Effects of Paroxetine and Sertraline on Low-Density Lipoprotein Cholesterol: An Observational Cohort Study

Background: Antidepressant use in US adults increased 3-fold from 2.5% in 1988–94 to 8.1% in 1999–2002, based on National Health and Nutrition Examination Surveys. As the use of antidepressants increases, a comprehensive understanding of the potential health risks that may be associated with their use becomes increasingly important. Objective: This study evaluated the effects of paroxetine and sertraline on low-density lipoprotein cholesterol (LDL-C). Study Design: An observational cohort study (1997–2004) of adults who had taken paroxetine or sertraline for at least 60 continuous days and had ≥2 LDL-C values measured during the study period, one while taking and one while not taking paroxetine or sertraline. A total of 13 634 LDL-C values clustered within 2682 patients were studied. Methods: We conducted mixed model regression analyses to quantify the relationship between antidepressant use and LDL-C values. Results: The number of days taking paroxetine (β = 0.0045; 95% CI 0.0018, 0.0073) and sertraline (β = 0.0074; 95% CI 0.0054, 0.0093) prior to the LDL-C test were related to higher LDL-C values, after accounting for age, sex, year LDL-C was tested, co-morbidity, depression and lipid medication. The number of days that had passed since exposure to paroxetine (β =−0.0013; 95% CI −0.0020, −0.00061) or sertraline (β = −0.00093; 95% CI −0.016, −0.00022) were related to lower LDL-C values. The significant interaction between exposure to an antidepressant and taking a lipid medication demonstrates that the increase in LDL-C values associated with antidepressant use is ameliorated among patients who were taking a lipid medication when LDL-C was measured. Conclusion: Our study showed that long-term use of paroxetine or sertraline may have a measurable adverse impact on cardiovascular risk in adults. Clinical strategies should be used to address cardiovascular risk while maintaining effective treatment of major depression. In light of these findings, attention to LDL-C values should accompany antidepressant use

Assessing Organizational Readiness for Depression Care Quality Improvement: Relative Commitment and Implementation Capability

Background: Depression is a major cause of morbidity and cost in primary care patient populations. Successful depression improvement models, however, are complex. Based on organizational readiness theory, a practice’s commitment to change and its capability to carry out the change are both important predictors of initiating improvement. We empirically explored the links between relative commitment (i.e., the intention to move forward within the following year) and implementation capability. Methods: The DIAMOND initiative administered organizational surveys to medical and quality improvement leaders from each of 83 primary care practices in Minnesota. Surveys preceded initiation of activities directed at implementation of a collaborative care model for improving depression care. To assess implementation capability, we developed composites of survey items for five types of organizational factors postulated to be collaborative care barriers and facilitators. To assess relative commitment for each practice, we averaged leader ratings on an identical survey question assessing practice priorities. We used multivariable regression analyses to assess the extent to which implementation capability predicted relative commitment. We explored whether relative commitment or implementation capability measures were associated with earlier initiation of DIAMOND improvements. Results: All five implementation capability measures independently predicted practice leaders’ relative commitment to improving depression care in the following year. These included the following: quality improvement culture and attitudes (p = 0.003), depression culture and attitudes (p \u3c0.001), prior depression quality improvement activities (p \u3c0.001), advanced access and tracking capabilities (p = 0.03), and depression collaborative care features in place (p = 0.03). Higher relative commitment (p = 0.002) and prior depression quality improvement activities appeared to be associated with earlier participation in the DIAMOND initiative. Conclusions: The study supports the concept of organizational readiness to improve quality of care and the use of practice leader surveys to assess it. Practice leaders’ relative commitment to depression care improvement may be a useful measure of the likelihood that a practice is ready to initiate evidence-based depression care changes. A comprehensive organizational assessment of implementation capability for depression care improvement may identify specific barriers or facilitators to readiness that require targeted attention from implementers

The sizes of mini-voids in the local universe: an argument in favor of a warm dark matter model?

Using high-resolution simulations within the Cold and Warm Dark Matter models we study the evolution of small scale structure in the Local Volume, a sphere of 8 Mpc radius around the Local Group. We compare the observed spectrum of mini-voids in the Local Volume with the spectrum of mini-voids determined from the simulations. We show that the \LWDM model can easily explain both the observed spectrum of mini-voids and the presence of low-mass galaxies observed in the Local Volume, provided that all haloes with circular velocities greater than 20 km/s host galaxies. On the contrary within the LCDM model the distribution of the simulated mini-voids reflects the observed one if haloes with maximal circular velocities larger than 35 km/s host galaxies. This assumption is in contradiction with observations of galaxies with circular velocities as low as 20 km/s in our Local Universe. A potential problem of the LWDM model could be the late formation of the haloes in which the gas can be efficiently photo-evaporated. Thus star formation is suppressed and low-mass haloes might not host any galaxy at all.Comment: 13 pages, 10 figures, version 2, subsection 3.1 added, accepted to MNRA

