Influence of temporary emigration on wood turtle (Glyptemys insculpta) detectability, with implications for abundance estimation

Reliable population estimates are important for making informed management decisions about wildlife species. Standardized survey protocols have been developed for monitoring population trends of the wood turtle (Glyptemys insculpta), a semi-aquatic freshwater turtle species of conservation concern throughout its distribution in east-central North America. The protocols use repeated active search surveys of defined areas, allowing for estimation of survey-specific detection probability (p) and site-specific abundance. These protocols assume population closure within the survey area during the survey period, which is unlikely to be met as wood turtles are a highly mobile species. Additionally, current protocols use a single-pass design that does not allow for separation of availability (pa) and detectability (pd). If there are systematic influences on pa or pd that are not accounted for in the survey design or data analysis, then resulting abundance estimates could be biased. The objectives of this study were to determine if pa is a random process and if pa and pd are influenced by demographic characteristics. We modified the wood turtle survey protocol used in the upper Midwest to include a double-pass design, allowing us to estimate pa and pd using a robust design capture-recapture model. The modified protocol was implemented at 14 wood turtle monitoring sites in Minnesota and Wisconsin between 2017 and 2022. Our results indicated that pa was non-random and that pd increased with turtle carapace length. Our study suggests that model assumptions for current wood turtle population models may be violated, likely resulting in an overestimation of abundance. We discuss possible protocol and modeling modifications that could result in more accurate wood turtle abundance estimates.

Sensitive and rapid analysis of plasmid DNA topology isoforms by capillary gel electrophoresis with laser induced fluorescence in uncoated capillary

The work describes the use of SYBR Gold to improve the detection sensitivity of plasmid DNA topoisomers by capillary gel electrophoresis with laser induced fluorescence in an uncoated capillary. The impact of different dyes, including ethidium bromide, SYBR Green and SYBR Gold, was compared based on detection and separation of DNA plasmid topoisomers. Use of SYBR Gold enabled improvement of detection sensitivity by 15-fold while maintaining good separation resolution of the different topoisomers. The baseline dropped with the use SYBR Gold but was overcome by the employment of a capillary with longer ineffective length (40 vs. 20 cm). Separation resolution and reproducibility were impacted by the concentration of SYBR Gold and hydroxypropyl methylcellulose. With the use of a short capillary (10 cm effective length and 50 cm total length), fast separations of supercoiled, linear, open circular, and other isoforms were accomplished within 8 min. Appropriate capillary cleaning with 0.1 M sodium hydroxide/0.1 M hydrochloric acid and capillary storage with 0.1 M hydrochloric acid ensured good separation reproducibility of 217 runs during an extended period of use.

Atomic Engineering of Molecular Qubits for High-Speed, High-Fidelity Single Qubit Gates

Universal quantum computing requires fast single- and two-qubit gates with individual qubit addressability to minimize decoherence errors during processor operation. Electron spin qubits using individual phosphorus donor atoms in silicon have demonstrated long coherence times with high fidelities, providing an attractive platform for scalable quantum computing. While individual qubit addressability has been demonstrated by controlling the hyperfine interaction between the electron and nuclear wave function in a global magnetic field, the small hyperfine Stark coefficient of 0.34 MHz/MV m-1 achieved to date has limited the speed of single quantum gates to ∼42 μs to avoid rotating neighboring qubits due to power broadening from the antenna. The use of molecular 2P qubits with more than one donor atom has not only demonstrated fast (0.8 ns) two-qubit SWAP gates and long spin relaxation times of ∼30 s but provides an alternate way to achieve high selectivity of the qubit resonance frequency. Here, we show in two different devices that by placing the donors with comparable interatomic spacings (∼0.8 nm) but along different crystallographic axes, either the [110] or [310] orientations using STM lithography, we can engineer the hyperfine Stark shift from 1 MHz/MV m-1 to 11.2 MHz/MV m-1, respectively, a factor of 10 difference. NEMO atomistic calculations show that larger hyperfine Stark coefficients of up to ∼70 MHz/MV m-1 can be achieved within 2P molecules by placing the donors ≥5 nm apart. When combined with Gaussian pulse shaping, we show that fast single qubit gates with 2π rotation times of 10 ns and ∼99% fidelity single qubit operations are feasible without affecting neighboring qubits. By increasing the single qubit gate time to ∼550 ns, two orders of magnitude faster than previously measured, our simulations confirm that >99.99% single qubit control fidelities are achievable.

