The international society for bipolar disorders (ISBD) task force report on antidepressant use in bipolar diosrders

Objective:
The risk-benefit profile of antidepressant medications in bipolar disorder is controversial. When conclusive evidence is lacking, expert consensus can guide treatment decisions. The International Society for Bipolar Disorders (ISBD) convened a task force to seek consensus recommendations on the use of antidepressants in bipolar disorders.

Method:  
An expert task force iteratively developed consensus through serial consensus-based revisions using the Delphi method. Initial survey items were based on systematic review of the literature. Subsequent surveys included new or reworded items and items that needed to be rerated. This process resulted in the final ISBD Task Force clinical recommendations on antidepressant use in bipolar disorder.

Results:  
There is striking incongruity between the wide use of and the weak evidence base for the efficacy and safety of antidepressant drugs in bipolar disorder. Few well-designed, long-term trials of prophylactic benefits have been conducted, and there is insufficient evidence for treatment benefits with antidepressants combined with mood stabilizers. A major concern is the risk for mood switch to hypomania, mania, and mixed states. Integrating the evidence and the experience of the task force members, a consensus was reached on 12 statements on the use of antidepressants in bipolar disorder.

Conclusions:
Because of limited data, the task force could not make broad statements endorsing antidepressant use but acknowledged that individual bipolar patients may benefit from antidepressants. Regarding safety, serotonin reuptake inhibitors and bupropion may have lower rates of manic switch than tricyclic and tetracyclic antidepressants and norepinephrine-serotonin reuptake inhibitors. The frequency and severity of antidepressant-associated mood elevations appear to be greater in bipolar I than bipolar II disorder. Hence, in bipolar I patients antidepressants should be prescribed only as an adjunct to mood-stabilizing medications.

Youth mental health first aid: a description of the program and an initial evaluation

BACKGROUND: Adolescence is the peak age of onset for mental illness, with half of all people who will ever have a mental illness experiencing their first episode prior to 18 years of age. Early onset of mental illness is a significant predictor for future episodes. However, adolescents and young adults are less likely than the population as a whole to either seek or receive treatment for a mental illness. The knowledge and attitudes of the adults in an adolescent's life may affect whether or not help is sought, and how quickly. In 2007, the Youth Mental Health First Aid Program was launched in Australia with the aim to teach adults, who work with or care for adolescents, the skills needed to recognise the early signs of mental illness, identify potential mental health-related crises, and assist adolescents to get the help they need as early as possible. This paper provides a description of the program, some initial evaluation and an outline of future directions.

METHODS: The program was evaluated in two ways. The first was an uncontrolled trial with 246 adult members of the Australian public, who completed questionnaires immediately before attending the 14 hour course, one month later and six months later. Outcome measures were: recognition of schizophrenia or depression; intention to offer and confidence in offering assistance; stigmatising attitudes; knowledge about adolescent mental health problems and also about the Mental Health First Aid action plan. The second method of evaluation was to track the uptake of the program, including the number of instructors trained across Australia to deliver the course, the number of courses they delivered, and the uptake of the YMHFA Program in other countries.

RESULTS: The uncontrolled trial found improvements in: recognition of schizophrenia; confidence in offering help; stigmatising attitudes; knowledge about adolescent mental health problems and application of the Mental Health First Aid action plan. Most results were maintained at follow-up. Over the first 3 years of this program, a total of 318 instructors were trained to deliver the course and these instructors have delivered courses to 10,686 people across all states and territories in Australia. The program has also spread to Canada, Singapore and England, and will spread to Hong Kong, Sweden and China in the near future.

CONCLUSIONS: Initial evaluation suggests that the Youth Mental Health First Aid course improves participants' knowledge, attitudes and helping behaviour. The program has spread successfully both nationally and internationally.

