Do antipsychotic dose reduction trials result in worsening behavior among nursing home residents with dementia: a systematic review of the literature

Background: While federal regulations require gradual dose reduction trials of antipsychotics prescribed for behavior management in nursing home (NH) residents with dementia, widespread concern about precipitating behavioral disturbances limits implementation. We conducted a systematic review of clinical trials reducing antipsychotic drug use in NH residents to determine best dose reduction practices and risk of behavior escalation. Methods: A comprehensive literature search was conducted in MEDLINE, EMBASE, and International Pharmaceutical Abstracts between January 1970 and October 2011 using the terms “antipsychotic agent or neuroleptic agent,” “dementia,” “nursing homes,” and “withdrawal.” One investigator reviewed abstracts for inclusion based on: English-language, human subjects, clinical trial, nursing home site, and ≥5 participants, and reported reduction in medications due to an intervention. We excluded review articles and commentaries and secondary analysis of main trial results. The remaining articles were reviewed by 2 investigators for final inclusion, resulting in 9 articles. Results: The nine articles meeting inclusion criteria included randomized controlled trials of both typical and atypical antipsychotics. Study populations ranged in size from 55 to 183 NH residents with dementia and typically targeted patients who were not psychotic and did not have a history of violent behavior. Gradual dose reduction protocols typically followed a strategy of 50% dose reduction per week for 2-3 sequential weeks. Outcomes measured included behavioral problems, cognitive function, and resumption of antipsychotic medications. All 9 studies reported that the majority of residents randomized to gradual dose reductions of antipsychotics had no overall detrimental effect on functional and cognitive status, or exacerbation of behavioral symptoms. Conclusions: Clinical trials evaluating the withdrawal of antipsychotic medications from NH residents with dementia do not show evidence of rebound behavioral escalation after gradual dose reductions

Two new pulsating low-mass pre-white dwarfs or SX Phenix stars?*

Context. The discovery of pulsations in low-mass stars opens an opportunity for probing their interiors and to determine their evolution, by employing the tools of asteroseismology. Aims. We aim to analyze high-speed photometry of SDSSJ145847.02$+$070754.46 and SDSSJ173001.94$+$070600.25 and discover brightness variabilities. In order to locate these stars in the $T_{\rm eff} - \log g$ diagram we fit optical spectra (SDSS) with synthetic non-magnetic spectra derived from model atmospheres. Methods. To carry out this study, we used the photometric data obtained by us for these stars with the 2.15m telescope at CASLEO, Argentina. We analyzed their light curves and we apply the Discrete Fourier Transform to determine the pulsation frequencies. Finally, we compare both stars in the $T_{\rm eff} - \log g$ diagram, with known two pre-white dwarfs, seven pulsating pre-ELM white dwarf stars, $\delta$ Scuti and SX Phe stars. Results. We report the discovery of pulsations in SDSSJ145847.02$+$070754.46 and SDSSJ173001.94$+$070600.25. We determine their effective temperature and surface gravity to be $T_{\rm eff}$ = 7 972 $\pm$ 200 K, $\log g$ = 4.25 $\pm$ 0.5 and $T_{\rm eff}$ = 7 925 $\pm$ 200 K, $\log g$ = 4.25 $\pm$ 0.5, respectively. With these parameters these new pulsating low-mass stars can be identified with either ELM white dwarfs (with ~ 0.17 Mo) or more massive SX Phe stars. We identified pulsation periods of 3 278.7 and 1 633.9 s for SDSSJ145847.02$+$070754.46 and a pulsation period of 3 367.1 s for SDSSJ173001.94$+$070600.25. These two new objects together with those of Maxted et al. (2013, 2014) indicate the possible existence of a new instability domain towards the late stages of evolution of low-mass white dwarf stars, although their identification with SX Phe stars cannot be discarded.Comment: 5 pages, 5 figures, 1 table, accepted for publication in A&A

Evidence For Temperature Change And Oblique Pulsation From Light Curve Fits Of The Pulsating White Dwarf GD 358