Hybrid delivery of cluster-set resistance training for individuals previously treated for lung cancer: the results of a single-arm feasibility trial

BACKGROUND

Individuals with non-small cell lung cancer (NSCLC) are burdened by long-lasting symptoms (e.g., dyspnea and fatigue) post-treatment. These symptoms often reduce physical activity levels and increase the risk of functional decline. Though we have previously proposed cluster-set resistance training to mitigate symptom burden in lung cancer, there is currently no data on the feasibility or acceptability of this mode of exercise in cancer. Therefore, the purpose of this study was to investigate the feasibility and acceptability of a hybrid-delivery home-based cluster-set resistance training program in individuals with NSCLC stages I-III (i.e., early stage).

METHODS

This study aimed to recruit individuals with NSCLC stages I-III post-treatment to participate in 8 weeks of home-based resistance training, 3 days per week. The program included supervised sessions in the participants' homes and virtual supervision via videoconferencing. The primary outcome measure of feasibility was evaluated through recruitment, retention, and intervention fidelity (i.e., proportion of exercise completed, relative to what was prescribed). Intervention acceptability (i.e., ease and quality of virtual delivery, level of difficulty, and home-based approach) was assessed using a 4-point Likert-type scale from "strongly disagree" to "strongly agree".

RESULTS

Fourteen participants were recruited over a 6-month period, with 11 completing the intervention (2 withdrew due to unrelated illness, 1 withdrew due to requiring active treatment), yielding a retention rate of 79%. Characteristics of the participants who completed the intervention (n = 11) were as follows: mean age: 71 ± 10 years, mean BMI: 29.1 ± 6.5, and average time since diagnosis was 62 ± 51 months. Of completers, 27% were male, and 36% were Black; 10 were stage I (91%), and one was stage II (9%). Mean session attendance was 86.4 ± 9.5%. Mean intervention fidelity was 83.1 ± 13.1%. With regard to acceptability,  > 90% of participants positively rated all aspects of the intervention delivery. No adverse events related to exercise were recorded.

CONCLUSIONS

The hybrid delivery of a home-based resistance exercise program for individuals previously treated for early-stage NSCLC was found to be safe and feasible. Adaptations to the program for future interventions are required, particularly surrounding resistance exercise programming, and intervention delivery with home visits.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT05014035 . Registered January 20, 2021.

Biology of Yucatán Box Turtles (Terrapene yucatana) in Northern Yucatán

Yucatán Box Turtles (Terrapene yucatana) are the only fully tropical lineage of box turtles (Terrapene spp.). We studied the ecology, movements, behavior, and habitat associations of T. yucatana in northern Yucatán, México, over 218 field days from 2014-2019. We estimated the size of two subpopulations to comprise 36.6 and 3.0 turtles, with corresponding densities of 2.29 and 0.39 turtles/ha, respectively. We obtained 2,808 radio locations from radiotelemetry of 20 adults. We estimated an annual survivorship rate over a 5-yr period exceeding 0.989. For both sexes combined, the average annual 95% minimum convex polygon (MCP) home range size was 0.684 ha, and the average distance between consecutive annual home range centroids was 22.5 m. In 2 of 5 yr, males exhibited significantly larger 95% MCP home ranges than females. We observed feeding, courtship, and fighting in the wild between June and December. Females moved more than males in July, when gravid turtles were also observed. We found that T. yucatana was positively associated with Mimosa sp. and Bromelia spp. The use of aquatic habitats was infrequent (0.17%). Our findings support the conclusion that T. yucatana, an allopatric and fully tropical lineage, is an interior forest and thornscrub species that occurs at low densities. In such undisturbed contexts, T. yucatana may exhibit high survivorship rates, small home range size, and home range fidelity that underscore the importance of large-scale forest conservation efforts in concert with the targeted protection of documented Yucatán Box Turtle populations.

