Pharmacological prevention of postictal agitation after electroconvulsive therapy—A systematic review and meta-analysis

BackgroundPostictal agitation (PIA) after electroconvulsive therapy (ECT) is a serious clinical problem estimated to occur in 7–36% of patients and recur in 19–54% of patients. PIA has the potential to cause dangerous situations for the patient and staff members aside from the financial impact. To date, it is unclear which pharmacological interventions should be used in the management of PIA. This study aimed to systematically review the (preventative) pharmacological treatment options for PIA after ECT.MethodA systematic search was done in PubMed, EMBASE, PsycINFO, and Web of Science from inception until 10 November 2022. We included randomized trials with any pharmacological intervention or comparison and a predefined outcome measure on PIA. Studies that solely included patients with neurodegenerative disorders or stroke were excluded. Data quality was assessed with the RoB2 and GRADE. Meta-analysis was performed if possible. This study was registered on PROSPERO under CRD42021262323.ResultsWe screened 2,204 articles and included 14 studies. Dexmedetomidine was investigated in 10 studies. Alfentanil, lignocaine, esmolol, midazolam, propofol, ketamine, haloperidol, and diazepam were each studied in only one study. Meta-analysis revealed an OR of 0.45 (0.32–0.63), a moderate effect size, in favor of dexmedetomidine than placebo to prevent PIA with very low heterogeneity (I2 = 0%). The certainty of the evidence was moderate. The other interventions studied were all found to have low certainty of evidence.ConclusionFor clinical practice, we believe that our results indicate that dexmedetomidine should be considered for the prevention of PIA in patients that have previously experienced PIA

Climate, soil and land-use based land suitability evaluation for oil palm production in Ghana

In the past decade, oil palm (Elaeis guineensis Jacq.) has become the world’s most important oil crop. The large demand for palm oil has resulted in a rapid expansion of oil palm cultivation across the globe. Because of the dwindling availability of land in Southeast Asia, most expansion of the industry is expected in Central and South America and sub-Saharan Africa, where land with suitable agro-ecological conditions is available. Using Ghana as a case study, a method for evaluating areas that are both suitable and available for oil palm production is presented. Our assessment used spatial data and GIS techniques, and showed that areas with suitable climatic conditions (annual average water deficit <400 mm) is about 20% greater than was previously identified. The observed differences are the result of using different methods to determine suitability, and climate change. A major climatic factor limiting suitability for oil palm production in Ghana is the annual water deficit, with the most suitable areas located in the rainforest and semi-deciduous forest zones with higher rainfall in southern Ghana. Opportunities for large-scale oil palm plantation development is limited, however, because of the lack of availability of large and contiguous tracts of land that are required for commercial plantation oil palm development. A feasible strategy for oil palm expansion is therefore smallholder production, which can make use of smaller parcels of land. Alternatively, oil palm production in Ghana can be increased by yield intensification on land already planted to oil palm. This can also reduce the requirement for further land clearance for new plantations to meet the growing demand for palm oil. Such assessments will be essential for guiding government policy makers and investors considering investments in oil palm development

Yield gap analysis and entry points for improving productivity on large oil palm plantations and smallholder farms in Ghana

Oil palm production must increase in Ghana to meet the increasing demand for palm oil and avoid costly imports. Although maximum fruit bunch (FB) yields of >20 t ha−1 yr−1 are achievable, average FB yields in Ghana are only 7 t ha−1 yr−1. Despite the pressing need to increase palm oil production and improve yields, knowledge of the underlying causes of poor yields in Ghana is lacking. Closing yield gaps in existing plantings in smallholdings and plantations offers great opportunities to increase oil production without area expansion, thus sparing land for other uses. This study sought to understand the magnitude and underlying causes of yield gaps in plantation and smallholder oil palm production systems in Ghana based on a detailed characterization of management practices and yield measurements over a two-year period. Using a boundary line analysis, the water-limited yield (Yw) over a planting cycle was defined as about 21 t ha−1 yr−1 FB, with yield gaps of 15.4 t ha−1 yr−1 FB at smallholder farms and 9.8 t ha−1 yr−1 FB at plantations. Poor management practices, including incomplete crop recovery (i.e., harvesting all suitable crop) and inadequate agronomic management were the main factors contributing to these yield gaps. Productivity losses were further exacerbated by low oil extraction rates by small-scale processors of 12% as compared to 21% by the large-scale processors. The potential losses in annual crude palm oil (CPO) during the crop plateau yield phase therefore exceed 5 and 3 t ha−1 yr−1 for small-scale and large-scale production systems respectively. Investment to reduce yield gaps by appropriate agronomic and yield recovery practices across all production systems, while improving access of smallholder producers to more efficient oil palm processing facilities, can make a significant contribution to closing the supply gap for palm oil in Ghana. The impact of such investments on large-scale plantations could result in a doubling of CPO production. Smallholder farmers could benefit the most with a fourteen-fold increase in CPO production and economic gains of >1 billion US$

Adapting oil palm best management practices to Ghana: opportunities for production intensification.

