Treatment algorithm use to optimize management of symptomatic patients with a history of mania

BACKGROUND: While monotherapy has significant limitations in bipolar disorder, few published data addressing alternatives exist. Treatment algorithms have been proposed, but none have undergone empirical evaluation. This study provides a systematic prospective, open evaluation of the effectiveness and tolerability of a treatment algorithm for patients with histories of mania. METHOD: Twenty-eight symptomatic outpatients from a public mental health facility who were diagnosed as having either bipolar I or schizoaffective illness, bipolar type, entered the study. Minimum blood levels of lithium and divalproex sodium were defined. Medications were pushed to predetermined levels (as tolerated) before proceeding to the next algorithm step. Clinical symptoms were assessed monthly using the Brief Psychiatric Rating Scale (BPRS, 27 item) and Clinical Global Impressions scale. RESULTS: Pretreatment and posttreatment clinical symptoms were compared. Over 50% of patients attained 30% improvement from baseline BPRS after 4 months. Thirty-six percent of patients (N = 10) became mood stable, 46% (N = 13) remained mood unstable, and 18% (N = 5) dropped out before completing the algorithm. Although patients who finished the algorithm were taking more medication, either dosage and/or drugs, somatic complaints did not increase. CONCLUSION: The potential benefit of a defined treatment algorithm was demonstrated for these complex and persistently ill patients. Despite long treatment histories, patients improved with more frequent visits and addition of medication(s). A randomized controlled trial comparing a similar treatment algorithm with treatment-as-usual is warranted.     

Rheological studies on a slurry biofuel to aid in evaluating its suitability as a fuel

Biomass is an often abundant, renewable, low ash and low sulfur fuel. Due to these properties, biofuels are promising alternatives for traditional petroleum-based fuel applications; however, traditional biofuels for internal combustion engines are not cost competitive with gasoline, diesel or fuel oils. One method to reduce the cost of biofuels is to use slurry fuels which have a potential lower cost than liquid biofuels due to high conversion efficiencies. Slurry biofuels, such as a mixture of corn and water, could provide a biofuel alternative for diesel engines, pressurized gasifiers and heating oil applications such as burners or gas turbines. Use of these biomass slurries poses important questions about their stability and suitability for practical applications in internal combustion engines and combustors.This work reports rheology data for stable corn-starch water slurries (CSWS) which used a polyacrylic acid thickener to eliminate settling of the slurry and to provide desirable shear-thinning behavior for most of the compositions evaluated. The effect of shear rate on the viscosity of the CSWS was studied using a BOHLIN-controlled stress (CS) rheometer. The well-known Ostwald—de Waele power law and Sisko models for viscosity fit the data. The effect of corn starch content, thickener content and temperature on the viscosity of CSWS was also studied. The favorable shear thinning properties were observed for starch contents up to 45% starch and should aid pumping, injection and spraying. The lower heating values of the slurries, however, are undesirably low.     

A spline framework for estimating the EEG surface laplacian using the Euclidean metric

This letter develops a framework for EEG analysis and similar applications based on polyharmonic splines. This development overcomes a basic problem with the method of splines in the Euclidean setting: that it does not work on low-degree algebraic surfaces such as spherical and ellipsoidal scalp models. The method's capability is illustrated through simulations on the three-sphere model and using empirical data.     

Qualitative Axioms of Uncertainty as a Foundation for Probability and Decision-Making

Although the concept of uncertainty is as old as Epicurus’s writings, and an excellent quantitative theory, with entropy as the measure of uncertainty having been developed in recent times, there has been little exploration of the qualitative theory. The purpose of the present paper is to give a qualitative axiomatization of uncertainty, in the spirit of the many studies of qualitative comparative probability. The qualitative axioms are fundamentally about the uncertainty of a partition of the probability space of events. Of course, it is common to speak of the uncertainty, or randomness, of a random variable, but only the partition defined by the values of the random variable enter into the definition of uncertainty, not the actual values. It is straightforward to add axioms for decision making following the general line of Savage from the 1950s. Indeed, in the spirit of Epicurus, it is really our intuitive feeling about the uncertainty of the future that motivates much of our thinking about decisions. Here, the distinction between the concepts of probability and uncertainty can be made by citing many familiar examples. Without spelling out the technical details, the axiomatization of qualitative probability with uncertainty as the most important primitive concept, it is possible to raise a different kind of question about bounded rationality. This new question is whether or not one should bound the uncertainty in thinking and investigating any detailed framework of decision making. Discussion of this point is certainly different from the question of bounding rationality by not maximizing expected utility. In practice, we naturally bound uncertainty in our analysis of decision-making problems. As in the case of formulating an alternative for maximizing expected utility, so is the case of rational alternatives to maximizing uncertainty. There are several issues to consider. In the spirit of my other work in qualitative probability, I explore alternatives rather than attempt to give a definitive argument for one single solution.     

