Lurasidone for the treatment of bipolar depression: an evidence-based review

Bipolar disorder (BD) is a debilitating and difficult-to-treat psychiatric disease that presents a serious burden to patients’ lives as well as health care systems around the world. The essential diagnostic criterion for BD is episodes of mania or hypomania; however, the patients report that the majority of their time is spent in a depressive phase. Current treatment options for this component of BD have yet to achieve satisfactory remission rates. Lurasidone is a drug in the benzisothiazole class approved by the US Food and Drug Administration in June 2013 for the acute treatment of bipolar depression. Its pharmacological profile features high-affinity antagonism at D[subscript 2], 5-HT[subscript 2A], and 5-HT[subscript 7] receptors; moderate-affinity antagonism at α[subscript 2C]-adrenergic receptors; low- to very low-affinity antagonism at α[subscript 1A]-adrenergic, α[subscript 2A]-adrenergic, H[subscript 1], M[subscript 1], and 5-HT[subscript 2C] receptors; and high-affinity partial agonism at 5-HT1A. Preliminary findings from two recent double-blinded clinical trials suggest that lurasidone is efficacious in treating bipolar I depression, with clinical effects manifesting as early as the first 2–3 weeks of treatment (as measured by the Montgomery–Åsberg Depression Rating Scale and Clinical Global Impressions Scale for use in bipolar illness). Its therapeutic benefit appears to be comparable to the current US Food and Drug Administration-indicated treatments: quetiapine and olanzapine–fluoxetine, according to a measure of effect size known as number needed to treat. These studies reported relatively limited extrapyramidal and metabolic side effects as a result of treatment with lurasidone, with the most common side effect being nausea. Safety data drawn from these studies, as well as a more extensive body of schizophrenia research, indicate that in comparison with other atypical antipsychotics, treatment with lurasidone is less likely to result in metabolic side effects such as weight gain or disturbances of serum glucose or lipid levels. Lurasidone holds clinical potential as a novel, efficacious pharmacological treatment for bipolar depression. However, current data on its use for the treatment of BD are limited, and more extensive research, both longer in duration as well as independently conducted, is needed

Public Health Outcomes as a Measure of Efficacy of Syringe Exchange Programs

Introduction. A syringe exchange is a public health intervention that offers nonjudgmental services to intravenous drug users (IVDU), providing clean syringes in exchange for used syringes. While prior studies demonstrated that syringe exchanges can reduce transmission of HIV, hepatitis C, and other blood-borne pathogens, other measures of health improvements have been less studied. Methods. 91 members of Vermont CARES syringe exchange program were surveyed on their healthcare practices. New members were defined asprogram. Results. Long-term members tended to have a primary care provider (PCP). Lack of insurance and fear of judgment were commonly cited reasons for not having a PCP. Long-term members were significantly less likely (p=0.04) to use costly emergency department (ED) services and less likely to reuse their own or another person\u27s needles. Long-term members were more likely to be in addiction treatment and reported a greater desire to abstain from drug use. New members were more likely to obtain hepatitis C and HIV testing in the past year. Discussion. Subjects responded positively to the possibility of accessing PCP services through VT CARES, offering a continuation of the nonjudgmental healthcare environment. Decreased ED visits significantly correlated with longer membership, reflecting the positive impact of the syringe exchange education services on reducing healthcare costs. Decreased testing among long-term members may reflect prior knowledge of their status. Long-term members were less likely to reuse their own needles or ones used by another person, suggesting the distribution of clean syringes encourages safer injection practices.https://scholarworks.uvm.edu/comphp_gallery/1247/thumbnail.jp

Validation of a score tool for measurement of histological severity in juvenile dermatomyositis and association with clinical severity of disease.

OBJECTIVES: To study muscle biopsy tissue from patients with juvenile dermatomyositis (JDM) in order to test the reliability of a score tool designed to quantify the severity of histological abnormalities when applied to biceps humeri in addition to quadriceps femoris. Additionally, to evaluate whether elements of the tool correlate with clinical measures of disease severity. METHODS: 55 patients with JDM with muscle biopsy tissue and clinical data available were included. Biopsy samples (33 quadriceps, 22 biceps) were prepared and stained using standardised protocols. A Latin square design was used by the International Juvenile Dermatomyositis Biopsy Consensus Group to score cases using our previously published score tool. Reliability was assessed by intraclass correlation coefficient (ICC) and scorer agreement (α) by assessing variation in scorers' ratings. Scores from the most reliable tool items correlated with clinical measures of disease activity at the time of biopsy. RESULTS: Inter- and intraobserver agreement was good or high for many tool items, including overall assessment of severity using a Visual Analogue Scale. The tool functioned equally well on biceps and quadriceps samples. A modified tool using the most reliable score items showed good correlation with measures of disease activity. CONCLUSIONS: The JDM biopsy score tool has high inter- and intraobserver agreement and can be used on both biceps and quadriceps muscle tissue. Importantly, the modified tool correlates well with clinical measures of disease activity. We propose that standardised assessment of muscle biopsy tissue should be considered in diagnostic investigation and clinical trials in JDM

