Monitoring and prevalence rates of metabolic syndrome in military veterans with serious mental illness

Background: Cardiovascular disease is the leading cause of mortality among patients with serious mental illness (SMI) and the prevalence of metabolic syndrome-a constellation of cardiovascular risk factors-is significantly higher in these patients than in the general population. Metabolic monitoring among patients using second generation antipsychotics (SGAs)-a risk factor for metabolic syndrome-has been shown to be inadequate despite the release of several guidelines. However, patients with SMI have several factors independent of medication use that predispose them to a higher prevalence of metabolic syndrome. Our study therefore examines monitoring and prevalence of metabolic syndrome in patients with SMI, including those not using SGAs. Methods and Findings: We retrospectively identified all patients treated at a Veterans Affairs Medical Center with diagnoses of schizophrenia, schizoaffective disorder or bipolar disorder during 2005-2006 and obtained demographic and clinical data. Incomplete monitoring of metabolic syndrome was defined as being unable to determine the status of at least one of the syndrome components. Of the 1,401 patients included (bipolar disorder: 822; schizophrenia: 222; and schizoaffective disorder: 357), 21.4% were incompletely monitored. Only 54.8% of patients who were not prescribed SGAs and did not have previous diagnoses of hypertension or hypercholesterolemia were monitored for all metabolic syndrome components compared to 92.4% of patients who had all three of these characteristics. Among patients monitored for metabolic syndrome completely, age-adjusted prevalence of the syndrome was 48.4%, with no significant difference between the three psychiatric groups. Conclusions: Only one half of patients with SMI not using SGAs or previously diagnosed with hypertension and hypercholesterolemia were completely monitored for metabolic syndrome components compared to greater than 90% of those with these characteristics. With the high prevalence of metabolic syndrome seen in this population, there appears to be a need to intensify efforts to reduce this monitoring gap

Clostridium difficile infection.

Infection of the colon with the Gram-positive bacterium Clostridium difficile is potentially life threatening, especially in elderly people and in patients who have dysbiosis of the gut microbiota following antimicrobial drug exposure. C. difficile is the leading cause of health-care-associated infective diarrhoea. The life cycle of C. difficile is influenced by antimicrobial agents, the host immune system, and the host microbiota and its associated metabolites. The primary mediators of inflammation in C. difficile infection (CDI) are large clostridial toxins, toxin A (TcdA) and toxin B (TcdB), and, in some bacterial strains, the binary toxin CDT. The toxins trigger a complex cascade of host cellular responses to cause diarrhoea, inflammation and tissue necrosis - the major symptoms of CDI. The factors responsible for the epidemic of some C. difficile strains are poorly understood. Recurrent infections are common and can be debilitating. Toxin detection for diagnosis is important for accurate epidemiological study, and for optimal management and prevention strategies. Infections are commonly treated with specific antimicrobial agents, but faecal microbiota transplants have shown promise for recurrent infections. Future biotherapies for C. difficile infections are likely to involve defined combinations of key gut microbiota

Global urban environmental change drives adaptation in white clover.

Urbanization transforms environments in ways that alter biological evolution. We examined whether urban environmental change drives parallel evolution by sampling 110,019 white clover plants from 6169 populations in 160 cities globally. Plants were assayed for a Mendelian antiherbivore defense that also affects tolerance to abiotic stressors. Urban-rural gradients were associated with the evolution of clines in defense in 47% of cities throughout the world. Variation in the strength of clines was explained by environmental changes in drought stress and vegetation cover that varied among cities. Sequencing 2074 genomes from 26 cities revealed that the evolution of urban-rural clines was best explained by adaptive evolution, but the degree of parallel adaptation varied among cities. Our results demonstrate that urbanization leads to adaptation at a global scale

Frequency Control Requirements for Reliable Interconnection Frequency Response

In light of changes in how electricity is being both generated and consumed, the Department of Energy’s Lawrence Berkeley National Laboratory (Berkeley Lab) has written a new report analyzing challenges facing the nation’s electric grid and making recommendations for ensuring continued reliability. The report was prepared for the Federal Energy Regulatory Commission (FERC), Office of Electric Reliability, to support ongoing FERC and industry efforts to ensure reliable interconnection frequency response for the three major interconnections in the United States: the Eastern, Western, and Texas Interconnections. The purpose of this study (and its supporting supplemental reports) is to support policymaker and industry understanding of the physical requirements for reliable interconnection frequency response, which is the collective ability of the power system to respond to sudden loss events, such as the loss of a large generator. Grid reliability depends on controlling the power system frequency so that it remains within pre-established, safe operating bounds. Reliability is threatened when a large electric generator or generators experiences a problem and automatically disconnects from the power system; the loss of generation causes an immediate decline in power system frequency. If the remaining, still-connected generators do not respond and rapidly arrest the decline in frequency, power system frequency may decline below established, safe operating bounds and trigger automatic, emergency load shedding to avoid a cascading blackout. The study builds on an earlier study for FERC conducted in 2010

Frequency Control Requirements for Reliable Interconnection Frequency Response

In light of changes in how electricity is being both generated and consumed, the Department of Energy’s Lawrence Berkeley National Laboratory (Berkeley Lab) has written a new report analyzing challenges facing the nation’s electric grid and making recommendations for ensuring continued reliability. The report was prepared for the Federal Energy Regulatory Commission (FERC), Office of Electric Reliability, to support ongoing FERC and industry efforts to ensure reliable interconnection frequency response for the three major interconnections in the United States: the Eastern, Western, and Texas Interconnections. The purpose of this study (and its supporting supplemental reports) is to support policymaker and industry understanding of the physical requirements for reliable interconnection frequency response, which is the collective ability of the power system to respond to sudden loss events, such as the loss of a large generator. Grid reliability depends on controlling the power system frequency so that it remains within pre-established, safe operating bounds. Reliability is threatened when a large electric generator or generators experiences a problem and automatically disconnects from the power system; the loss of generation causes an immediate decline in power system frequency. If the remaining, still-connected generators do not respond and rapidly arrest the decline in frequency, power system frequency may decline below established, safe operating bounds and trigger automatic, emergency load shedding to avoid a cascading blackout. The study builds on an earlier study for FERC conducted in 2010