Convective driving, the mechanism originally proposed by Brickhill for pulsating white dwarf stars, has gained general acceptance as the generic linear instability mechanism in DAV and dbV white dwarfs. This physical mechanism naturally leads to a nonlinear formulation, reproducing the observed light curves of many pulsating white dwarfs. This numerical model can also provide information on the average depth of a star's convection zone and the inclination angle of its pulsation axis. In this paper, we give two sets of results of nonlinear light curve fits to data on the dbV GD 358. Our first fit is based on data gathered in 2006 by the Whole Earth Telescope; this data set was multiperiodic containing at least 12 individual modes. Our second fit utilizes data obtained in 1996, when GD 358 underwent a dramatic change in excited frequencies accompanied by a rapid increase in fractional amplitude; during this event it was essentially monoperiodic. We argue that GD 358's convection zone was much thinner in 1996 than in 2006, and we interpret this as a result of a short-lived increase in its surface temperature. In addition, we find strong evidence of oblique pulsation using two sets of evenly split triplets in the 2006 data. This marks the first time that oblique pulsation has been identified in a variable white dwarf star.Delaware Asteroseismic Research CenterNational Science Foundation AST-0909107, AST-0607840Norman Hackerman Advanced Research Program 003658-0255-2007Crystal Trust FoundationMt. Cuba ObservatoryUniversity of DelawareAstronom

Towards a pure ZZ Ceti instability strip

We have observed again two stars inside the ZZ Ceti instability strip that were previously classified as not-observed-to-vary (NOV) by Mukadam et al. (2004) and found them to be low-amplitude variables. Some evidence points to a pure ZZ Ceti instability strip; other evidence contests it. The two stars previously classified as NOV have Sloan Digital Sky Survey (SDSS) spectroscopic effective temperatures that place them inside the ZZ Ceti instability strip, and they were "contaminating" the strip as constant stars, which could indicate that the instability strip was no longer a simple evolutionary stage. A pure instability strip indicates that pulsation is a normal phase which all DAs must go through. We used effective temperatures derived from SDSS optical spectra by comparing them with model atmospheres to look for pulsators through time-resolved photometry and stars previously classified as NOV. Our new results indicate, but do not prove, a pure instability strip, because there are still other NOV stars that need to be observed again. Additionally, we have discovered five other ZZ Ceti stars based on their effective temperatures.Comment: 12 pages, 3 figur

Primeras curvas de luz de estrellas variables ZZ Ceti observadas en el CASLEO

Las estrellas enanas blancas DA variables, o ZZ Ceti, constituyen la familia de enanas blancas pulsantes más numerosa. A partir del advenimiento del Sloan Digital Sky Survey (SDSS) el número de objetos conocidos de esta clase se elevó a 160. Estas estrellas poseen atmósferas ricas en Hidrógeno y se localizan en un rango de temperaturas efectivas entre 10500 y 12300 K. La astrosismología de enanas blancas permite extraer información acerca de la estructura interna y las propiedades globales de estos objetos compactos y antiguos. Esta técnica consiste básicamente en la comparación de los peréodos de pulsación observados con períodos calculados a partir de modelos teóricos representativos. En este trabajo presentamos las primeras curvas de luz resultantes de datos fotométricos de estrellas enanas blancas candidatas a ser variables ZZ Ceti, obtenidos con el telescopio de 2.15 m del CASLEO. Se incluyen también, nuevos peréodos de pulsación y parámetros físicos derivados para las enanas blancas pulsantes ya conocidas: BPM37093, L19-2 y PG1159-035, entre otras.DA white dwarf stars, ZZ Ceti, are the most numerous class among the pulsating white dwarfs. These stars have atmospheres dominated by hydrogen, and effective temperatures between 10500 and 12300 K. Because of the periodic variations of their luminosity, we can use asteroseismology to study the inner structure and the global properties of these compact and old objects. These techniques basically consists on the comparison between the observed pulsation periods and theoretical periods computed from representative models. In this work we present the first light curves and Fourier transforms of the ZZ Ceti stars WD162813+122452 y BPM37093, obtained with the 2,15 m telescope at CASLEO. Observational data and physical parameters derived for some ZZ Ceti observed candidates are also included.Fil: Corti, Mariela A.. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico la Plata. Instituto Argentino de Radioastronomia (i); Argentina. Universidad Nacional de la Plata. Facultad de Ciencias Astronómicas y Geofísicas; ArgentinaFil: Romero, Alejandra D.. Universidade Federal do Rio Grande do Sul; BrasilFil: Kanaan, Antonio. Universidade Federal Da Santa Catarina; BrasilFil: Kepler, S. O.. Universidade Federal do Rio Grande do Sul; BrasilFil: Costa, J. E.. Centro de Previsao de Tempo e Estudos Climaticos. Instituto Nacional de Pesquisas Espaciais; BrasilFil: Córsico, Alejandro H.. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico La Plata. Instituto de Astrofísica de La Plata; Argentina; Argentina. Universidad Nacional de la Plata. Facultad de Ciencias Astronómicas y Geofísicas; ArgentinaFil: Althaus, Leandro G.. Universidad Nacional de la Plata. Facultad de Ciencias Astronómicas y Geofísicas; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico La Plata. Instituto de Astrofísica de La Plata; Argentina; Argentin

