The complications of alcoholism: an epidemiological, statistical and nutritional study on alcoholics admitted to a general hospital psychiatric unit

1) A study of alcoholics admitted to a general hospital psychiatric unit over a period of 4 years (527 males and 148 females) is presented. The various demographic, social and drinking characteristics are given and the male and female alcoholics are compared. The complications and associated physical conditions were studied epidemiologically and with special reference to blood vitamin levels in an attempt to elucidate their aetiology. A follow-up study was carried out to find the causes of death in these patients and at the same time the prognosis studied to ascertain its relationship to these complications.2) There were more alcoholics in social classes I, II and 7 and in the widowed and divorced. The age pattern of alcoholics was similar to other studios with an almost normal distribution curve around the mean of 43.7 years in males and 45.4 years in females. The religion of the patients was similar to that of the surrounding area.3) Over half of the alcoholics were admitted as emergencies} a quarter did not finish the course of in-patient treatment and one-fifth of the total were re-admitted during the four year period.4) Whisky was the preferred drink among male alcoholics and "fortified wine" among females. The former had been drinking for considerably longer than the latter (a mean of 16.2 years compared to 9.9 years) and they drank, on average, much more, (the equivalent of a bottle of whisky a day compared to the equivalent of a bottle of sherry per day).5) A quarter of all the patients were given an associated psychiatric diagnosis of which most were in the personality disorder group.6) There was a large incidence of behavioural disturbance, so that only one-third of men, but two-thirds of women, had no previous convictions. However more women (33%) than men (18%) had previous suicide attempts and more abused drugs than men (25% compared to 11%.7) Male and female alcoholics were shown to have a number of differences especially in drinking habits noted above. Female alcoholics were older, and they were admitted via other hospital wards or by Alcoholics Anonymous, They stayed longer in hospital and were admitted more frequently. They had more spouses who were alcoholic than males. They showed more evidence of malnutrition in the form of weight loss and clinical signs of nutritional disease and they had a higher incidence of alcoholic dementia and of the "rare" neuropsychiatric disorders. They had a lower incidence of alcoholic epilepsy, delirium tremens, alcoholic hallucinosis and E.E.G. abnormalities, as well as hepatitis and previous gastric operations, but similar incidences of cirrhosis, neuropathy and anaemia8) Only 18% of patients had no associated physical condition. Almost one-fifth of the patients had each of the following: anaemia, peripheral neuropathy, gastritis, hepatitis, severe withdrawal signs and E.C.G. abnormalities and one-tenth had cirrhosis. These results are very similar to other studies despite differences in drinking habits and social class. There were only 8 patients who had had previous venereal disease and 4 who had previous pancreatic disease.9) There was no objective evidence of withdrawal in 40% of the patients, on the other hand 20% had severe effects including delirium tremens. Alcoholics with delirium tremens tended to have associated cirrhosis, anaemia, peripheral neuropathy and epilepsy, as well as abnormal levels of whole blood thiamine and serum folate.More female patients had alcoholic dementia which was related to increased age, increased length of excess drinking and peripheral neuropathy as well as subnormal whole blood thiamine and nicotinic acid levels.Alcoholic epilepsy was associated with delirium tremens and with drug abuse, abnormal levels of S.G.O.T., S.G.P.T., serum proteins, whole blood thiamine and serum folate levels.Alcoholic hallucinosis was associated only with paranoid psychosis though there were more patients in this group with raised S.G.O.T. levels and low whole blood thiamine levels.Thus the alcoholic psychoses as a whole appear to have a relationship to nutritional factors.10) Peripheral neuropathy was associated with delirium tremens, cirrhosis and dementia. Food intake was poorer in these patients and on admission they had more evidence of wight loss, whole blood thiamine levels were low in 70% of the patients and there was an increase of abnormal protein levels. These findings confirm that nutritional factors are of importance in the condition, but there was also a relationship with the increased daily amount of alcohol, especially of fortified wine, and with the length of time of excess alcohol intake .`11) Whereas cirrhosis was related to delirium tremens, peripheral neuropathy, alcoholic cardiomyopathy and E.C.G. abnormalities, acute liver disease was related to no other physical condition. Similarly an increased number of cirrhotics load abnormal whole blood thiamine levels which were not found in patients with acute liver disease. Patients with cirrhosis were older and had been drinking for longer than other alcoholic patients.12) Gastritis, diagnosed on clinical grounds, was found in 17% of these alcoholics, was only related in male patients to various behavioral abnormalities. Most patients with gastric operations, found in 11% of male alcoholics and 4.5% of female alcoholics had their operations years after the start of heavy drinking. There was evidence of an increased incidence of peptic ulceration in these alcoholics.15) Alcoholic cardiomyopathy was present in only nine male alcoholics, all of whom had been drinking to excess for over 20 years and had a heavy daily intake of alcohol. However 113 patients were shown to have E.C.G. abnormalities usually of a minor degree.14) Anaemia was found in one-fifth of the patients, but was varied in nature, though in two-thirds of female alcoholics and a half of male alcoholics it was iron deficient in type. It was associated with increased alcohol intake, especially "crude spirits". Nutritional factors were important and there was an association with cirrhosis and delirium tremens.15) Female alcoholics were shown to have more evidence of nutritional deficiencies on most of the parameters utilised than male alcoholics. It would seem that nutritional deficiency is important in delirium tremens, alcoholic dementia, alcoholic epilepsy, cirrhosis and peripheral neuropathy.16) The average length of follow-up was four years, 10% of patients were untraced. Twenty-five per cent of patients were found to be improved, 20% worsened and 10% had died. The indicators of good prognosis were those in social classes I and II compared to social class V, decreased length of drinking and absence of behavioral abnormalities. Female patients did no better than male patients.17) Hale patients died mainly from cirrhosis, cardiovascular or respiratory disorders, including carcinoma of the bronchus, whereas females were much more likely to commit suicide.18) There were many associated physical and behavioral abnormalities in this group of alcoholic in-patients. No clear pattern as to exact aetiology of the different conditions emerged though nutritional factors appear to play a part in the conditions which are classically considered to be the "complications" of alcoholism

