Clozapine use in personality disorder and intellectual disability

Purpose: Clozapine is a well-known antipsychotic medication licensed for treatment-resistant schizophrenia, but there is limited research available to suggest its efficacy in the context of personality disorder and intellectual disabilities presenting with high-risk behaviour with or without psychotic symptoms. The purpose of this paper is to raise awareness of the benefits of using clozapine in patients with intellectual disabilities and personality disorder that present with a complex picture of serious risk of harm to both their life and the lives of others. Design/methodology/approach: The authors present five patients with intellectual disabilities and serious life-threatening challenging behaviour whom were started on clozapine as part of their multidisciplinary treatment plan to manage their presentation. The authors completed baseline assessment of five main symptom domains and then repeated this assessment following treatment with clozapine. Findings: In all five cases use of clozapine was objectively associated with an improvement in symptomatology, quality of life and a safe transfer to the community. Originality/value: The findings suggest that judicious use of clozapine could be considered as one of the effective pharmacological strategies in the management of patients with intellectual disabilities and personality disorder who present with serious life-threatening challenging behaviours

Seasonal changes in xylem sap flow rate in mature rubber plants

The rate of flow of xylem sap of mature rubber tree was recorded round the clock continuously for two years using a Granier type thermal dissipation probe (TDP). The measurements were made on 19 year old trees of the clones, RRII 5 and PR 255 with a mean girth of 78 and 82 cm, respectively at 150 cm above bud union. Overall, the average rate of water mining by a tree was to the tune of 22 3 L day-1. The diurnal and seasonal differences in the sap flow rate were very evident which responded to the ambient weather conditions such as intensity of sunlight, temperature, rainfall etc. In the morning hours, as the sunlight intensity increased there was a corresponding sharp increase in sap flow rate which attained maximum level around mid-day. In the evening, as the light intensity declined, the sap flow rate also declined. The maximum rate of sap flow per day was recorded in December and the minimum in February coinciding with complete defoliation of the canopy. Taking a mean water consumption of 22 L tree-1day-1 and assuming there are 400 trees ha-1, the water consumption works out to be in the range of 1-2 mm day-1. This is significantly lesser than the potential evapo-transpiration (ET) of an open field in this traditional region. Taking the long-term average rain fall in the region (3000 mm year-1), it can be seen that the water loss due to transpiration (T) by the trees amounted only to 11 per cent of the annual rainfall

Seasonal changes in xylem sap flow rate in mature rubber plants

The rate of flow of xylem sap of mature rubber tree was recorded round the clock continuously for two years using a Granier type thermal dissipation probe (TDP). The measurements were made on 19 year old trees of the clones, RRII 5 and PR 255 with a mean girth of 78 and 82 cm, respectively at 150 cm above bud union. Overall, the average rate of water mining by a tree was to the tune of 22 3 L day-1. The diurnal and seasonal differences in the sap flow rate were very evident which responded to the ambient weather conditions such as intensity of sunlight, temperature, rainfall etc. In the morning hours, as the sunlight intensity increased there was a corresponding sharp increase in sap flow rate which attained maximum level around mid-day. In the evening, as the light intensity declined, the sap flow rate also declined. The maximum rate of sap flow per day was recorded in December and the minimum in February coinciding with complete defoliation of the canopy. Taking a mean water consumption of 22 L tree-1day-1 and assuming there are 400 trees ha-1, the water consumption works out to be in the range of 1-2 mm day-1. This is significantly lesser than the potential evapo-transpiration (ET) of an open field in this traditional region. Taking the long-term average rain fall in the region (3000 mm year-1), it can be seen that the water loss due to transpiration (T) by the trees amounted only to 11 per cent of the annual rainfall

Seasonal Variation of Atmospheric Aerosols over Prominent Hotspot Regions in South India by Employing MODIS Data