Biology of Yucatán Box Turtles (Terrapene yucatana) in Northern Yucatán

Yucatán Box Turtles (Terrapene yucatana) are the only fully tropical lineage of box turtles (Terrapene spp.). We studied the ecology, movements, behavior, and habitat associations of T. yucatana in northern Yucatán, México, over 218 field days from 2014-2019. We estimated the size of two subpopulations to comprise 36.6 and 3.0 turtles, with corresponding densities of 2.29 and 0.39 turtles/ha, respectively. We obtained 2,808 radio locations from radiotelemetry of 20 adults. We estimated an annual survivorship rate over a 5-yr period exceeding 0.989. For both sexes combined, the average annual 95% minimum convex polygon (MCP) home range size was 0.684 ha, and the average distance between consecutive annual home range centroids was 22.5 m. In 2 of 5 yr, males exhibited significantly larger 95% MCP home ranges than females. We observed feeding, courtship, and fighting in the wild between June and December. Females moved more than males in July, when gravid turtles were also observed. We found that T. yucatana was positively associated with Mimosa sp. and Bromelia spp. The use of aquatic habitats was infrequent (0.17%). Our findings support the conclusion that T. yucatana, an allopatric and fully tropical lineage, is an interior forest and thornscrub species that occurs at low densities. In such undisturbed contexts, T. yucatana may exhibit high survivorship rates, small home range size, and home range fidelity that underscore the importance of large-scale forest conservation efforts in concert with the targeted protection of documented Yucatán Box Turtle populations.

Assessing Antigen-Adjuvant Complex Stability Against Physical Stresses By wNMR

This study applies an emerging analytical technology, wNMR (water proton nuclear magnetic resonance), to assess the stability of aluminum adjuvants and antigen-adjuvant complexes against physical stresses, including gravitation, flow and freeze/thaw. Results from wNMR are verified by conventional analytical technologies, including static light scattering and microfluidic imaging. The results show that wNMR can quickly and noninvasively determine whether an aluminum adjuvant or antigen-adjuvant complex sample has been altered by physical stresses.

Is the future female for turtles? Climate change and wetland configuration predict sex ratios of a freshwater species

Climate change and land-use change are leading drivers of biodiversity decline, affecting demographic parameters that are important for population persistence. For example, scientists have speculated for decades that climate change may skew adult sex ratios in taxa that express temperature-dependent sex determination (TSD), but limited evidence exists that this phenomenon is occurring in natural settings. For species that are vulnerable to anthropogenic land-use practices, differential mortality among sexes may also skew sex ratios. We sampled the spotted turtle (Clemmys guttata), a freshwater species with TSD, across a large portion of its geographic range (Florida to Maine), to assess the environmental factors influencing adult sex ratios. We present evidence that suggests recent climate change has potentially skewed the adult sex ratio of spotted turtles, with samples following a pattern of increased proportions of females concomitant with warming trends, but only within the warmer areas sampled. At intermediate temperatures, there was no relationship with climate, while in the cooler areas we found the opposite pattern, with samples becoming more male biased with increasing temperatures. These patterns might be explained in part by variation in relative adaptive capacity via phenotypic plasticity in nest site selection. Our findings also suggest that spotted turtles have a context-dependent and multi-scale relationship with land use. We observed a negative relationship between male proportion and the amount of crop cover (within 300 m) when wetlands were less spatially aggregated. However, when wetlands were aggregated, sex ratios remained consistent. This pattern may reflect sex-specific patterns in movement that render males more vulnerable to mortality from agricultural machinery and other threats. Our findings highlight the complexity of species' responses to both climate change and land use, and emphasize the role that landscape structure can play in shaping wildlife population demographics.

Study protocol: investigating the feasibility of a hybrid delivery of home-based cluster set resistance training for individuals previously treated for lung cancer

Background

Symptom burden remains a critical concern for individuals with non-small cell lung cancer (NSCLC) following the completion of treatment. The most common symptom clusters, dyspnea (shortness of breath) and fatigue, can contribute to physical decline, reductions in quality of life, and a higher risk of comorbidities and mortality. Dyspnea is a primary limiter of exercise capacity in individuals with lung cancer, resulting in exercise avoidance and an accelerated physical decline. As such, designing resistance training with cluster sets to mitigate symptoms of dyspnea and fatigue may result in improved exercise tolerance. Thus, maintaining the exercise stimulus via cluster sets, combined with improved tolerance of the exercise, could result in the maintenance of physical function and quality of life. The purpose of this study is to investigate the feasibility and preliminary efficacy of a hybrid-delivery home-based cluster-set resistance training program in individuals with NSCLC.