Smaller yields in Western Australia (WA), Australia, are partly the result of sub-optimal climate conditions and poor management practices. Water stress is the main yield-determining factor outside management control in WA. In order to guide government policy makers and investors, it is essential to know where the most suitable conditions for the expansion of oil palm production in WA exists. Using Ghana as a case study, this paper describes a framework for evaluating areas that are both suitable and available for oil palm production based upon land suitability evaluation methods and geographical information system techniques. The suitability assessment shows that highly fragmented suitable areas for oil palm production in Ghana are limiting the expansion of large-scale plantings. Therefore, a feasible strategy for expansion of smallholder production is needed, provided there are enough and efficient milling facilities to process the fruit. Some recommendations are given for sustainable development of the oil palm sector in Ghana

Refined saddle-point preconditioners for discretized Stokes problems

This paper is concerned with the implementation of efficient solution algorithms for elliptic problems with constraints. We establish theory which shows that including a simple scaling within well-established block diagonal preconditioners for Stokes problems can result in significantly faster convergence when applying the preconditioned MINRES method. The codes used in the numerical studies are available online

Discontinuous Galerkin method for multifluid Euler equations

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/106454/1/AIAA2013-2595.pd

Determinants of Persistence and Tolerance of Carnivores on Namibian Ranches: Implications for Conservation on Southern African Private Lands

Changing land use patterns in southern Africa have potential to dramatically alter the prospects for carnivore conservation. Understanding these influences is essential for conservation planning. We interviewed 250 ranchers in Namibia to assess human tolerance towards and the distribution of large carnivores. Cheetahs (Acinonyx jubatus), leopards (Panthera pardus) and brown hyaenas (Hyaena brunnea) were widely distributed on Namibian farmlands, spotted hyaenas (Crocuta crocuta) had a narrower distribution, and wild dogs (Lycaon pictus) and lions (Panthera leo) are largely limited to areas near source populations. Farmers were most tolerant of leopards and least tolerant of lions, wild dogs and spotted hyaenas. Several factors relating to land use correlated consistently with carnivore-presence and landowner tolerance. Carnivores were more commonly present and/or tolerated where; wildlife diversity and biomass were higher; income from wildlife was higher; income from livestock was lower; livestock biomass was lower; in conservancies; game fencing was absent; and financial losses from livestock depredation were lower. Efforts to create conditions whereby the costs associated with carnivores are lowest, and which confer financial value to them are likely to be the most effective means of promoting carnivore conservation. Such conditions are achieved where land owners pool land to create conservancies where livestock are replaced with wildlife (or where livestock husbandry is improved) and where wildlife generates a significant proportion of ranch income. Additional measures, such as promoting improved livestock husbandry and educational outreach efforts may also help achieve coexistence with carnivores. Our findings provide insights into conditions more conducive to the persistence of and tolerance towards large carnivores might be increased on private (and even communal) lands in Namibia, elsewhere in southern and East Africa and other parts of the world where carnivore conservation is being attempted on private lands

Benefits of wildlife-based land uses on private lands in Namibia and limitations affecting their development

Legislative changes during the 1960s–1970s granted user rights over wildlife to landowners in southern Africa, resulting in a shift from livestock farming to wildlifebased land uses. Few comprehensive assessments of such land uses on private land in southern Africa have been conducted and the associated benefits are not always acknowledged by politicians. Nonetheless, wildlife-based land uses are growing in prevalence on private land. In Namibia wildlife-based land use occurs over c. 287,000 km2. Employment is positively related to income from ecotourism and negatively related to income from livestock. While 87% of meat from livestock is exported $95% of venison from wildlife-based land uses remains within the country, contributing to food security. Wildlife populations are increasing with expansion of wildlife-based land uses, and private farms contain 21–33 times more wildlife than in protected areas. Because of the popularity of wildlife-based land uses among younger farmers, increasing tourist arrivals and projected impacts of climate change on livestock production, the economic output of wildlife-based land uses will probably soon exceed that of livestock. However, existing policies favour livestock production and are prejudiced against wildlife-based land uses by prohibiting reintroductions of buffalo Syncerus caffer, a key species for tourism and safari hunting, and through subsidies that artificially inflate the profitability of livestock production. Returns from wildlife-based land uses are also limited by the failure to reintroduce other charismatic species, failure to develop fully-integrated conservancies and to integrate black farmers sufficiently.TRAFFIC East/Southern Africa and Tom Milliken for instigating this project and the German Federal Ministry for Economic Cooperation and Development and African Wildlife Conservation Fund.http://journals.cambridge.orgam201

Interrogating Associations Between Polygenic Liabilities and Electroconvulsive Therapy Effectiveness

Background: Electroconvulsive therapy (ECT) is the most effective treatment for severe major depressive episodes (MDEs). Nonetheless, firmly established associations between ECT outcomes and biological variables are currently lacking. Polygenic risk scores (PRSs) carry clinical potential, but associations with treatment response in psychiatry are seldom reported. Here, we examined whether PRSs for major depressive disorder, schizophrenia (SCZ), cross-disorder, and pharmacological antidepressant response are associated with ECT effectiveness. Methods: A total of 288 patients with MDE from 3 countries were included. The main outcome was a change in the 17-item Hamilton Depression Rating Scale scores from before to after ECT treatment. Secondary outcomes were response and remission. Regression analyses with PRSs as independent variables and several covariates were performed. Explained variance (R 2) at the optimal p-value threshold is reported. Results: In the 266 subjects passing quality control, the PRS-SCZ was positively associated with a larger Hamilton Depression Rating Scale decrease in linear regression (optimal p-value threshold = .05, R 2 = 6.94%, p < .0001), which was consistent across countries: Ireland (R 2 = 8.18%, p = .0013), Belgium (R 2 = 6.83%, p = .016), and the Netherlands (R 2 = 7.92%, p = .0077). The PRS-SCZ was also positively associated with remission (R 2 = 4.63%, p = .0018). Sensitivity and subgroup analyses, including in MDE without psychotic features (R 2 = 4.42%, p = .0024) and unipolar MDE only (R 2 = 9.08%, p < .0001), confirmed the results. The other PRSs were not associated with a change in the Hamilton Depression Rating Scale score at the predefined Bonferroni-corrected significance threshold. Conclusions: A linear association between PRS-SCZ and ECT outcome was uncovered. Although it is too early to adopt PRSs in ECT clinical decision making, these findings strengthen the positioning of PRS-SCZ as relevant to treatment response in psychiatry