs can play an important role in achieving earlier cancer diagnosis to improve patient outcomes, for example through prompt use of the urgent suspected cancer referral pathway. Barriers to early diagnosis include individual practitioner variation in knowledge, attitudes, beliefs, professional expectations, and norms. AIM: This programme of work (Wales Interventions and Cancer Knowledge about Early Diagnosis [WICKED]) will develop a behaviour change intervention to expedite diagnosis through primary care and contribute to improved cancer outcomes. DESIGN & SETTING: Non-experimental mixed-method study with GPs and primary care practice teams from Wales. METHOD: Four work packages will inform the development of the behaviour change intervention. Work package 1 will identify relevant evidence-based interventions (systematic review of reviews) and will determine why interventions do or do not work, for whom, and in what circumstances (realist review). Work package 2 will assess cancer knowledge, attitudes, and behaviour of GPs, as well as primary care teams' perspectives on cancer referral and investigation (GP survey, discrete choice experiment [DCE], interviews, and focus groups). Work package 3 will synthesise findings from earlier work packages using the behaviour change wheel as an overarching theoretical framework to guide intervention development. Work package 4 will test the feasibility and acceptability of the intervention, and determine methods for measuring costs and effects of subsequent behaviour change in a randomised feasibility trial. RESULTS: The findings will inform the design of a future effectiveness trial, with concurrent economic evaluation, aimed at earlier diagnosis. CONCLUSION: This comprehensive, evidence-based programme will develop a complex GP behaviour change intervention to expedite the diagnosis of symptomatic cancer, and may be applicable to countries with similar healthcare systems

    Relational legacies impacting on veteran transition from military to civilian life: trajectories of acquisition, loss and re-formulation of a sense of belonging

    Get PDF
    The veteran cohort has been inextricably linked in the general public's mind by media generated perceptions of high risk and fear of crime, echoed in wider contemporary debates linking issues of place, social identity, social exclusion (Pain 2000) and a loss of belonging in wider communities (Walklate 1998). Despite the growing interest in the longer term outcomes of transition from military to civilian life from policy-makers, practitioners and academics, few qualitative studies explore the social and relational impacts of this transitional experience on those who have experienced it. Tensions and frustrations expressed by ex-forces personnel, engaging in addictions services with a history of engagement in the criminal justice sector, are explored through the lens of belongingness, loss and related citizenship frameworks to expose temporal impacts on the acquisition, loss and reformulation of a sense of belonging across the life course. The relevance of a significant loss of belonging in the transition from military to civilian life is useful, given the widely accepted damaging consequences of having this need thwarted. This paper concludes that a broader understanding of this largely disenfranchised grief (Doka, 2002) can enable more informed reflexive opportunities to facilitate a valued military veteran citizenship status and thereby contribute to the formulation of current policy debates concerning the veteran question

    Forced, not voluntary, exercise effectively induces neuroprotection in stroke

    Get PDF
    Previous treadmill exercise studies showing neuroprotective effects have raised questions as to whether exercise or the stress related to it may be key etiologic factors. In this study, we examined different exercise regimens (forced and voluntary exercise) and compared them with the effect of stress-only on stroke protection. Adult male Sprague-Dawley rats (n = 65) were randomly assigned to treatment groups for 3 weeks. These groups included control, treadmill exercise, voluntary running wheel exercise, restraint, and electric shock. Levels of the stress hormone, corticosterone, were measured in the different groups using ELISA. Animals from each group were then subjected to stroke induced by a 2-h middle cerebral artery (MCA) occlusion followed by 48-h reperfusion. Infarct volume was determined in each group, while changes in gene expression of stress-induced heat shock proteins (Hsp) 27 and 70 were compared using real-time PCR between voluntary and treadmill exercise groups. The level of corticosterone was significantly higher in both stress (P < 0.05) and treadmill exercise (P < 0.05) groups, but not in the voluntary exercise group. Infarct volume was significantly reduced (P < 0.01) following stroke in rats exercised on a treadmill. However, the amelioration of damage was not duplicated in voluntary exercise, even though running distance in the voluntary exercise group was significantly (P < 0.01) longer than that of the forced exercise group (4,828 vs. 900 m). Furthermore, rats in the electric shock group displayed a significantly increased (P < 0.01) infarct volume. Expression of both Hsp 27 and Hsp 70 mRNA was significantly increased (P < 0.01) in the treadmill exercise group as compared with that in the voluntary exercise group. These results suggest that exercise with a stressful component, rather than either voluntary exercise or stress alone, is better able to reduce infarct volume. This exercise-induced neuroprotection may be attributable to up-regulation of stress-induced heat shock proteins 27 and 70

    Dopaminergic Influences on Emotional Decision Making in Euthymic Bipolar Patients

    Get PDF
    We recently reported that the D2/D3 agonist pramipexole may have pro-cognitive effects in euthymic patients with bipolar disorder (BPD); however, the emergence of impulse-control disorders has been documented in Parkinson\u27s disease (PD) after pramipexole treatment. Performance on reward-based tasks is altered in healthy subjects after a single dose of pramipexole, but its potential to induce abnormalities in BPD patients is unknown. We assessed reward-dependent decision making in euthymic BPD patients pre- and post 8 weeks of treatment with pramipexole or placebo by using the Iowa Gambling Task (IGT). The IGT requires subjects to choose among four card decks (two risky and two conservative) and is designed to promote learning to make advantageous (conservative) choices over time. Thirty-four BPD patients completed both assessments (18 placebo and 16 pramipexole). Baseline performance did not differ by treatment group (F = 0.63; p = 0.64); however, at week 8, BPD patients on pramipexole demonstrated a significantly greater tendency to make increasingly high-risk, high-reward choices across the five blocks, whereas the placebo group\u27s pattern was similar to that reported in healthy individuals (treatment x time x block interaction,
    corecore