Are antipsychotic prescribing patterns different in older and younger adults? : a survey of 1357 psychiatric inpatients in Toronto

Objective: To compare antipsychotic prescribing patterns in younger (aged 59 years or younger) and older (aged 60 years or older) patients with psychotic or mood disorders. Method: Pharmacy records of all patients discharged from the Centre for Addiction and Mental Health over a 21-month period were reviewed. A total of 1357 patients who were prescribed an antipsychotic at the time of their discharge were included in the analysis (956 with a primary psychotic disorder and 401 with a primary mood disorder). World Health Organization-defined daily doses were used as the standardized dosing unit. Results: Both in patients with a primary psychotic disorder and in patients with a primary mood disorder, the prescribing patterns were similar in older and younger patients, with no statistical difference in the proportions receiving first-generation antipsychotics, second-generation antipsychotics (SGAs), multiple antipsychotics, or long-acting (depot) antipsychotics. Overall, the mean daily antipsychotic doses were lower only in the older group of patients with a primary mood disorder. However, the mean dose of SGAs was about 30% lower in older patients in both diagnostic groups. Regardless of age, patients with a mood disorder were prescribed lower doses of antipsychotics than those with a psychotic disorder. Conclusions: Our data suggest that older patients are prescribed lower antipsychotic dosages primarily when using SGAs. This finding emphasizes the need for dose-finding studies assessing both the efficacy and the safety of antipsychotics in older patients with a psychotic or mood disorder.peer-reviewe

A re-appraisal of the reliability of the 20 m multi-stage shuttle run test

This is the author's PDF version of an article published in European journal of applied physiology in 2007. The original publication is available at www.springerlink.co

Redressing the balance: Commentary on “Examining motor learning in older adults using analogy instruction” by Tse, Wong, and Masters (2017)

Tse, Wong, and Masters (2017) recently published a study that indicated that analogy instruction may help older adults acquire resilient motor skills that require reduced cognitive processing compared to traditional explicit instruction. Although we do not dispute that analogy learning may prove useful for this population, in this commentary, we contend that there are methodological issues in this research—which are shared with previous studies comparing analogy and explicit instruction—that potentially limit ecological validity, impact the size of detected effects, influence the development and understanding of associated theory, and, as such, constrain resulting recommendations for applied practice. Of particular concern is the comparison of the single-item analogy instruction to the list of nine explicit instructions, which risks conflating the effects of the type of instruction with the volume of instruction. We further argue that the benefits of analogy may be more parsimoniously explained by the instruction’s capability to succinctly convey skill (rather than its potential for limiting reinvestment), but that this capability may only be realised if the to-be-learned analogy is relevant and readily understood by the learner. Finally, we suggest that research in this area must look to incorporate more rigorous methods that compare experimental conditions to representative reference groups that allow us to explore how and when to deploy the myriad instructional tools available to practitioners and learners

Buprenorphine-Naloxone in the Treatment of Codeine Dependence: a Scoping Review of Clinical Case Presentations

Misuse of prescribed and over the counter (OTC) codeine containing medicines is an increasing public health concern in recent times. Studies have called for low threshold treatment services for individuals experiencing codeine dependence using buprenorphine naloxone therapy. We present a scoping review of clinical case presentation literature on the use of buprenorphine-naloxone in the treatment of codeine dependence. Seven records (four single case studies and three case series) on codeine dependence treated with buprenorphine-naloxone were included. Five themes emerged following a review of the cases for the treatment of codeine dependence with buprenorphine-naloxone. They are: (1) Patient Profiles; (2) History of Codeine Misuse; (3) Medical Problems; (4) Use of Other Substances; and (5) Buprenorphine-naloxone in the treatment of Codeine Dependence. The review highlights the complexities of patients with regards to pain, psychiatric illness, poly substance use and iatrogenic dependence, with findings encouraging in terms of patient stabilisation and recovery

