A case of severe adolescent obsessive-compulsive disorder treated with inpatient hospitalization, risperidone and sertraline

Background: The initial treatment of obsessive-compulsive disorder (OCD) has generally been limited to serotonergic agents, cognitive-behavioral therapy (CBT), or a combination of the two. These findings were supported by the POTS study for OCD in children and adolescents. However, treatment with serotonergic agents or CBT can take several weeks before benefit is seen; severe cases of OCD may require more immediate treatment. Case report: The authors present a case of severe OCD in an adolescent that required immediate treatment due to her critical medical condition. The patient's symptoms included not eating or taking medications or fluids by mouth due to fears of contamination. A medical hospitalization was previously required due to dehydration. As treatment with an SSRI would not have quick enough onset and the patient was initially resistant to participating in CBT, the patient was psychiatrically hospitalized and first started on liquid risperidone. After several doses of risperidone, the patient was able to participate in CBT and start sertraline. Discussion: The authors discuss the differential diagnosis of such a patient, including the continuum of OCD symptoms and psychotic symptoms. The authors discuss the different treatment options, including the utilization of inpatient psychiatric hospitalization. The authors discuss the potential risks and benefits of using atypical antipsychotics in lieu of benzodiazepines for the initial treatment of severe adolescent OCD. The authors also discuss other current treatment recommendations and rationale for the treatment that was pursued. Conclusions: This patient received benefit of her symptoms relatively quickly with psychiatric hospitalization and an atypical antipsychotic. The diagnosis of a psychotic disorder should be considered. These treatment options must be weighed against the risks of atypical antipsychotics, including extrapyramidal symptoms, weight gain, and metabolic syndrome; benzodiazepines also have their risks and benefits. Additionally, the cost of time and finances of inpatient hospitalization must be considered. More research is needed regarding the short- and long-term efficacy and safety of antipsychotics in the treatment of OCD in the child and adolescent population

Program Assessment: A Structured, Systematic, Sustainable Example for Civil Engineers

As the outcomes-based accreditation process continues to evolve since its implementation six years ago, the standards for program assessment and continuous improvement are progressively being raised and many schools struggle with what is required. This paper offers an example of a structured, systematic, sustainable assessment program implemented by the civil engineering program at the United States Military Academy. The process is compatible with the university assessment process and has eight years of documented results. The assessment includes fast loop and slow loop cycles that accomplish very different things. Other features include standardized course assessments, embedded indicators, performance measures for all outcomes and objectives, advisory boards, feedback from all constituencies, faculty involvement, and closing of the feedback loop

What children know about the source of their knowledge without reporting it as the source

We argue that, amongst 3- to 5- year-olds, failure to report the source of knowledge recently acquired in answer to “How do you know…?” is due to a specific failure to make a causal inference, in line with source monitoring theory but not fuzzy trace theory. In three Experiments, children (N = 37; 30; 59) identified a hidden toy by seeing, feeling, or by being told, having had two modes of access on each trial, one informative (e.g. seeing a toy identified by colour) and the other uninformative (e.g. being told the toy’s colour by the Experimenter who had only felt it). Children who answered the know question wrongly nevertheless reported accurately who saw and who felt the toy, and what the well-informed player had said. They also realised when the Experimenter’s uninformative access implied their own knowledge was unreliable, suggesting precocious working understanding of knowledge sources

DPYD and fluorouracil-based chemotherapy: Mini review and case report

5-Fluorouracil remains a foundational component of chemotherapy for solid tumour malignancies. While considered a generally safe and effective chemotherapeutic, 5-fluorouracil has demonstrated severe adverse event rates of up to 30%. Understanding the pharmacokinetics of 5-fluorouracil can improve the precision medicine approaches to this therapy. A single enzyme, dihydropyrimidine dehydrogenase (DPD), mediates 80% of 5-fluorouracil elimination, through hepatic metabolism. Importantly, it has been known for over 30-years that adverse events during 5-fluorouracil therapy are linked to high systemic exposure, and to those patients who exhibit DPD deficiency. To date, pre-treatment screening for DPD deficiency in patients with planned 5-fluorouracil-based therapy is not a standard of care. Here we provide a focused review of 5-fluorouracil metabolism, and the efforts to improve predictive dosing through screening for DPD deficiency. We also outline the history of key discoveries relating to DPD deficiency and include relevant information on the potential benefit of therapeutic drug monitoring of 5-fluorouracil. Finally, we present a brief case report that highlights a limitation of pharmacogenetics, where we carried out therapeutic drug monitoring of 5-fluorouracil in an orthotopic liver transplant recipient. This case supports the development of robust multimodality precision medicine services, capable of accommodating complex clinical dilemmas

Preliminary age-based life history characteristics of the dogtooth tuna, Gymnosarda unicolor (Ruppell, 1838), in the southwest Pacific Ocean