Nuevas estrellas pre enanas blancas pulsantes de masa extremadamente baja descubiertas en el CASLEO

The Extremely Low Mass white dwarfs (ELM, M 0.18--0.20 M) could arise after the loss of large amount of mass suffered by a red giant star in a binary system. The low mass white dwarfs have become an important source of study because some of them are pulsating stars. The latter is an unprecedented opportunity to know their interior and the evolutionary channels leading to their origin, by employing asteroseismology. In this paper, we present photometric analysis of data obtained in the CASLEO (Complejo Astronómico El Leoncito) about four new pulsating stars, that according to their surface gravities and effective temperatures, would be pre-ELM white dwarf stars. With this discovery, the number of pulsating pre-ELM white dwarf stars known would increase to six members.Fil: Corti, Mariela Alejandra. Universidad Nacional de la Plata. Facultad de Ciencias Astronómicas y Geofísicas; Argentina. Provincia de Buenos Aires. Gobernación. Comision de Investigaciones Científicas. Instituto Argentino de Radioastronomía. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Instituto Argentino de Radioastronomia; ArgentinaFil: Kanaan, Antonio. Universidade Federal de Santa Catarina; BrasilFil: Corsico, Alejandro Hugo. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Instituto de Astrofísica La Plata. Universidad Nacional de La Plata. Facultad de Ciencias Astronómicas y Geofísicas. Instituto de Astrofísica la Plata; ArgentinaFil: Kepler, S. O.. Universidade Federal do Rio Grande do Sul; BrasilFil: Althaus, Leandro Gabriel. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Instituto de Astrofísica La Plata. Universidad Nacional de La Plata. Facultad de Ciencias Astronómicas y Geofísicas. Instituto de Astrofísica la Plata; ArgentinaFil: Koester, D.. Universität Kiel; AlemaniaFil: Sánchez Arias, Julieta Paz. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Instituto de Astrofísica La Plata. Universidad Nacional de La Plata. Facultad de Ciencias Astronómicas y Geofísicas. Instituto de Astrofísica la Plata; Argentin