A perspective on using experiment and theory to identify design principles in dye-sensitized solar cells

Dye-sensitized solar cells (DSCs) have been the subject of wide-ranging studies for many years because of their potential for large-scale manufacturing using roll-to-roll processing allied to their use of earth abundant raw materials. Two main challenges exist for DSC devices to achieve this goal; uplifting device efficiency from the 12 to 14% currently achieved for laboratory-scale ‘hero’ cells and replacement of the widely-used liquid electrolytes which can limit device lifetimes. To increase device efficiency requires optimized dye injection and regeneration, most likely from multiple dyes while replacement of liquid electrolytes requires solid charge transporters (most likely hole transport materials – HTMs). While theoretical and experimental work have both been widely applied to different aspects of DSC research, these approaches are most effective when working in tandem. In this context, this perspective paper considers the key parameters which influence electron transfer processes in DSC devices using one or more dye molecules and how modelling and experimental approaches can work together to optimize electron injection and dye regeneration. This paper provides a perspective that theory and experiment are best used in tandem to study DSC device

Randomized clinical trial of a brief and extensive dyadic intervention for advanced cancer patients and their family caregivers

Background Few intervention programs assist patients and their family caregivers to manage advanced cancer and maintain their quality of life (QOL). This study examined (i) whether patient–caregiver dyads (i.e., pairs) randomly assigned to a brief or extensive dyadic intervention (the FOCUS Program) had better outcomes than dyads randomly assigned to usual care and (ii) whether patients' risk for distress and other factors moderated the effect of the brief or extensive program on outcomes. Methods Advanced cancer patients and their caregivers ( N  = 484 dyads) were stratified by patients' baseline risk for distress (high versus low), cancer type (lung, colorectal, breast, or prostate), and research site and then randomly assigned to a brief (three‐session) or extensive (six‐session) intervention or control. The interventions offered dyads information and support. Intermediary outcomes were appraisals (i.e., appraisal of illness/caregiving, uncertainty, and hopelessness) and resources (i.e., coping, interpersonal relationships, and self‐efficacy). The primary outcome was QOL. Data were collected prior to intervention and post‐intervention (3 and 6 months from baseline). The final sample was 302 dyads. Repeated measures MANCOVA was used to evaluate outcomes. Results Significant group by time interactions showed that there was an improvement in dyads' coping ( p  < 0.05), self‐efficacy ( p  < 0.05), and social QOL ( p  < 0.01) and in caregivers' emotional QOL ( p  < 0.05). Effects varied by intervention dose. Most effects were found at 3 months only. Risk for distress accounted for very few moderation effects. Conclusions Both brief and extensive programs had positive outcomes for patient–caregiver dyads, but few sustained effects. Patient–caregiver dyads benefit when viewed as the ‘unit of care’. Copyright © 2012 John Wiley & Sons, Ltd.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/96760/1/pon3036.pd

One class classification as a practical approach for accelerating π–π co-crystal discovery

Machine learning using one class classification on a database of existing co-crystals enables the identification of co-formers which are likely to form stable co-crystals, resulting in the synthesis of two co-crystals of polyaromatic hydrocarbons.</p

Global commitments to conserving and monitoring genetic diversity are now necessary and feasible

Global conservation policy and action have largely neglected protecting and monitoring genetic diversity—one of the three main pillars of biodiversity. Genetic diversity (diversity within species) underlies species’ adaptation and survival, ecosystem resilience, and societal innovation. The low priority given to genetic diversity has largely been due to knowledge gaps in key areas, including the importance of genetic diversity and the trends in genetic diversity change; the perceived high expense and low availability and the scattered nature of genetic data; and complicated concepts and information that are inaccessible to policymakers. However, numerous recent advances in knowledge, technology, databases, practice, and capacity have now set the stage for better integration of genetic diversity in policy instruments and conservation efforts. We review these developments and explore how they can support improved consideration of genetic diversity in global conservation policy commitments and enable countries to monitor, report on, and take action to maintain or restore genetic diversity