Methods

Individuals with NSCLC (n = 15), within 12 months of completion of treatment, will be recruited to participate in this single-arm feasibility trial. Participants will complete 8 weeks of home-based resistance training designed to minimize dyspnea and fatigue. The hybrid delivery of the program will include supervised sessions in the participants’ home and virtual supervision via video conferencing. The primary outcome of feasibility will be quantified by recruitment rates, retention, acceptability, and intervention fidelity. Exploratory outcomes (dyspnea, fatigue, quality of life, physical function, and body composition) will be assessed pre- and post-intervention.

Discussion

This study will provide important data on the feasibility of delivering this intervention and inform procedures for a future randomized controlled trial.

Trial registration

Record not yet public

Evaluating the effect of expert elicitation techniques on population status assessment in the face of large uncertainty

Population projection models are important tools for conservation and management. They are often used for population status assessments, for threat analyses, and to predict the consequences of conservation actions. Although conservation decisions should be informed by science, critical decisions are often made with very little information to support decision-making. Conversely, postponing decisions until better information is available may reduce the benefit of a conservation decision. When empirical data are limited or lacking, expert elicitation can be used to supplement existing data and inform model parameter estimates. The use of rigorous techniques for expert elicitation that account for uncertainty can improve the quality of the expert elicited values and therefore the accuracy of the projection models. One recurring challenge for summarizing expert elicited values is how to aggregate them. Here, we illustrate a process for population status assessment using a combination of expert elicitation and data from the ecological literature. We discuss the importance of considering various aggregation techniques, and illustrate this process using matrix population models for the wood turtle (Glyptemys insculpta) to assist U.S. Fish and Wildlife Service decision-makers with their Species Status Assessment. We compare estimates of population growth using data from the ecological literature and four alternative aggregation techniques for the expert-elicited values. The estimate of population growth rate based on estimates from the literature (λ_mean = 0.952, 95% CI: 0.87-1.01) could not be used to unequivocally reject the hypotheses of a rapidly declining population nor the hypothesis of a stable, or even slightly growing population, whereas our results for the expert-elicited estimates supported the hypothesis that the wood turtle population will decline over time. Our results showed that the aggregation techniques used had an impact on model estimates, suggesting that the choice of techniques should be carefully considered. We discuss the benefits and limitations associated with each method and their relevance to the population status assessment. We note a difference in the temporal scope or inference between the literature-based estimates that provided insights about historical changes, whereas the expert-based estimates were forward looking. Therefore, conducting an expert-elicitation in addition to using parameter estimates from the literature improved our understanding of our species of interest.

Rapid and Noninvasive Quantification of Capsid Gene Filling Level Using Water Proton Nuclear Magnetic Resonance

The present work reports an enabling novel technology for quantifying the gene content in adeno-associated viral capsids. The method is based on the water proton nuclear magnetic resonance (wNMR) technique. Instead of analyzing the capsid directly, it utilizes water molecules to distinguish empty and full capsids, as water interacts with them differently. The transverse relaxation rate of water protons, R₂(¹H₂O), readily distinguishes empty and full capsids and is capable of quantifying the fraction of full capsids in a mixture of full and empty ones. It involves no sample preparation and no reagents. Measurement is rapid (data collection takes 1-2 min), noninvasive (the capsid sample can stay inside the original sealed and labeled container to be used in other studies or administered to a patient), and performed using a wide-bore benchtop NMR instrument. The method can be readily implemented at a production plant for product release as part of product quality control.

