Sex differences in plasma clozapine and norclozapine concentrations in clinical practice and in relation to body mass index and plasma glucose concentrations: a retrospective survey

Background Clozapine is widely prescribed and, although effective, can cause weight gain and dysglycemia. The dysmetabolic effects of clozapine are thought to be more prevalent in women with this gender on average attaining 17 % higher plasma clozapine concentrations than men. Methods We investigated the relationship between dose, body mass index (BMI), plasma glucose concentration, and plasma clozapine and N-desmethylclozapine (norclozapine) concentrations in 100 individuals with a severe enduring mental illness. Results Mean (10th/90th percentile) plasma clozapine concentrations were higher for women [0.49 (0.27–0.79) mg/L] compared with men [0.44 (0.26–0.70) mg/L] (F = 2.2; p = 0.035). There was no significant gender difference in the prescribed clozapine dose. BMI was significantly higher in women [mean (95 % CI) = 34.5 (26.0–45.3)] for females compared with 32.5 (25.2–41.0) for males. Overall, BMI increased by 0.7 kg/m 2 over a mean follow-up period of 210 days. A lower proportion, 41 % of women had a fasting blood glucose ≤6.0 mmol/L (<6.0 mmol/L is defined by the International Diabetes Federation as normal glucose handling), compared with 88 % of men (χ2  = 18.6, p < 0.0001). Conclusions We have shown that mean BMI and blood glucose concentrations are higher in women prescribed clozapine than in men. Women also tended to attain higher plasma clozapine concentrations than men. The higher BMI and blood glucose in women may relate to higher tissue exposure to clozapine, as a consequence of sex differences in drug metabolism

Proceedings of the conference on the Apalachicola River drainage system, 23-24 April 1976 Gainesville, Florida

(Document has 177 pages.

POTENTIAL MARKET IMPACTS OF SOYBEAN RUST

Crop Production/Industries,

Quality of life among adolescents with cerebral palsy: what does the literature tell us?

Developmental Medicine & Child Neurology, 49(3): pp. 225-231.This review describes trends in quality of life (QOL) and health-related quality of life (HRQOL) among adolescents with cerebral palsy (CP). Twenty original articles were identified by a structured search of multiple databases and grouped by design. Categories included descriptive crosssectional studies (n=8), measurement validation studies (n=9), and exploratory qualitative studies (n=3). Several trends were apparent. First, individuals with CP are reported to have decreased QOL and HRQOL compared with a normative population in some but not all areas of well-being. Second, functional status measures such as the Gross Motor Function Classification System are reliable indicators of variations in physical function, but do not correlate consistently with psychosocial well-being. Third, although adolescents with CP have different life issues than adults or children, limited research on factors associated with QOL and HRQOL has been described for this age range. We recommend that clinicians and researchers interested in assessing well-being among adolescents with CP include participants from across the spectrum of motor impairment, allow adolescents to self-report whenever possible, and assess adolescents independently, rather than including them with individuals from other age groups or clinical populations

Associations between Delta-8 THC and Four Loko retail availability in Fort Worth, Texas

Alcohol and cannabis are two of the most widely used substances among young people, and availability and price are two of the most significant determinants of use. Four Loko products contain up to 5.5 standard alcoholic drinks in a single can, are one of the least expensive ready-to-drink alcohol products on the market and are commonly consumed by underage drinkers. Delta-8 THC is a psychoactive substance with no federal regulations regarding minimum purchase age, ingredients and synthesis, marketing, and testing for potency or contaminants. Delta-8 THC products can be inexpensively synthesized and are sold for low prices. Given that young people often use both products, and use of these products can result in negative consequences, it is important to understand whether these products are being sold in the same stores, which would indicate the presence of niche stores marketing high-risk, youth-oriented substances. This study included 360 locations with off-premise beer or beer/wine licenses in Fort Worth, Texas. Locations were called and asked whether they sold Delta-8 THC. Four Loko’s availability was determined using the manufacturer’s website. A logistic regression model examined associations between the availability of Delta-8 THC and Four Loko. Of the 360 locations, 38% sold Four Loko and 9% sold Delta-8 THC. Delta-8 THC availability was significantly associated with higher odds of Four Loko availability (OR=2.15,95%CI=1.05,4.43). Given the associations between the retail availability of Delta-8 THC and Four Loko, policies that limit access to such products, including near schools and in stores that youth patronize, may be warranted

Quality of life and health-related quality of life of adolescents with cerebral palsy