Nanoformulated mutant SurR9-C84A: a possible key for alzheimer's and its associated inflammation

PURPOSE: Alzheimer's disease (AD) is one of the untreatable neurodegenerative diseases characterised by the pathologic amyloid plaque deposition and inflammation. The aim of this study is to evaluate the neuroprotective effects of nanoformulated SurR9-C84A, a survivin mutant belonging to the inhibitors of the apoptosis (IAP) protein family. The effect of SurR9-C84A was studied against the β-amyloid toxicity and various inflammatory insults in the differentiated SK-N-SH neurons. METHOD: SurR9-C84A loaded poly(lactic-co-glycolic acid) nanoparticles were prepared following the modified double emulsion technique. The neuroprotective effect of SurR9-C84A was evaluated against the amyloid-β (Aβ) peptide fragment, N-methyl-D-aspartate (NMDA) toxicity and the inflammatory assaults. To mimic the in vivo situation, a co-culture of neurons and microglia was also studied to validate these results. RESULTS: SurR9-C84A treatments showed improved neuronal health following Aβ, and NMDA toxicity in addition to inflammatory insults induced in mono and co-cultures. The neuroprotective effect was evident with the reduced neuronal death, accelerated expression of neuronal integrity markers (neurofilaments, beta-tubulin III etc.,) and the neuroprotective ERK/MAPK signalling. CONCLUSION: The current results demonstrated that the SurR9-C84A nanoformulation was very effective in rescuing the neurons and holds a potential future application against AD.

Home range, habitat use and movements by the little raven (Corvus mellori) in a coastal peri-urban landscape

Context In peri-urban environments, high availability of anthropogenic resources may result in relatively high abundances of some species, with potentially negative implications for other native biota. Effective management of such impacts requires understanding of the spatial ecology of problem species. However, home range and habitat use have not been described for the little raven (Corvus mellori), a superabundant native predator that occurs in urban and natural habitats, including those where threatened shorebirds breed. Aims The aim of this study was to provide basic information on little raven home range, habitat use and movements in a coastal peri-urban landscape. Methods Between October 2011 and January 2012 we radio-tracked 20 little ravens captured in a coastal wetland (near Melbourne, Australia). Key results Little ravens were highly mobile, moving up to 9.9km in an hour (median≤2km), and had large ranges: Minimum Convex Polygons were 1664-9989ha (median≤3362ha). Although most birds used both anthropogenic and natural habitats, some birds strongly selected for coastal wetland habitat. Birds used multiple roosts during the study period, most of which occurred in grassland (58.7%) or urban (22.3%) areas. Movement of up to 8.3km (median≤2.2km) between roosts during the night was also detected. Conclusions Ravens were highly mobile and used large home ranges and a variety of habitats, with habitat preferences varying between birds. Implications Considering the large home ranges and inter-individual variation in habitat preferences of little raven populations, localised management to reduce their impacts on breeding shorebirds is unlikely to be successful. Journal compilation

Adding a new anticoagulant or antiplatelet agent for patient receiving aspirin after an acute coronary syndrome? - Results from a pairwise and network meta-analysis of randomized-controlled trials