Enzymatic depolymerization of streptococcus pneumoniae type 8 polysaccharide

Although there have been decades of research on streptococcus pneumoniae, it is still among the leading cause of infectious disease in the world. As a type of capsular polysaccharide (CPS) of streptococcus pneumoniae, pneumococcal polysaccharides are essential components for colonization and virulence in mammalian hosts. This study aimed to characterize the CPS structure of type 8 streptococcus pneumoniae, which is one of the most fatal serotypes. In this work, heparinase I&III was used to successfully digest pneumococcal type 8 polysaccharide (Pn8P). We characterized the oligosaccharide generated from the enzymatic depolymerization of Pn8P by size exclusion chromatography, mass spectrometry and nuclear magnetic resonance. This is the first study to enzymatically depolymerize and characterize Pn8P.

Sensitive quantitation of low level free polysaccharide in conjugate vaccines by size exclusion chromatography-reverse phase liquid chromatography with UV detection

The level of free polysaccharide is a critical quality attribute of polysaccharide-protein conjugate vaccines. The work presented describes a simple and sensitive method for the determination of low level free polysaccharides in multiple polysaccharide-protein conjugates. The method utilizes a reverse phase (RP) column to perform a size exclusion chromatography (SEC) separation of free polysaccharide and a reverse phase liquid chromatography (RPLC) separation of free protein and protein-polysaccharide conjugate. The use of phosphate buffer in the mobile phase enables the universal and sensitive detection of low level free polysaccharides at UV 200 nm. The method has been validated to monitor low level free polysaccharide (<1 %) in multiple polysaccharide-protein conjugates. The limit of quantitation is 2 μg/ml or 0.3 % free polysaccharide in 0.6 mg/ml polysaccharide-protein conjugate. The accuracy is in the range of 94.1.0-108.5 %.

Control Strategy for Small Molecule Impurities in Antibody-Drug Conjugates

Antibody-drug conjugates (ADCs) are an emerging class of biopharmaceuticals. As such, there are no specific guidelines addressing impurity limits and qualification requirements. The current ICH guidelines on impurities, Q3A (Impurities in New Drug Substances), Q3B (Impurities in New Drug Products), and Q6B (Specifications: Test Procedures and Acceptance Criteria for Biotechnological/Biological Products) do not adequately address how to assess small molecule impurities in ADCs. The International Consortium for Innovation and Quality in Pharmaceutical Development (IQ) formed an impurities working group (IWG) to discuss this issue. This white paper presents a strategy for evaluating the impact of small molecule impurities in ADCs. This strategy suggests a science-based approach that can be applied to the design of control systems for ADC therapeutics. The key principles that form the basis for this strategy include the significant difference in molecular weights between small molecule impurities and the ADC, the conjugation potential of the small molecule impurities, and the typical dosing concentrations and dosing schedule. The result is that exposure to small impurities in ADCs is so low as to often pose little or no significant safety risk.

Acute Effect of Cluster and Traditional Set Configurations on Myokines Associated with Hypertrophy

This study compared the acute cytokine response, and kinetic and kinematic profile following back squat exercise in resistance-trained men. In a randomized, cross-over design, 10 resistance-trained men (27±4 y, 1.80±0.07 m, 82.8±6.7 kg, 16.3±3.5% fat) performed the back squat exercise using traditional and cluster set configurations. Kinetic and kinematic data were sampled throughout each condition. Venous blood was sampled prior, immediately post, 30 min, 60 min, 24 h, and 48 h post-exercise for plasma interleukin-6 (IL-6) and interleukin-15 (IL-15). Cluster sets allowed for greater mean power (mean difference, 110 W; 90% confidence interval, ±63 W; benefit odds, 41 447:1), driven by higher overall mean velocities (0.053 m∙s^-1; 0.039 m∙s^-1; 3 105:1) as evidenced by the lack of clear contrasts for mean force. IL-15 increased post-exercise in both conditions, but increased at 24 h (0.13 pg·mL^-1; ±0.11 pg·mL^-1; 486:1) and 48 h (0.12 pg·mL^-1; ±0.10 pg·mL^-1; 667:1) in traditional sets only. IL-6 increased similarly in both conditions, post-exercise through 60 min post. Cluster set configurations allow for greater mean power, attributed to higher velocities. Despite a similar response of IL-6, traditional set configuration may provide a greater stimulus for hypertrophy as evidenced by a secondary increase in IL-15.