Developmental Medicine & Child Neurology, 49(7): pp. 516-521.This study assessed quality of life (QOL) and health-related quality of life (HRQOL) of 203 adolescents with cerebral palsy (111 males, 92 females; mean age 16y [SD 1y 9mo]). Participants were classified using the Gross Motor Function Classification System (GMFCS), as Level I (n=60), Level II (n=33), Level III (n=28), Level IV (n=50), or Level V (n=32). QOL was assessed by self (66.5%) or by proxy (33.5%) with the Quality of Life Instrument for People With Developmental Disabilities, which asks about the importance and satisfaction associated with the QOL domains of Being, Belonging, and Becoming; HRQOL was captured through proxy reports with the Health Utilities Index, Mark 3 (HUI3), which characterizes health in terms of eight attributes, each having five or six ordered levels of function. GMFCS level was not a source of variation for QOL domain scores but was significantly associated with the eight HRQOL attributes and overall HUI3 utility scores (p<0.05). Some QOL domain scores varied significantly by type of respondent (self vs proxy; p<0.05). Overall HUI3 utility values were significantly but weakly correlated with QOL Instrument scores for Being (r=0.37), Belonging (r=0.17), Becoming (r=0.20), and Overall QOL (r=0.28), and thus explain up to 14% of the variance (r2). These findings suggest that although QOL and HRQOL are somewhat related conceptually, they are different constructs and need to be considered as separate dimensions of the lives of people with functional limitations

ImSET 3.1: Impact of Sector Energy Technologies Model Description and User's Guide

This 3.1 version of the Impact of Sector Energy Technologies (ImSET) model represents the next generation of the previously-built ImSET model (ImSET 2.0) that was developed in 2005 to estimate the macroeconomic impacts of energy-efficient technology in buildings. In particular, a special-purpose version of the Benchmark National Input-Output (I-O) model was designed specifically to estimate the national employment and income effects of the deployment of Office of Energy Efficiency and Renewable Energy (EERE)–developed energy-saving technologies. In comparison with the previous versions of the model, this version features the use of the U.S. Bureau of Economic Analysis 2002 national input-output table and the central processing code has been moved from the FORTRAN legacy operating environment to a modern C++ code. ImSET is also easier to use than extant macroeconomic simulation models and incorporates information developed by each of the EERE offices as part of the requirements of the Government Performance and Results Act. While it does not include the ability to model certain dynamic features of markets for labor and other factors of production featured in the more complex models, for most purposes these excluded features are not critical. The analysis is credible as long as the assumption is made that relative prices in the economy would not be substantially affected by energy efficiency investments. In most cases, the expected scale of these investments is small enough that neither labor markets nor production cost relationships should seriously affect national prices as the investments are made. The exact timing of impacts on gross product, employment, and national wage income from energy efficiency investments is not well-enough understood that much special insight can be gained from the additional dynamic sophistication of a macroeconomic simulation model. Thus, we believe that this version of ImSET is a cost-effective solution to estimating the economic impacts of the development of energy-efficient technologies

Sequential single doses of cisapride, erythromycin, and metoclopramide in critically ill patients intolerant to enteral nutrition: A randomized, placebo-controlled, crossover study

Objective: To evaluate the comparative efficacy of enteral cisapride, metoclopramide, erythromycin, and placebo for promoting gastric emptying in critically ill patients with intolerance to gastric enteral nutrition (EN). Design: A randomized, crossover study. Setting: Adult medical intensive care unit at a university-affiliated private hospital and trauma intensive care unit at a university teaching hospital. Patients: Ten adult, critically ill, mechanically ventilated patients not tolerating a fiber-containing EN product defined as a single aspirated gastric residual volume \u3e150 mL or two aspirated gastric residual volumes \u3e120 mL during a 12-hr period. Interventions: Patients received 10 mg of cisapride, 200 mg of erythromycin ethylsuccinate, 10 mg of metoclopramide, and placebo as 20 mL of sterile water every 12 hrs over 48 hrs. Acetaminophen solution (1000 mg) was administered concurrently. Gastric residual volumes were assessed, and plasma acetaminophen concentrations were serially determined by TDx between 0 and 12 hrs to evaluate gastric emptying. Measurements and Main Results: Gastric residual volumes during the study were not significantly different between agents. No differences in area under the concentration vs. time curve or elimination rate constant were identified between agents. Metoclopramide and cisapride had a significantly shorter mean residence time of absorption than erythromycin (6.3 ± 4.5 [SEM] mins and 10.9 ± 5.8 vs. 30.1 ± 4.5 mins, respectively [p \u3c .05]). Metoclopramide (9.7 ± 15.3 mins) had a significantly shorter time to peak concentration compared with erythromycin and placebo (60.7 ± 8.1 and 50.9 ± 13.5 mins, respectively [p \u3c .05]). The time to onset of absorption was significantly shorter for metoclopramide vs. cisapride (5.7 ± 4.5 vs. 22.9 ± 5.7 mins [p \u3c .05]). Conclusion: In critically ill patients intolerant to EN, single enteral doses of metoclopramide or cisapride are effective for promoting gastric emptying in critically ill patients with gastric motility dysfunction. Additionally, metoclopramide may provide a quicker onset than cisapride