Mounting the amount of aerosols in the atmosphere is a subject of deep concern all over the globe. This elevated level of aerosol concentrations has proven direct impact on the radiative forcing (Gadhavi and Jayaraman A, 2004) and subsequent climate change. Thus it becomes imperative to study the inter-annual and seasonal variations of aerosols with the aid of remote sensing method by employing MODIS data. This paper pertains to the study of seasonal variations of Aerosol Optical Depths over three different locations which are lying along the same latitude in South India. The five year (2005-2009) observation is presented and it reveals that aerosol abundance has strong dependence on the geography, environment and local climate at a specific region. The variation of aerosol abundance is found to be higher at the coastal region than the region surrounded by land mass

Variation of CO Column over North Kerala by Exploring MOPITT Data

Carbon Monoxide (CO) is one of the prominent pollutant species mainly produced from of fossil fuel burning and motor vehicles. Being a toxic trace gas, it can considerably affect human health. The rapid increase in CO enhances the production of surface ozone which contributes to global warming. This is the first attempt to retrieve the increase in CO over a column of atmosphere up to 100 mb pressure from the surface using MOPITT version 3 of level 2 data. The increase in column abundance of CO observed is correlated with the increase in vehicles in this region and it gives a positive correlation for the four years of observation from 2004. The prominence of this location of north Kerala is that no major industries are sited within this region and the increase in pollution is solely due to anthropogenic activities.ÂÂ

The Significant Role of CO and NOx in the Tropospheric Ozone Chemistry

Ozone being a greenhouse gas, the chemistry of ozone in the troposphere is considered as an emerging area of investigation after global warming became a reality. The potential role of ozone and its dynamics that changes the atmospheric composition can be retrieved only with the aid of photochemical processes involved in the atmosphere. The various possible chemical reactions that take place at different locations in the atmosphere can significantly change the weather pattern. This is an attempt to review some of the prominent features of the photochemistry of the troposphere and stratosphere

Comparing the Safety and Efficacy of a Rapid High-Sensitivity Cardiac Troponin I Protocol Between Hospital-Based and Free-Standing Emergency Departments

Study Objectives: Current high sensitivity cardiac troponin I (hs-cTnI) research has been conducted almost exclusively in hospital-based emergency department (HBED) settings and the translation of these protocols into free-standing emergency departments (FSED) has yet to be explored. This study compared the safety and efficacy of applying a rapid-rule out protocol using hs-cTnI for exclusion of acute myocardial infarction (AMI) in HBEDs and FSEDs. Methods: This was a secondary analysis of a randomized trial of patients evaluated for possible AMI in 9 emergency departments (ED) from July 2020 through March 2021. The trial arms included a new 0/1-hour rapid protocol using hs-cTnI versus standard care, which used a 0/3-hour protocol without reporting hs-cTnI values below the 99th percentile. The primary outcome was safe ED discharge, defined as discharge with no death or AMI within 30-days. Analysis included a mixed-effect model adjusting for demographic variables. Results: There was a statistically significant difference in safe discharges from FSEDs when comparing the standard care arm (86.2%) to the rapid rule-out protocol (95.1%). There was a statistically significant reduction in FSED length of stay with application of a rapid rule-out protocol at 3.43 hours vs. 3.97 hours using standard care. The percentage of patients who ruled-out with their initial hs-cTnI (\u3c4 ng/L) at FSEDs (74%) was also significantly larger when compared to HBEDs (54%). Conclusion: Implementation of a hs-cTnI rapid 0/1-hour protocol to evaluate for AMI in FSEDs is feasible and had greater impact on safe ED discharge and length of stay compared to HBEDs

A Four-Year Multi-Center Retrospective Observational Study of Pediatric Emergency Medical Services Utilization in a Large Metropolitan Health System