Spin Diffusion Editing for Structural Fingerprints of Therapeutic Antibodies

The growing importance of biologics and biosimilars as therapeutic and diagnostic agents is giving rise to new demands for analytical methodology that can quickly and accurately assess the chemical and physical state of protein-based products. A particular challenge exists in physical characterization where the proper fold and extent of disorder of a protein is a major concern. The ability of NMR to reflect structural and dynamic properties of proteins is well recognized, but sensitivity limitations and high levels of interference from excipients in typical biologic formulations have prevented widespread applications to quality assessment. Here we demonstrate applicability of a simple one-dimensional proton NMR method that exploits enhanced spin diffusion among protons in well-structured areas of a protein. We show that it is possible to reduce excipient signals and allow focus on structural characteristics of the protein. Additional decomposition of the resulting spectra based on rotating frame spin relaxation allows separate examination of components from aggregates and disordered regions. Application to a comparison of two different monoclonal antibodies and to detection of partial pH denaturation of a monoclonal antibody illustrates the procedure.

Assessment of power, speed, and agility in athletic, preadolescent youth

AIM

The aim of this report was to assess power, speed, and agility in athletic, preadolescent youth, and determine how agility related to muscular strength and power.

METHODS

Boys (N.=53) and girls (N.=104) completed vertical jump (VJ), standing long jump (SLJ), seated medicine ball throw (SMBT), proagility shuttle run (PRO), partial curl-ups (CURL), and 20 yd sprint (20 SP). One-way analysis of variance for gender comparison and multiple regression analysis for determining association among tests were used.

RESULTS

No gender differences (P>0.05) existed for VJ or PRO. However, boys performed better on SLJ (P=0.03; 162.61+24.64 vs.154.51+20.78 cm), 20 SP (P=0.001; 3.70+0.35 vs. 3.96+0.33 s), and CURL (P=0.02; 35.16+9.67 vs. 31.48+8.80) while girls scored higher on SMBT (P=0.001; 340.46+68.58 vs. 287.12+56.39 cm). Among girls, PRO was correlated (P<0.01) with SLJ (r=-0.70) and VJ (r=-0.67). In boys, correlations (P<0.01) existed between VJ and SLJ (r=0.73) and 20 SP and PRO (r=0.72).

CONCLUSION

The current study supports previous research that found a correlation between SLJ and VJ. SLJ, VJ and SP were significant predictors of PRO, accounting for 55%, 46%, and 43% of the variation, respectively. The PRO agility test is easy to administer and requires lower body strength and power necessary for the quick changes in direction inherent to ground-based field sports. When designing a performance-related test battery for young athletes, PRO, SLJ, and VJ are effective measures and worthy of inclusion.

Effects of Stochastic Flood Disturbance on Adult Wood Turtles,

The homing ability of non-marine turtles has been studied in a variety of taxa, and many species appear to be capable of short-range homing on the scale of several hundred meters or a few kilometers following experimental displacement. However, the behavioral response of turtles following a naturally caused displacement has seldom been reported. In this paper, we describe the effect of displacement ranging from 1.4 to 16.8 km (average = 4.8 km) by severe floods in a stream system in Massachusetts. We radio-tracked 38 adult Wood Turtles (Glyptemys insculpta) at five separate sites in Franklin County, Massachusetts, for periods ranging from one to four activity seasons and documented the displacement of a total of 12 Wood Turtles during seven floods between 2004 and 2008. Based on the average rate of displacement per flood and annual flood frequency, we estimate that, during our study, floods displaced over 40% of this Wood Turtle subpopulation annually. We present evidence that displacement results in elevated mortality rates and that displaced Wood Turtles mate and nest in the year following displacement at rates well below average; on a longer time scale, however, displacement by flooding may be an important mechanism of population connectivity in some areas. We also present evidence that most Wood Turtles avoid stream segments with stream gradient steeper than 1%; this may in part reflect an adaptation to avoid severe floods. Regional models and empirical data from stream gages suggest that flood intensity may currently be on an increasing trend. Conversion of upland from forest and fields to impervious surfaces and hardening of upstream riverbanks may have exacerbated recent flooding and decreased the resiliency of the riparian system to increased precipitation.