Spreading continents kick-started plate tectonics

International audienceStresses acting on cold, thick and negatively buoyant oceanic litho- sphere are thought to be crucial to the initiation of subduction and the operation of plate tectonics, which characterizes the present- day geodynamics of the Earth. Because the Earth’s interior was hotter in the Archaean eon, the oceanic crust may have been thicker, thereby making the oceanic lithosphere more buoyant than at present, and whether subduction and plate tectonics occurred during this time is ambiguous, both in the geological record and in geodynamic models. Here we show that because the oceanic crust was thick and buoyant5, early continents may have produced intra-lithospheric gravitational stresses large enough to drive their gravitational spreading, to initiate subduction at their margins and to trigger episodes of subduction. Our model predicts the co-occurrence of deep to progressively shallower mafic volcanics and arc magmatism within continents in a self-consistent geodynamic framework, explaining the enigmatic multimodal volcanism and tectonic record of Archaean cratons. Moreover, our model predicts a petrological stratification and tectonic structure of the sub-continental lithospheric mantle, two predictions that are consistent with xenolith and seismic studies, respectively, and consistent with the existence of a mid-lithospheric seismic discontinuity. The slow gravitational collapse of early continents could have kick-started transient episodes of plate tectonics until, as the Earth’s interior cooled and oceanic lithosphere became heavier, plate tectonics became self-sustaining

Seven naturally variant loci serve as genetic modifiers of Lamc2jeb induced non-Herlitz junctional Epidermolysis Bullosa in mice.

Epidermolysis Bullosa (EB) is a group of rare genetic disorders that compromise the structural integrity of the skin such that blisters and subsequent erosions occur after minor trauma. While primary genetic risk of all subforms of EB adhere to Mendelian patterns of inheritance, their clinical presentations and severities can vary greatly, implying genetic modifiers. The Lamc2jeb mouse model of non-Herlitz junctional EB (JEB-nH) demonstrated that genetic modifiers can contribute substantially to the phenotypic variability of JEB and likely other forms of EB. The innocuous changes in an \u27EB related gene\u27, Col17a1, have shown it to be a dominant modifier of Lamc2jeb. This work identifies six additional Quantitative Trait Loci (QTL) that modify disease in Lamc2jeb/jeb mice. Three QTL include other known \u27EB related genes\u27, with the strongest modifier effect mapping to a region including the epidermal hemi-desmosomal structural gene dystonin (Dst-e/Bpag1-e). Three other QTL map to intervals devoid of known EB-associated genes. Of these, one contains the nuclear receptor coactivator Ppargc1a as its primary candidate and the others contain related genes Pparg and Igf1, suggesting modifier pathways. These results, demonstrating the potent disease modifying effects of normally innocuous genetic variants, greatly expand the landscape of genetic modifiers of EB and therapeutic approaches that may be applied

Impact of large-scale distribution and subsequent use of free nicotine patches on primary care physician interaction

Background Large-scale distribution efforts of free nicotine replacement therapy (NRT) have been documented to be cost-effective interventions for increasing smoking quit rates. However, despite nearly a dozen studies evaluating their effectiveness, none have examined whether free NRT provision promotes further primary care help-seeking and the impact that it may have on cessation efforts. Methods In the context of a randomized controlled trial, a secondary analysis was conducted on 1000 adult regular smokers randomized to be mailed a 5-week supply of nicotine patches or to a no intervention control group. Recipients and users of free nicotine patches at an 8 week follow-up were successfully case matched to controls based on age, gender, baseline level of nicotine dependence and intent to quit (n = 201 per group). Differences in physician interaction between the two groups were evaluated at both 8 week and 6 month follow-ups. The impact of physician interaction on self-reported smoking abstinence at each follow-up was also examined. Results Although no differences in physician interaction were noted between groups at the 8 week follow-up, at the 6 month follow-up, nicotine patch users reported greater frequency of discussing smoking with their physician (43.9%), as compared to the control group (30.3%) (p = 0.011). Across both groups, over 90% of those that discussed smoking with a physician were encouraged to quit and approximately 70% were provided with additional support. Separate ANOVAs revealed no significant impact of physician interaction on cessation (p > 0.05), regardless of group or follow-up period, however, at the 6 month follow-up, nicotine patch users who discussed cessation with a physician had made serious quit attempts at significantly greater rates (72.6%), compared to controls (49.1%) (p = 0.007). Conclusions Irrespective of group, the majority of smokers in the present study did not discuss cessation with their physician. Recipients and users of nicotine patches however, were more likely to discuss smoking with their physician, suggesting that the provision of free NRT particularly to those who are likely to use it may facilitate opportunities for benefits beyond the direct pharmacological effects of the medication.This research was funded by the Canadian Institutes of Health Research (FRN:111209