Dogtooth tuna, Gymnosarda unicolor were sampled off the east coast of Australia (southwest Pacific Ocean) from 2007 to 2012. Ages were determined by examining thin transverse sections of their sagittal otoliths and were based on counts of alternating opaque and translucent zones (annual growth increments). Growth was rapid during the first year of life, after which growth in length was much reduced. Parameters of the constrained von Bertalanffy growth function (fork length-at-age) were L∞ = 1164.77 (mm, FL) and K = 0.44 year−1. Preliminary estimates of longevity indicate a maximum observed age of at least 20 years. There was a high degree of variation in the observed length and age of sexual maturity for G. unicolor. Despite this variation, the size at 50% maturity for female G. unicolor estimated in this study was 713 mm FL (<2 years of age). The diet of G. unicolor is very broad and covers a range of fish species. The life history characteristics of G. unicolor overall, indicate that this species may be somewhat resilient to fishing. However, reports of localised depletions, in association with heavy targeting by sports fishers, low effective population sizes and patchy recruitment indicate that this species is particularly vulnerable to overfishing

Assessment of novel gear designs to reduce interactions between species

This project tested modified gillnets designed by commercial net fishers in the Queensland East Coast Inshore Finfish Fishery (ECIFF) to try and identify gears that would mitigate and/or improve interactions between fishing nets and Species of Conservation Interest (SOCI). The study also documents previously unrecognised initiatives by pro-active commercial net fishers that reflect a conservation-minded approach to their fishing practices, which is the opposite of what is perceived publicly. Between 2011 and 2014, scientists from James Cook University and the Queensland Department of Agriculture and Fisheries teamed with commercial fishers representing the Queensland Seafood Industry Association and the Moreton Bay Seafood Industry Association to conduct field trials of various modified net designs under normal fishery conditions. Trials were conducted in Moreton Bay (southern part of the fishery) and Bowling Green Bay (northern) and tested different net designs developed by fishers to improve the nature of interactions between net fishing gear and SOCI

Millisecond optical phase modulation using multipass configurations with liquid-crystal devices

We present two configurations for analog 0 to 2π optical phase modulation using liquid crystals (LCs), each of which achieve switching times that are 1 ms or less. One configuration is based on the switching behavior of a so-called nematic pi cell, and the other is based on the flexoelectro-optic effect in chiral nematic LCs when operated in the uniform lying helix geometry. Both configurations exploit a multipass optical arrangement to enhance the available optical phase range, while maintaining a fast switching speed. Moreover, these devices can be operated at or close to room temperature. Experimental data are found to be in good agreement with results predicted from theory for these multipass phase-modulation configurations

Characterization of large tilt-angle flexoelectro-optic switching in chiral nematic liquid crystal devices

The “flexoelastic ratio”, which is the ratio of the effective flexoelectric coefficient to the elasticcoefficients, is commonly used to characterize the electro-optic behavior of chiral nematic liquid crystal(LC) devices that exhibit flexoelectro-optic switching. In the uniform lying helix configuration, thiselectro-optic effect is manifested as a rapid (~100 s) rotation of the macroscopic optic axis when anelectric field is applied perpendicular to the helix axis of the chiral nematic LC and is attractive for bothintensity and phase modulation devices. There has been renewed interest in this electro-effect as newLC materials and mixtures have been developed that exhibit large tilt angles, , of the optic axis ( ≥45°) whilst maintaining a fast response time. In this Letter, we consider the relevance of the flexoelasticratio when characterizing the performance of the devices and find that an alternative ratio is required tocharacterize materials that can switch by = ±45° when the pitch is constrained. We show that for largetilt angles of the optic axis the values for the new and conventional flexoelastic ratios measurablydiverge. In addition, a simple way of determining this new characteristic ratio is presented that involvesdetermining the electric field amplitude at the point the transmission levels are the same for bothpositive and negative electric field polarities

Effect of gut microbiome modulation on muscle function and cognition:the PROMOTe randomised controlled trial

Studies suggest that inducing gut microbiota changes may alter both musclephysiology and cognitive behaviour. Gut microbiota may play a role in bothanabolic resistance of older muscle, and cognition. In this placebo controlleddouble blinded randomised controlled trial of 36 twin pairs (72 individuals),aged ≥60, each twin pair are block randomised to receive either placebo orprebiotic daily for 12 weeks. Resistance exercise and branched chain aminoacid (BCAA) supplementation is prescribed to all participants. Outcomes arephysical function and cognition. The trial is carried out remotely using videovisits, online questionnaires and cognitive testing, and posting of equipmentand biological samples. The prebiotic supplement is well tolerated and resultsin a changed gut microbiome [e.g., increased relative Bifidobacterium abundance].There is no significant difference between prebiotic and placebo forthe primary outcome of chair rise time (β=0.579; 95% CI −1.080-2.239p = 0.494). The prebiotic improves cognition (factor score versus placebo(β = −0.482; 95% CI,−0.813, −0.141; p = 0.014)). Our results demonstrate thatcheap and readily available gut microbiome interventions may improve cognitionin our ageing population. We illustrate the feasibility of remotelydelivered trials for older people, which could reduce under-representation ofolder people in clinical trials. ClinicalTrials.gov registration: NCT04309292