Retrospective analysis of serum valproate levels and need for an antidepressant drug

We sought to determine whether patients receiving valproate plus an antidepressant had significantly lower serum valproate levels before initiation of the antidepressant than those patients receiving valproate without an antidepressant. We further sought to identify the prevalence of antidepressant-induced mania and to determine if valproate provided a protective effect against antidepressant-induced mania. A computer database search from January 1, 1990-June 30, 1998, identified patients with bipolar or schizoaffective disorder treated with valproate. Patients receiving an antidepressant during valproate therapy were identified as the treatment group (9 patients), and the remaining patients served as the control group (17 patients). Serum valproate levels were recorded just before starting the antidepressant for the treatment group and monthly during a comparable period for the control group. The mean time to antidepressant initiation was 15 +/- 8 weeks. The mean serum valproate level just before antidepressant initiation was significantly lower for the treatment group compared with the mean serum valproate level averaged over 16 +/- 6 weeks for the control group (54 +/- 24 vs 73 +/- 13 microg/ml, p<0.05). Four patients (44%) developed antidepressant-induced mania. Three required discontinuation of the antidepressant; their serum valproate levels were 54, 60, and 71 microg/ml. Patients requiring the addition of an antidepressant had significantly lower valproate serum levels than those who did not require an antidepressant. Further study is necessary to determine whether higher serum valproate levels are needed for prevention of depressive symptoms in bipolar and schizoaffective disorders.

A critical review of published economic modelling studies in depression

Depression is a very costly chronic disease. An important cost driver is treatment failure caused by patient noncompliance due, in part, to the adverse effects of medications. Additionally, inadequate duration of therapy and inappropriate medication switching contribute to the high cost of treatment. With the epidemiological data for depression demonstrating a rise in both incidence and prevalence over the last 20 years, and the fact that many of the newer antidepressants will see patent expiry in the near future, previous antidepressant cost-effectiveness scenarios are likely to change. As economic models play an increasingly important role in therapeutic decision-making, clinicians are encouraged to understand the strategies and methods involved in modelling antidepressant therapy. The aim of this review of the literature and synthesis of the various techniques important to the modelling of antidepressant therapies is for the practitioner to gain an increased understanding of the modelling methods previously utilised and be in a position to better evaluate future health economic models for the treatment of depression.

Pharmacist-designed and -implemented pharmaceutical care plan for antipsychotic-induced movement disorders

We developed a systematic approach to assess the presence, severity, and management of extrapyramidal symptoms (EPS) in patients treated with antipsychotics. Patients were evaluated by the Modified Simpson-Angus scale, Abnormal Involuntary Movement Scale, and Dyskinesia Identification System: Condensed User Scale. We completed 235 sets of evaluations in 83 patients. A pharmaceutical intervention was proposed in 54% (130) of evaluations, of which 82% (107) were accepted and followed. In 93% (99) evaluations in which a recommendation was followed, clinical outcome was positive. The most common intervention was reducing the dosage or discontinuing the antidyskinetic agent, most often an anticholinergic (55% of cases). Our results show that detailed monitoring of EPS in a clinical pharmacist-operated clinic promotes rational drug therapy, limits unnecessary drugs, and improves clinical outcome of patients with EPS.

Coronary surgery in Europe: comparison of the national subsets of the European system for cardiac operative risk evaluation database

OBJECTIVE

To compare the national samples of patients who underwent isolated coronary artery bypass grafting (CABG) during the European System for Cardiac Operative Risk Evaluation (EuroSCORE) trial in order to evaluate national differences in epidemiology, patient risk profile and surgical methods.

METHODS

From September to November 1995, 11731 patients had CABG in the six largest contributing nations to the EuroSCORE project: Germany, UK, Spain, Finland, France and Italy. The Chi-square and Kruskal-Wallis tests were applied to obtain an international comparison of patient general status, including pre-operative risk factors, cardiac status, critical pre-operative states, rare conditions, urgency of surgery, angina status, coronary lesions, procedures and EuroSCORE risk assessment.