Study Objectives: The COVID-19 pandemic has significantly decreased pediatric emergency department (ED) utilization. The objective of this study was to quantify the characteristics of pediatric EMS utilization both before and during the COVID-19 pandemic in a metropolitan health care system. Methods: We performed a multi-center, retrospective observational study of all pediatric ED visits between 1/1/2018 and 12/31/2021, that presented to one of nine EDs within our health system. The data were sorted by mode of arrival; children arriving to the ED via EMS, or arrival by other means. Data collection included a variety of demographic and clinical variables. We compared overall pediatric ED patients’ arrival methods as well as ED and EMS volumes by year using a binomial test with a null hypothesis that the population proportion equals 50%. Analysis compared ED mode of arrival, admission rate, and Emergency Severity Index (ESI) triage scores using chi-square tests. Results: There were 201,313 pediatric ED encounters for 118,744 unique patients meeting the inclusion criteria. There were 8,815 (4.38%) children who arrived via EMS compared to 192,498 (95.62%) children who arrived by other means (p \u3c 0.0001). Children who arrived via EMS had a higher admission rate of 22.27% (1963) compared to 5.9% (11,351, p \u3c 0.0001). ESI among children arriving via EMS was higher, with 44.3% (3847) having ESI 1 or 2 triage scores compared to 8.8% (16,790) for children arriving by other means (p \u3c 0.0001). Overall pediatric ED mortality was 0.03% (61 deaths), with 86.9% (53) of those children arriving via EMS (p \u3c 0.0001). Pediatric ED and EMS volumes in 2018 and 2019 pre-pandemic were 127,652 ED visits and 5,306 EMS visits, respectively, compared to 73,661 and 3,509 visits in 2020 and 2021. This represents a 42.3% overall reduction in pediatric ED visits (p \u3c 0.0001) and a 33.9% reduction in pediatric EMS visits (p \u3c 0.0001). Conclusion: Approximately 5% of pediatric ED encounters in our health system arrived via EMS. These children appeared to have higher acuity presentations and required inpatient services more often than children who arrived by other means. Pediatric ED and EMS encounters have decreased substantially since the onset of the pandemic

Understanding the dopant induced effects on SFX-MeOTAD for perovskite solar cells: a spectroscopic and computational investigation

SFX-MeOTAD [2,2′,7,7′-Tetrakis(N,N-di(4-methoxyphenyl)amino)-spiro-(fluorene-9,9′-xanthene)] (also known as X60) has emerged as a cost-effective alternative to the ubiquitous, but excessively-expensive, spiro-MeOTAD hole transport material (HTM) in perovskite solar cells. Using its pre-oxidised dicationic salt, SFX-(TFSI)2, a controlled concentration dependent conductivity tuning of this HTM without the requirement of air (oxygen) exposure is carried out. This study details the modifications in optical and electrical properties of this low cost HTM as a function of concentration of the dicationic salt (0-100 mol %) using UV-Vis absorption and electrical conductivity measurements. X-ray absorption and photoelectron spectroscopic investigations have been carried out to elucidate the role of the dicationic salt on the enhanced electronic properties of SFX-MeOTAD. By incorporating the dicationic SFX-(TFSI)2 it was shown that the conductivity of SFX-MeOTAD increased by 4 orders of magnitude from 2.55 × 10-8 S cm-1 to 9.4 × 10-4 S cm-1 using an optimal dopant concentration of 20.5 mol %. The degree of oxidation of SFX-MeOTAD was determined through UV-Vis absorption and consolidated by the computational calculations. XPS study reveal that doping SFX-MeOTAD with SFX(TFSI)2 results not only in oxidation of the HTM but also leads to variation in the local chemistry around carbon and nitrogen which directly influence the conductivity of the doped films. NEXAFS studies indicates that doping enhances the aromatic nature of the molecule initially but increasing the dopant concentration further affects the aromaticity and possibly the π stacking, similar to the trend seen in dopant concentration dependent conductivity of the SFX-MeOTAD films. These findings have implications on the choice of dopant concentration and counterions more generally for triarylamine based HTMs