Gaining the PROMIS perspective from children with nephrotic syndrome: a Midwest pediatric nephrology consortium study

Background and objectives Nephrotic syndrome (NS) represents a common disease in pediatric nephrology typified by a relapsing and remitting course and characterized by the presence of edema that can significantly affect the health-related quality of life in children and adolescents. The PROMIS pediatric measures were constructed to be publically available, efficient, precise, and valid across a variety of diseases to assess patient reports of symptoms and quality of life. This study was designed to evaluate the ability of children and adolescents with NS to complete the PROMIS assessment via computer and to initiate validity assessments of the short forms and full item banks in pediatric NS. Successful measurement of patient reported outcomes will contribute to our understanding of the impact of NS on children and adolescents. Design This cross-sectional study included 151 children and adolescents 8-17 years old with NS from 16 participating institutions in North America. The children completed the PROMIS pediatric depression, anxiety, social-peer relationships, pain interference, fatigue, mobility and upper extremity functioning measures using a web-based interface. Responses were compared between patients experiencing active NS (n = 53) defined by the presence of edema and patients with inactive NS (n = 96) defined by the absence of edema. Results All 151 children and adolescents were successfully able to complete the PROMIS assessment via computer. As hypothesized, the children and adolescents with active NS were significantly different on 4 self-reported measures (anxiety, pain interference, fatigue, and mobility). Depression, peer relationships, and upper extremity functioning were not different between children with active vs. inactive NS. Multivariate analysis showed that the PROMIS instruments remained sensitive to NS disease activity after adjusting for demographic characteristics. Conclusions Children and adolescents with NS were able to successfully complete the PROMIS instrument using a web-based interface. The computer based pediatric PROMIS measurement effectively discriminated between children and adolescents with active and inactive NS. The domain scores found in this study are consistent with previous reports investigating the health-related quality of life in children and adolescents with NS. This study establishes known-group validity and feasibility for PROMIS pediatric measures in children and adolescents with NS

Global commitments to conserving and monitoring genetic diversity are now necessary and feasible

Global conservation policy and action have largely neglected protecting and monitoring genetic diversity—one of the three main pillars of biodiversity. Genetic diversity (diversity within species) underlies species’ adaptation and survival, ecosystem resilience, and societal innovation. The low priority given to genetic diversity has largely been due to knowledge gaps in key areas, including the importance of genetic diversity and the trends in genetic diversity change; the perceived high expense and low availability and the scattered nature of genetic data; and complicated concepts and information that are inaccessible to policymakers. However, numerous recent advances in knowledge, technology, databases, practice, and capacity have now set the stage for better integration of genetic diversity in policy instruments and conservation efforts. We review these developments and explore how they can support improved consideration of genetic diversity in global conservation policy commitments and enable countries to monitor, report on, and take action to maintain or restore genetic diversity

Global commitments to conserving and monitoring genetic diversity are now necessary and feasible

Global conservation policy and action have largely neglected protecting and monitoring genetic diversity—one of the three main pillars of biodiversity. Genetic diversity (diversity within species) underlies species’ adaptation and survival, ecosystem resilience, and societal innovation. The low priority given to genetic diversity has largely been due to knowledge gaps in key areas, including the importance of genetic diversity and the trends in genetic diversity change; the perceived high expense and low availability and the scattered nature of genetic data; and complicated concepts and information that are inaccessible to policymakers. However, numerous recent advances in knowledge, technology, databases, practice, and capacity have now set the stage for better integration of genetic diversity in policy instruments and conservation efforts. We review these developments and explore how they can support improved consideration of genetic diversity in global conservation policy commitments and enable countries to monitor, report on, and take action to maintain or restore genetic diversity

Global commitments to conserving and monitoring genetic diversity are now necessary and feasible

Global conservation policy and action have largely neglected protecting and monitoring genetic diversity—one of the three main pillars of biodiversity. Genetic diversity (diversity within species) underlies species’ adaptation and survival, ecosystem resilience, and societal innovation. The low priority given to genetic diversity has largely been due to knowledge gaps in key areas, including the importance of genetic diversity and the trends in genetic diversity change; the perceived high expense and low availability and the scattered nature of genetic data; and complicated concepts and information that are inaccessible to policymakers. However, numerous recent advances in knowledge, technology, databases, practice, and capacity have now set the stage for better integration of genetic diversity in policy instruments and conservation efforts. We review these developments and explore how they can support improved consideration of genetic diversity in global conservation policy commitments and enable countries to monitor, report on, and take action to maintain or restore genetic diversity

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London