Nutrition and Social Eating Habits Among Seniors Living Independently

Background: Older adults have unique nutritional needs due to physiologic changes that occur as part of the normal aging process. Maintaining adequate nutrition has the potential to reduce morbidity and mortality related to chronic disease, fall risk, dementia and Alzheimer’s disease. Aging also poses an increased risk of isolation and lack of social interaction, particularly noted at meal times. Unintentional weight loss is an independent risk factor for early mortality. Social eating is related to higher food intake, and meal programs can improve nutritional risk for vulnerable seniors. We partnered with the Cathedral Square Corporation (CSC) to assess nutrition and social eating in residents at Heineberg Senior Housing in Burlington, VT and conducted focus groups to determine general nutritional concerns and evaluate potential interventions.https://scholarworks.uvm.edu/comphp_gallery/1033/thumbnail.jp

Improving Access to Healthcare for LGBTQ Individuals in Burlington

Studies consistently show that LGBTQ individuals are at higher risk for substance abuse, tobacco use, suicide, HIV, and chronic health conditions. The Community Health Centers of Burlington recently created a specialty clinic called the Be You Clinic, which will focus on delivering healthcare to LGBTQ persons, by LGBTQ-affirmative and –knowledgeable providers. This project sought to spread awareness of this new clinic by advertising.https://scholarworks.uvm.edu/fmclerk/1359/thumbnail.jp

Aerial Surveillance and the Fourth Amendment – California v. Ciraolo

This is the published version.Law enforcement officials have increasingly turned to aerial surveillance as a means of combating crime. Aerial surveillance often enables police to view areas that they otherwise would be unable to view without a warrant. Consequently, considerable conflict has developed over whether this means of surveillance constitutes a search under the fourth amendment. In California v. Ciraolo, the United States Supreme Court held that naked-eye aerial observations of the curtilage of a home, when made from navigable airspace, do not constitute a search protected by the fourth amendment

Florida History - A Field of Colorful Original Sources

This address was delivered by Mrs. Corse before the Society at its recent annual meeting

DeBrahm’s Report on East Florida, 1773

The most detailed of the early reports on the Florida peninsula is that of John Gerard William DeBrahm, Surveyor General of the southern district of North America for George III of England. His observations on Florida are contained in a work entitled “History of the Three Provinces, South Carolina, Georgia and East Florida,” in manuscript in the British Museum, with a copy in Harvard University Library. The South Carolina and Georgia sections of this report have been printed but the Florida material is still only in manuscript. A great benefit would be conferred upon students of Colonial Florida if this part were printed also

Denys Rolle. and Rollestown, A Pioneer for Utopia

This account of Denys Rolle and his attempt at colonization in Florida is based on forty-three contemporaneous documents preserved in the Public Record Office, London,- letters and reports of Governors Grant and Tonyn to the Lords of Trade and Plantations,. to the Earl of Shelburne and to Lord Hillsborough; memorials of Rolle, and his letters to the governor and the secretaries; Acts of the Privy Council; private letters; etc. Copies of these papers were secured from London by Mrs. Corse and given to the library of the Florida Historical Society where they may be seen; hence it is considered unnecessary to cite the source of each statement made. Three of these documents follow this article. Others may be published here when space is available

Gestion du chêne vert en Corse, quelques éléments de sylviculture

Le chêne vert est, en Corse, placé dans des conditions naturelles différentes de celles qui existent sur le continent : pluviosité généralement supérieure, relief accusé. Les peuplements peuvent être classés selon les types différents : le taillis, le maquis à chêne vert, la futaie et le taillis sous futaie. Outre la pérennité de l'état boisé, le gestionnaire recherche dans chaque peuplement à obtenir l'équilibre entre divers objectifs : produire du bois, obtenir des glands, préserver l'environnement pour rester une forêt accueillante aux promeneurs. Une gestion forestière peut être envisagée par le traitement en taillis et en futaie