Patterns of initiation of second generation antipsychotics for bipolar disorder: a month-by-month analysis of provider behavior

Background: Several second generation antipsychotics (SGAs) received FDA approval for bipolar disorder in the 2000s. Although efficacious, they have been costly and may cause significant side effects. Little is known about the factors associated with prescribers’ decisions to initiate SGA prescriptions for this condition. Methods: We gathered administrative data from the Department of Veterans Affairs on 170,713 patients with bipolar disorder between fiscal years 2003–2010. Patients without a prior history of taking SGAs were considered eligible for SGA initiation during the study (n =126,556). Generalized estimating equations identified demographic, clinical, and comorbidity variables associated with initiation of an SGA prescription on a month-by-month basis. Results: While the number of patients with bipolar disorder using SGAs nearly doubled between 2003 and 2010, analyses controlling for patient characteristics and the rise in the bipolar population revealed a 1.2% annual decline in SGA initiation during this period. Most medical comorbidities were only modestly associated with overall SGA initiation, although significant differences emerged among individual SGAs. Several markers of patient severity predicted SGA initiation, including previous hospitalizations, psychotic features, and a history of other antimanic prescriptions; these severity markers became less firmly linked to SGA initiation over time. Providers in the South were somewhat more likely to initiate SGA treatment. Conclusions: The number of veterans with bipolar disorder prescribed SGAs is rising steadily, but this increase appears primarily driven by a corresponding increase in the bipolar population. Month-by-month analyses revealed that higher illness severity predicted SGA initiation, but that this association may be weakening over time

Reaching for Peak Performance in Existing Homes -- A Cold Climate Study With Synergy Construction

Two test homes located in Millbury and Somerville, MA are examined with the goal of providing case studies that could be applied to other similar New England homes. The retrofit process for the enclosure and mechanical systems are examined in detail and the decision-making process is discussed

Performance Evaluation of a Hot-Humid Climate Community

Project Home Again is a development in New Orleans, LA created to provide new homes to victims of Hurricane Katrina. Building Science Corporation acted as a consultant for the project, advocating design strategies for durability, flood resistance, occupant comfort, and low energy use while maintaining cost effectiveness. These techniques include the use of high density spray foam insulation, LoE3 glazing, and supplemental dehumidification to maintain comfortable humidity levels without unnecessary cooling

Student Behavior and Its Association with Multi-Device Addiction and Back Pain in Western Romania

The rapid development of modern technologies has brought enormous benefits to today's society in all areas of life. On the one hand, they have a positive effect on people's relationships, learning, and development. On the other hand, the incorrect use of electronic devices can cause health damage and serious problems. In recent years, the use of digital devices has increased among students, highlighting the problem of digital addiction. This study aimed to observe the problems of spinal pain associated with the use of mobile phones by students in schools and to find constructive solutions to turn mobile phones into an effective learning tool to be used only in the classroom. The method used in this study was to apply questionnaires to a sample of 506 students from Arad County. The results of this study showed that students in the study group are addicted to the internet and social networks, and also confirmed that some of them cannot experience all this without sacrificing their physical and mental health. In conclusion, educational and policy measures to combat digital addiction are urgently needed worldwide. Schools should implement comprehensive digital literacy programs to educate students about the risks of excessive use of digital devices and promote healthy online behaviors

Leveraging Limited Scope for Maximum Benefit in Occupied Renovation of Uninsulated Cold Climate Multifamily Housing

This project examines a large-scale renovation project within a 500 unit, 1960's era subsidized urban housing community. This research focuses on the airflow control and window replacement measures implemented as part of the renovations to the low-rise apartment buildings. The window replacement reduced the nominal conductive loss of the apartment enclosure by approximately 15%; air sealing measures reduced measured air leakage by approximately 40% on average

Uneven focal shoe deterioration in Tourette syndrome.

A 31-year-old single man (AB) sought neuropsychiatric consultation for treatment-resistant motor and vocal tics. He described himself expressing a total of 24 different tics, mainly facial twitches (eye blinking, raising eyebrows, mouth opening, lips licking, stereotyped grimacing) and inappropriate utterances (grunting, throat clearing, sniffing), since the age of 7. There appeared to be no family history of tic disorder. He reported occasional utterance of swear words in contextually inappropriate situations (coprolalia), and the urge to copy other people’s movements (echopraxia). Other tic-associated symptoms included self-injurious behaviours and forced touching of objects. A.B. met both DSM-IV-tr and ICD-10 criteria for Tourette syndrome, and also DSM-IV-tr criteria for attention deficit hyperactivity disorder (combined type) in childhood

Proven Performance of Seven Cold Climate Deep Retrofit Homes

Seven test homes located in Massachusetts are examined within this report. The retrofit strategies of each home are presented along with a comparison of the pre- and post-retrofit airtightness achieved by the group. Pre- and post-retrofit utility bills were collected; energy models were used to estimate pre-retrofit energy use when bills were unavailable

Development of Two Heliodon Systems and Recommendations for their Use

Heliodons aid the building design process by allowing the simulation of different solar angles with respect to physical scale models. At MIT, two different variations of this setup are being developed. The first one consists of a small, portable heliodon that is manually operated, and meant for use outdoors with the real sun and sky. The second is a larger indoor setup that consists of a computer-controlled moving table exposed to a stationary light source. A computer interface allows the designer to automatically take useful sets of model photos from a camera positioned next to or inside a model. Both approaches are presented in this paper and their limitations, causes of inaccuracy and potentialities are discussed based on experimental verification and through Radiance simulations. The results of a usability study with student volunteers and a case study on an existing research space on the MIT campus are also presented

Hysteroscopic resection of a uterine caesarean scar defect (niche) in women with postmenstrual spotting : a randomised controlled trial

This study is funded by ZonMw, a Dutch organization for Health Research and Development (project number 80-82305-97-12030) and was co-funded by the VU University Medical Centre Amsterdam. These sponsors had no role in the study design, data collection, data analysis, data interpretation or writing of this article.Peer reviewedPublisher PD