 Objectives: To synthesize the efficacy and safety outcomes from randomized-controlled trials (RCTs) regarding new oral anticoagulant, protease-activated receptor-1 (PAR-1) antagonist, and warfarin adjunctive to aspirin for patients after acute coronary syndrome (ACS) via pair-wise and network meta-analyses.
Methods: A comprehensive literature search was performed in Embase, Medline, Cochrane Library Web of Knowledge, and Scopus. The pair-wise meta-analysis was undertaken respectively to each agent/treatment category via Revmen 5.1. In order to estimate the relative efficacy of each agent/treatment category whilst preserving the randomized comparisons within each trial, a Bayesian network meta-analysis was conducted in WinBUGS using both fixed- and random-effects model. Covariate analysis was performed to explore the effects of length of follow-up and age of subject on the final results.
Results: In total, 23 RCTs were included in the meta-analysis. As shown by the results (OR,95%CI) for the pair-wise meta-analysis, new oral anticoagulants (0.85, [0.78, 0.93] and 3.04, [2.21, 4.19]), PAR-1 antagonists (0.80, [0.52, 1.22] and 1.55, [1.25, 1.93]) and warfarin (0.87, [0.74, 1.02] and 1.77, [1.46, 2.14]) might be able to provide better outcome in the incidences of major adverse events (MAE) but with higher bleeding risk comparing to aspirin treatment alone. Based on the model fit assessment, the random-effects model was adopted. The network meta-analysis (treatment effect comparing to aspirin lone) identified ximelagatran (-0.3044, [-0.8601, 0.2502]), dabigatran (-0.2144, [-0.8666, 0.4525]), rivoroxaban (-0.2179, [-0.5986, 0.1628]) and vorapaxar (-0.2272, [-0.81, 0.1664]) produced better improvements in MAE incidences whereas vorapaxar (0.3764, [-0.4444, 1.124]), warfarin (0.663, [0.3375, 1.037]), ximelagatran (0.7509, [-0.4164, 2.002]) and apixaban (0.8594, [-0.0049, 1.7]) produced less major bleeding events. The indirect comparisons among drug category (difference in incidence comparing to aspirin lone) showed new oral anticoagulants (-0.1974, [-0.284, -0.111]) and PAR-1 antagonists (-0.1239, [-0.215, -0.033]) to besuperior to warfarin (-0.1004, [-0.166, -0.035]) in the occurrences of MAE whereas PAR-1 antagonists (0.4292, [0.2123, 0.6476]) afforded better outcomes in major bleeding events against warfarin (0.5742, [0.3889, 0.7619]) and new oral anticoagulants (1.169, [0.8667, 1.485]).
Conclusion: Based on the study results, we cannot recommend the routine administration of new oral anticoagulant as add-on treatment for patients after ACS. However, for ACS patients comorbid with atrial fibrillation, new oral anticoagulant might be superior to warfarin in both efficacy and safety outcomes.

Marketing de relacionamento e operação de call center: análise comparada do posicionamento de operadoras de telefonia celular em São Paulo

O presente trabalho aborda o Marketing de Relacionamento, que vem conquistando destaque nas organizações em razão do crescente reconhecimento da relevância do conhecimento dos clientes e de suas necessidades. A partir dessa perspectiva, investigou-se as estratégias de Telemarketing de organizações de telefonia móvel celular do Estado de São Paulo, a fim de comparar a orientação e o posicionamento dessas empresas. O estudo também faz uma avaliação comparativa entre as organizações, tomando como base a relação entre Call Center, posicionamento, estratégias e objetivos corporativos. Quanto à metodologia adotada, optou-se por uma pesquisa qualitativa, de caráter exploratório, partindo-se da análise de conteúdo das entrevistas.

Receptor de quimiocina CCR5 e a suscetibilidade ao Lúpus Eritematoso sistêmico

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O ecletismo na arquitetura pelotense até as décadas de 30 e 40

Esta dissertação tem como objetivo principal identificar dados e elaborar um estudo sobre a produção arquitetônica da cidade de Pelotas de 1758 ao fim da década de 40 do século XX, analisando as características peculiares de tal produção e as transformações decorrentes do abandono dos padrões historicistas e da implantação de uma arquitetura moderna. Nesse sentido, traduz-se em revisão de parte da própria história da cidade, da qual a arquitetura é manifestação e testemunho significativo.

Avaliação de Projetos de Investimento com Opções Reais: Cálculo de Valor de Opção de Espera de uma Unidade Separadora de Propeno

O tema central deste trabalho é a avaliação do valor da opção real de espera do investimento em uma Unidade Separadora de Propeno, em comparação com uma análise estática de Valor Presente Líquido. Para isso, foi exposta a teoria de opções reais, os processos estocásticos para a estimação das suas principais variáveis de incerteza (preço de produto e insumo), bem como a descrição das ferramentas de simulação a serem utilizadas. Com os instrumentos expostos, pretendemos demonstrar aos responsáveis por projetos de investimento que as incertezas podem ser medidas, levando a maior flexibilidade na tomada de decisões. Os resultados obtidos apontam para o exercício imediato da opção pela abordagem de ativos contingentes e resultados divergentes na análise de ativos contingentes em função do diferencial de preços, em função da taxa de dividendos adotada. A influência dos valores da volatilidade e da taxa de dividendos nos resultados também foi avaliada, levando à conclusão de que o primeiro gera impactos maiores no valor da opção do que o segundo.