Correlating the nanostructure and electronic properties of InAs nanowires

The electronic properties and nanostructure of InAs nanowires are correlated by creating multiple field effect transistors (FETs) on nanowires grown to have low and high defect density segments. 4.2 K carrier mobilities are ~4X larger in the nominally defect-free segments of the wire. We also find that dark field optical intensity is correlated with the mobility, suggesting a simple route for selecting wires with a low defect density. At low temperatures, FETs fabricated on high defect density segments of InAs nanowires showed transport properties consistent with single electron charging, even on devices with low resistance ohmic contacts. The charging energies obtained suggest quantum dot formation at defects in the wires. These results reinforce the importance of controlling the defect density in order to produce high quality electrical and optical devices using InAs nanowires.Comment: Related papers at http://pettagroup.princeton.ed

Molecular-scale remnants of the liquid-gas transition in supercritical polar fluids

An electronically coarse-grained model for water reveals a persistent vestige of the liquid-gas transition deep into the supercritical region. A crossover in the density dependence of the molecular dipole arises from the onset of non-percolating hydrogen bonds. The crossover points coincide with the Widom line in the scaling region but extend further, tracking the heat capacity maxima, offering evidence for liquid- and gas-like state points in a "one-phase" fluid. The effect is present even in dipole-limit models suggesting that it is common for all molecular liquids exhibiting dipole enhancement in the liquid phase.Comment: A Letter with Supp. Materia

The diverse evolutionary pathways of post-starburst galaxies

About 35 years ago a class of galaxies with unusually strong Balmer absorption lines and weak emission lines was discovered in distant galaxy clusters(1,2). These objects, alternatively referred to as post-starburst, E+A or k+a galaxies, are now known to occur in all environments and at all redshifts(3-7), with many exhibiting compact morphologies and low-surface brightness features indicative of past galaxy mergers(3,8). They are commonly thought to represent galaxies that are transitioning from blue to red sequence, making them critical to our understanding of the origins of galaxy bimodality(9-14). However, recent observational studies have questioned this simple interpretation(15-18). From observations alone, it is challenging to disentangle the different mechanisms that lead to the quenching of star formation in galaxies. Here we present examples of three different evolutionary pathways that lead to galaxies with strong Balmer absorption lines in the Evolution and Assembly of Galaxies and their Environments (EAGLE) simulation(19,20): classical blue -> red quenching, blue -> blue cycle and red -> red rejuvenation. The first two are found in both post-starburst galaxies and galaxies with truncated star formation. Each pathway is consistent with scenarios hypothesized for observational samples(2,15,18,21,22). The fact that 'post-starburst' signatures can be attained via various evolutionary channels explains the diversity of observed properties, and lends support to the idea that slower quenching channels are important at low redshift(23,24).Peer reviewe

Molecular Dynamics Simulation of Nanoindentation-induced Mechanical Deformation and Phase Transformation in Monocrystalline Silicon

This work presents the molecular dynamics approach toward mechanical deformation and phase transformation mechanisms of monocrystalline Si(100) subjected to nanoindentation. We demonstrate phase distributions during loading and unloading stages of both spherical and Berkovich nanoindentations. By searching the presence of the fifth neighboring atom within a non-bonding length, Si-III and Si-XII have been successfully distinguished from Si-I. Crystallinity of this mixed-phase was further identified by radial distribution functions

Procalcitonin-guided antibiotic use versus a standard approach for acute respiratory tract infections in primary care: study protocol for a randomised controlled trial and baseline characteristics of participating general practitioners [ISRCTN73182671]

BACKGROUND: Acute respiratory tract infections (ARTI) are among the most frequent reasons for consultations in primary care. Although predominantly viral in origin, ARTI often lead to the prescription of antibiotics for ambulatory patients, mainly because it is difficult to distinguish between viral and bacterial infections. Unnecessary antibiotic use, however, is associated with increased drug expenditure, side effects and antibiotic resistance. A novel approach is to guide antibiotic therapy by procalcitonin (ProCT), since serum levels of ProCT are elevated in bacterial infections but remain lower in viral infections and inflammatory diseases. The aim of this trial is to compare a ProCT-guided antibiotic therapy with a standard approach based on evidence-based guidelines for patients with ARTI in primary care. METHODS/DESIGN: This is a randomised controlled trial in primary care with an open intervention. Adult patients judged by their general practitioner (GP) to need antibiotics for ARTI are randomised in equal numbers either to standard antibiotic therapy or to ProCT-guided antibiotic therapy. Patients are followed-up after 1 week by their GP and after 2 and 4 weeks by phone interviews carried out by medical students blinded to the goal of the trial. Exclusion criteria for patients are antibiotic use in the previous 28 days, psychiatric disorders or inability to give written informed consent, not being fluent in German, severe immunosuppression, intravenous drug use, cystic fibrosis, active tuberculosis, or need for immediate hospitalisation. The primary endpoint is days with restrictions from ARTI within 14 days after randomisation. Secondary outcomes are antibiotic use in terms of antibiotic prescription rate and duration of antibiotic treatment in days, days off work and days with side-effects from medication within 14 days, and relapse rate from the infection within 28 days after randomisation. DISCUSSION: We aim to include 600 patients from 50 general practices in the Northwest of Switzerland. Data from the registry of the Swiss Medical Association suggests that our recruited GPs are representative of all eligible GPs with respect to age, proportion of female physicians, specialisation, years of postgraduate training and years in private practice