Seismology Of A Massive Pulsating Hydrogen Atmosphere White Dwarf

We report our observations of the new pulsating hydrogen atmosphere white dwarf SDSS J132350.28+010304.22. We discovered periodic photometric variations in frequency and amplitude that are commensurate with nonradial g-mode pulsations in ZZ Ceti stars. This, along with estimates for the star's temperature and gravity, establishes it as a massive ZZ Ceti star. We used time-series photometric observations with the 4.1 m SOAR Telescope, complemented by contemporary McDonald Observatory 2.1 m data, to discover the photometric variability. The light curve of SDSS J132350.28+010304.22 shows at least nine detectable frequencies. We used these frequencies to make an asteroseismic determination of the total mass and effective temperature of the star: M-star = 0.88 +/- 0.02 M-circle dot and T-eff = 12,100 +/- 140 K. These values are consistent with those derived from the the optical spectra and photometric colors.CNPqFAPERGS/PronexUS National Science Foundation AST-0909107Norman Hackerman Advanced Research Program 003658-0252-2009MICINN grant AYA08-1839/ESPESF EUROCORES Program EuroGENESIS (MICINN grant) EUI2009-04170Generalitat de Catalunya 2009SGR315EU-FEDER fundsAGENCIA through the Programa de Modernizacion Tecnologica BID 1728/OC-ARCONICET PIP 112-200801-00940Astronom

Two new pulsating low-mass pre-white dwarfs or SX Phoenicis stars?

Context. The discovery of pulsations in low-mass stars opens an opportunity to probe their interiors and determine their evolution by employing the tools of asteroseismology. Aims. We aim to analyse high-speed photometry of SDSS J145847.02+070754.46 and SDSS J173001.94+070600.25 and discover brightness variabilities. In order to locate these stars in the Teff - log g diagram, we fit optical spectra (SDSS) with synthetic non-magnetic spectra derived from model atmospheres. Methods. To carry out this study, we used the photometric data we obtained for these stars with the 2.15 m telescope at CASLEO, Argentina. We analysed their light curves and applied the discrete Fourier transform (FT) to determine the pulsation frequencies. Finally, we compare both stars in the Teff - log g diagram, with two known pre-white dwarfs and seven pulsating pre-ELM white dwarf stars, δ Scuti, and SX Phe stars Results. We report the discovery of pulsations in SDSS J145847.02+070754.46 and SDSS J173001.94+070600.25. We determine their effective temperature and surface gravity to be Teff = 7972 ± 200 K, log g = 4.25 ± 0.5 and Teff = 7925 ± 200 K, log g = 4.25 ± 0.5, respectively. With these parameters, these new pulsating low-mass stars can be identified with either ELM white dwarfs (with ∼0.17 MO) or more massive SX Phe stars. We identified pulsation periods of 3278.7 and 1633.9 s for SDSS J145847.02+070754.46 and a pulsation period of 3367.1 s for SDSS J173001.94+070600.25. These two new objects, together with those of Maxted et al. (2013, 2014), indicate the possible existence of a new instability domain towards the late stages of evolution of low-mass white dwarf stars, although their identification with SX Phe stars cannot be discarded.Facultad de Ciencias Astronómicas y GeofísicasInstituto Argentino de Radioastronomí

Dissemination of Evidence-based Atypical Antipsychotic Information to Nursing Homes

Background: Accumulating evidence demonstrates minimal benefit and increased risk of off-label use of atypical antipsychotic medications for dementia-related behaviors. Optimal strategy for disseminating evidence-based guides to nursing home (NH) stakeholders is unclear. Our objective is to describe the impact of differing dissemination efforts in Connecticut NHs. Methods: Forty-three Connecticut NHs were randomized to one of 3 arms receiving incrementally intensive dissemination strategies of the Agency for Healthcare Research and Quality Comparative Effectiveness Review Summary Guide on the off-label use of atypical antipsychotic drugs, which was included in a toolkit informed by a needs assessment of NHs. All NHs received the paper-based toolkit and notifications regarding the online toolkit. Additionally, Arm 2 received individualized quarterly audit and feedback reports with atypical antipsychotic prescribing rates; Arm 3 received in-person educational visits and audit and feedback reports. Toolkit reach was assessed using interviews with NH leadership and staff. Online toolkit use was assessed using Google analytics. Results: Eighty leaders and 222 direct care staff were interviewed. Leadership and direct care staff in Arm 3 NHs were more likely to be familiar with the toolkit that those in Arm 1 (p=0.008) and Arm 2 (p Conclusions: Intensive dissemination, using multi-pronged approach including academic detailing and direct care staff trainings, appeared to be associated with higher familiarity with paper-based toolkit, but not Internet-based use of the toolkit in the NH setting