Treatment and outcomes of an Australian cohort of outpatients with bipolar 1 or schizoaffective disorder over twenty-four months : implications for clinical practice

Background The Bipolar Comprehensive Outcomes Study (BCOS) is a 2-year, prospective, non-interventional, observational study designed to explore the clinical and functional outcomes associated with ‘real-world’ treatment of participants with bipolar I or schizoaffective disorder. All participants received treatment as usual. There was no study medication.

Methods Participants prescribed either conventional mood stabilizers (CMS; n = 155) alone, or olanzapine with, or without, CMS (olanzapine ± CMS; n = 84) were assessed every 3 months using several measures, including the Young Mania Rating Scale, 21-item Hamilton Depression Rating Scale, Clinical Global Impressions Scale – Bipolar Version, and the EuroQol Instrument. This paper reports 24-month longitudinal clinical, pharmacological, functional, and socioeconomic data.

Results On average, participants were 42 (range 18 to 79) years of age, 58%; were female, and 73%; had a diagnosis of bipolar I. Polypharmacy was the usual approach to pharmacological treatment; participants took a median of 5 different psychotropic medications over the course of the study, and spent a median proportion of time of 100%; of the study on mood stabilizers, 90%; on antipsychotics, 9%; on antidepressants, and 5%; on benzodiazepines/hypnotics. By 24 months, the majority of participants had achieved both symptomatic and syndromal remission of both mania and depression. Symptomatic relapse rates were similar for both the CMS alone (65%;) and the olanzapine ± CMS (61%;) cohorts.

Conclusions Participants with bipolar I or schizoaffective disorder in this study were receiving complex medication treatments that were often discordant with recommendations made in contemporary major treatment guidelines. The majority of study participants demonstrated some clinical and functional improvements, but not all achieved remission of symptoms or syndrome.

Effect of surface treatment and knit structure on comfort properties of wool fabrics

The comfort properties of the pique and single jersey knitted wool fabrics were investigated using the Wool ComfortMeter (WCM). The fabrics were knitted in three cover factors and treated with either plasma or a silicone softening agent and were compared with untreated fabrics. Plasma treatment did not show significant effects on the comfort value. However, silicone polymer significantly reduced WCM values suggesting that the silicone coating reduced the number of protruding fibres on the fabric surface. Regardless of treatment used, pique fabrics showed a lower WCM value, and therefore were perceived to be more comfortable than the single jersey structure. While the effect of cover factor was not significant, in fitted model to predict the WCM value of fabrics, mass/unit area and fabric thickness were significant predictors along with fabric structure and finishing treatment.

Urban stormwater inputs to an adapted coastal wetland : role in water treatment and impacts on wetland biota

The Lake Pertobe wetland system is a semi-natural wetland that has been modified primarily for recreational use. However, this lake system receives stormwater from much of the central business district of Warrnambool City (Victoria, Australia) and serves as a buffer zone between the stormwater system and the Merri River and Merri Marine Sanctuary. This work considers the impact of stormwater inputs on Lake Pertobe and the effectiveness of the lake in protecting the associated marine sanctuary. Sediment contaminants (including heavy metals and polycyclic aromatic hydrocarbons (PAHs)) and water quality parameters within the lake, groundwater and stormwater system were measured. Water quality parameters were highly variable between stormwater drains and rain events. Suspended solids rapidly settled along open drains and shortly after entering the lake. Groundwater inputs increased both salinity and dissolved nitrogen in some stormwater drains. Some evidence of bioaccumulation of metals in the food chain was identified and sediment concentrations of several PAHs were very high. The lake acted as a sink for PAHs and some metals and reductions in Escherichia coli, biological oxygen demand and total phosphorus were observed, affording some protection to the associated marine sanctuary. Nutrient retention was inadequate overall and it was identified that managing the lake primarily as a recreational facility impacted on the effectiveness of stormwater treatment in the system.

Estimation and extrapolation of optimal treatment and testing strategies

We review recent developments in the estimation of an optimal treatment strategy or regime from longitudinal data collected in an observational study. We also propose novel methods for using the data obtained from an observational database in one health-care system to determine the optimal treatment regime for biologically similar subjects in a second health-care system when, for cultural, logistical, or financial reasons, the two health-care systems differ (and will continue to differ) in the frequency of, and reasons for, both laboratory tests and physician visits. Finally, we propose a novel method for estimating the optimal timing of expensive and/or painful diagnostic or prognostic tests. Diagnostic or prognostic tests are only useful in so far as they help a physician to determine the optimal dosing strategy, by providing information on both the current health state and the prognosis of a patient because, in contrast to drug therapies, these tests have no direct causal effect on disease progression. Our new method explicitly incorporates this no direct effect restriction.

Grain growth and β-Mg17Al12 intermetallic phase dissolution during heat treatment and its impact on deformation behavior of AZ80 Mg-alloy

Microstructure evolution after solutionizing and ageing treatment of cast AZ80 Mg alloy were investigated using optical and scanning electron microscopy. Effect of these treatments on grain size, β-Mg17Al12 intermetallic phase, mechanical behavior, and flow asymmetry were investigated. The initial continuous network of β-phase found to be reduced after solutionizing. The dissolution of β-phase and simultaneous grain growth are found to be interrelated. Mechanical properties including yield strength, maximum strength (ultimate compressive strength), and maximum strain attainable in compressive found almost twice than the corresponding values obtained in tension. The asymmetry in compressive and tensile properties is found to decrease with grain size at certain solutionizing duration. Particular heat treatment found to offer best combination of tensile compressive flow properties in AZ80 Mg alloy. Aging under certain conditions found to minimize the strength asymmetry. © ASM International.

Cleaning, resistant bacteria, and antibiotic prescribing in residential aged care facilities

Residents of residential aged care facilities (RACFs) are at risk of colonization and infection with multidrug-resistant bacteria, and antibiotic prescribing is often inappropriate and not based on culture-proven infection. We describe low levels of resident colonization and environmental contamination with resistant gram-negative bacteria in RACFs, but high levels of empirical antibiotic use not guided by microbiologic culture. This research highlights the importance of antimicrobial stewardship and environmental cleaning in aged care facilities.

Gender difference in treatment and mortality of patients with ST-segment elevation myocardial infarction admitted to Victorian public hospitals: A retrospective database study.

BACKGROUND: Death from acute coronary syndrome (ACS) is avoidable with early reperfusion therapy, however, evidence suggests inequity in women's ACS treatment within a number of international healthcare systems, when compared to men's. Research indicates mortality rates are higher in some age groups of women when compared to men for the sub-group of ACS known as ST-segment elevation myocardial infarction (STEMI). OBJECTIVE: To determine whether patient sex was associated with patterns of reperfusion treatment variation or increased inhospital mortality in patients with STEMI. METHODS: We undertook retrospective analyses on a government database for patients admitted to Victorian public hospitals with STEMI. Patients were categorised into two age groups: 18-64 and 65-84 years (inclusive), to determine whether patient sex and these age groups influenced treatment from 2005 to 2008 and mortality from 2005 to 2010. RESULTS: Both younger and older women received less frequent angioplasty with stent and more often received no reperfusion treatment than men in corresponding younger and older age groups (p=0.006 and p<0.001, respectively). Overall, women in both age groups were more likely to die inhospital than men from equivalent age groups with STEMI (p<0.001, both groups). CONCLUSIONS: Proportionately, both younger and older women received less interventional reperfusion therapy for STEMI than their male cohorts, and died more often during admission than men. Further research needs to be undertaken to verify the findings and causes, and guide future research to ensure application of evidence to treatment in patients with STEMI.