RESULTS

Large national samples (from 984 patients in Finland to 3138 in Germany) identified significant differences in epidemiology, risk profile and surgical practice. Regarding epidemiology, CABG accounted for 62.8% of adult cardiac surgery, with a range of 46.2 in Spain to 77.7% in Finland (P<0.001). The mean age was 62.9 years (61.4 in Britain to 64.4 in France, P<0.001). The mean body mass index was 26.8 (26 in France to 27.5 in Finland, P<0.001). With regard to risk profile, diabetes was present in 20.3% of patients (11.8% in Britain to 27.7% in Spain, P<0.001). Chronic renal failure was present in 8.3% (6.8% in Germany to 10.6% in Spain, P<0.001). Chronic airway disease affected 3.8% (1.9% in Italy to 5. 1% in Germany, P<0.001). The mean ejection fraction was 0.56 (0.48 in Britain to 0.58 in Finland, P<0.001). The mean predicted mortality (according to EuroSCORE) was 3.3% (2.8% in Finland to 3.6% in France, P<0.001). The prevalence of chronic congestive heart failure, unstable angina and recent myocardial infarction also showed statistically significant differences. No differences were found for some critical preoperative states (such as immediate preoperative cardiac massage and pre-operative intubation), or for surgery for catheter laboratory complication. Regarding surgical practice, major differences were noted in preoperative intra-aortic balloon use (mean 1%, Finland 0%, Spain 2.3%, P<0.001), the number of mammary artery conduits used (mean 0.9, Spain 0.7, France 1.1, P=0.0001) and the number of distal anastomoses (mean 3, France 2.7, Finland 3.8, P=0.001).

CONCLUSION

There are important epidemiological differences in the national cohorts of CABG patients in the EuroSCORE database. Any international comparison of European surgical results must therefore take into account the risk profile of patients by using a compatible risk stratification system.

Risk factors and outcome in European cardiac surgery: analysis of the EuroSCORE multinational database of 19030 patients

OBJECTIVE

To assess risk factors for mortality in cardiac surgical adult patients as part of a study to develop a European System for Cardiac Operative Risk Evaluation (EuroSCORE).

METHODS

From September to November 1995, information on risk factors and mortality was collected for 19030 consecutive adult patients undergoing cardiac surgery under cardiopulmonary bypass in 128 surgical centres in eight European states. Data were collected for 68 preoperative and 29 operative risk factors proven or believed to influence hospital mortality. The relationship between risk factors and outcome was assessed by univariate and logistic regression analysis.

RESULTS

Mean age (+/- standard deviation) was 62.5+/-10.7 (range 17-94 years) and 28% were female. Mean body mass index was 26.3+/-3.9. The incidence of common risk factors was as follows: hypertension 43.6%, diabetes 16.7%, extracardiac arteriopathy 2.9%, chronic renal failure 3.5%, chronic pulmonary disease 3.9%, previous cardiac surgery 7.3% and impaired left ventricular function 31.4%. Isolated coronary surgery accounted for 63.6% of all procedures, and 29.8% of patients had valve operations. Overall hospital mortality was 4.8%. Coronary surgery mortality was 3.4% In the absence of any identifiable risk factors, mortality was 0.4% for coronary surgery, 1% for mitral valve surgery, 1.1% for aortic valve surgery and 0% for atrial septal defect repair. The following risk factors were associated with increased mortality: age (P = 0.001), female gender (P = 0.001), serum creatinine (P = 0.001), extracardiac arteriopathy (P = 0.001), chronic airway disease (P = 0.006), severe neurological dysfunction (P = 0.001), previous cardiac surgery (P = 0.001), recent myocardial infarction (P = 0.001), left ventricular ejection fraction (P = 0.001), chronic congestive cardiac failure (P = 0.001), pulmonary hypertension (P = 0.001), active endocarditis (P = 0.001), unstable angina (P = 0.001), procedure urgency (P = 0.001), critical preoperative condition (P = 0.001) ventricular septal rupture (P = 0.002), noncoronary surgery (P = 0.001), thoracic aortic surgery (P = 0.001).

CONCLUSION

A number of risk factors contribute to cardiac surgical mortality in Europe. This information can be used to develop a risk stratification system for the prediction of hospital mortality and the assessment of quality of care.