Proteome profile and functional classification of proteins in Arabidopsis thaliana (Landsberg erecta) mature pollen

Proteome analysis of mature Arabidopsis thaliana (Landsberg erecta ecotype) pollen was conducted using two-dimensional gel electrophoresis and mass spectrometry. A total of 960 spots were resolved on pH 4–7 IPG strips and 110 distinct proteins were identified from 150 spots analyzed. The identified proteins were categorized based on their functional role in the pollen, which included proteins involved in energy regulation, defense-related mechanisms, calcium-binding and signaling, cytoskeletal formation, pollen allergens, glycine-rich proteins (GRPs), and late embryogenesis abundant (LEA) proteins. These proteins potentially play important roles in pollen function at maturity and during subsequent germination and tube growth. Some of the proteins identified were related to known pollen-specific transcripts, while some were similar to proteins found in the seed. In this study, 66 new proteins were identified which were not reported in two other recent studies on Arabidopsis pollen, 17 proteins were common in all three studies, and 35 or 26 proteins reported here had an overlap with one or the other two studies. These differences may be attributed to the methods of protein extraction, spot selection for analysis, and the ecotype used. Together, the three studies provide a broad spectrum of the Arabidopsis pollen proteome

The effect of intraocular pressure during phacoemulsification in patients with either diabetic retinopathy or glaucoma; a randomized controlled feasibility trial

\ua9 The Author(s) 2025.Purpose: To investigate whether performing phacoemulsification with a lower infusion pressure using the Centurion active sentry system affects surgical efficiency, complications and a range of clinical and imaging parameters compared to the higher pressures routinely used in patients with cataract and concomitant diabetic retinopathy and glaucoma. Setting: Sunderland Eye Infirmary, Sunderland, United Kingdom. Design: Masked observer randomized controlled feasibility trial. Methods: Patients with cataracts undergoing routine phacoemulsification with either diabetic retinopathy or primary open-angle glaucoma of any severity were included and randomized to an infusion pressure of 30 (‘LOW’) or 60 (‘HIGH’) mmHg. All other fluidic settings were standardized. Surgical metrics and a range of imaging and clinical variables were measured pre- and postoperatively on days 1, 21 and 40. Results: Seventy eyes from 70 patients underwent surgery and completed follow-up. Forty-one patients had diabetic retinopathy and 29 had glaucoma. There was no difference in any of the recorded surgical metrics including cumulative dissipated energy (CDE) between the two randomization groups (mean CDE 6.5 versus 6.1 percent seconds in the HIGH and LOW groups respectively, p = 0.68). There were no patients in either group with posterior capsule rupture or other intraoperative complications. There was no significant difference in the number of patients with raised intraocular pressure (IOP) on day 1. Seven (21.2%) patients in the LOW and 5 (13.3%) in the HIGH group had slit lamp detectable corneal oedema on day 1, which had all resolved by day 21. There were no between group differences for visual acuity, IOP, corneal thickness, and any of the optical coherence tomography (OCT) acquired measures at any of the time points. The foveal avascular zone perimeter and area were significantly smaller on day 21 than at baseline in the HIGH group as compared to the LOW group (P = 0.03 and 0.04 respectively), with a corresponding increase in the superficial vascular plexus density (p = 0.04). Conclusion: Using an infusion pressure of 30mmHg with standardized aspiration fluidic settings on the Centurion active sentry system did not decrease surgical efficiency or increase complication rates compared to a pressure of 60mmHg. The lower infusion pressure may cause fewer short-term changes in the retinal microvasculature, the long-term significance of which is unknown. Key messages: What is known Traditionally, phacoemulsification has been carried out under relatively high intraocular pressure (IOP) to mitigate the effects of post occlusion aspiration surge during lens removal. A new enhanced phacoemulsification fluidics system has reduced surge allowing surgeons to operate at considerably lower, and more physiological IOP levels. What is new In patients undergoing phacoemulsification for moderate cataracts with either co-existing diabetic retinopathy or glaucoma, an IOP of 30 mmHg using the Centurion active sentry system did not result in any decrease in surgical efficiency or increase in complication rates compared to a higher pressure of 60 mmHg. Lower IOP phacoemulsification caused less short-term changes in the retinal microvasculature than higher pressure, the long-term significance of which is unknown and further study is needed