Density modeling of polyurethane box foam

A model based on about a dozen fundamental differential equations is used to evaluate and simulate the urethane reactions and physical processes of urethane box foaming. This work focuses on quantitative modeling of foam density for foams using water and physical blowing agents. The final densities of foams range from 30 to 90% of the density as projected with full utilization of the blowing agent. The primary sources of inefficient use of blowing agent are loss of the physical blowing during open‐air mixing and degassing—basically, physical blowing agents with boiling points between 25 and 80°C will evaporate and experience cell rupture in box foams. This loss of blowing agent would not apply to in‐line mixers used for commercial production and should be taken into account with scaling up box or cup foams commercial processes. POLYM. ENG. SCI., 54:1503–1511, 2014. © 2013 Society of Plastics Engineers     

Clinical experience using gabapentin adjunctively in patients with a history of mania or hypomania

Biliary, plasma, and urinary disposition of paclitaxel and paclitaxel metabolites were determined simultaneously in a patient with percutaneous biliary drain. The complete chemical structures of the major metabolites were established by mass spectrometry and NMR spectroscopy. A nonlinear elimination model was indicated by the fact that the rate of biliary excretion of paclitaxel rose as plasma concentrations fell. Dihydroxypaclitaxel was the predominant biliary metabolite, in contrast to the barely detectable levels in two previous patients. This derivative results from hydroxylation at the C6 position of the taxane ring and at the phenyl C3'-position on the C13 side chain mediated by cytochrome P450 2C8 and 3A4, respectively. In line with this mechanism, the two other main metabolites corresponded to 6alpha-hydroxypaclitaxel and to the paclitaxel derivative hydroxylated in the para-position on the phenyl ring at the C3'-position of the C13. A high CYP3A4 activity in the patient is consistent with the repeated administration of methylprednisolone for 14 days before paclitaxel treatment, a compound known to induce the CYP3A isoform, and with the increased ratio of 6beta-hydroxycortisol/cortisol in urine, an index of CYP3A activity. These findings emphasize the influence of pretreatment with corticoids on the disposition of paclitaxel.     

Modeling reaction kinetics of rigid polyurethane foaming process

A theoretical model was developed to simulate the polyurethane foaming process for a rigid foam. In the model, multiple ordinary differential equations were solved by MATLAB and the model was able to predict temperature profiles by inputting foam recipe information. This initial study on foam modeling focusses on reaction kinetic parameters that were fitted to experimental temperature data as a function of time. The modeling was able to accurately model temperature profiles of single‐polyol polyurethane formulations and was able to accurately predict temperature profiles of mixtures based on pure component kinetic parameters. A primary goal of this work is to expedite the ability to develop new foam formulations by simulation—especially for incorporation of new bio‐based polyols into formulations. © 2013 Wiley Periodicals, Inc. J. Appl. Polym. Sci. 130: 1131‐1138, 2013     

Roles of plug-in hybrid electric vehicles in the transition to the hydrogen economy

Closed-system regenerative fuel cells (RFCs) are an alternative to non-regenerative fuel cells as a transition technology and mainstay of a hydrogen economy. Substantially petroleum-free automobiles can spontaneously evolve from hybrid electric vehicles (HEVs) based solely on the economic viability of replacing batteries with RFCs as fuel cell prices decrease. The evolution can be projected first to plug-in HEVs (PHEVs) and finally to a substantially hydrogen-based transportation system.     

Projecting student trajectories in a computer-assisted instruction curriculum.

Proposes 10 models for predicting a student's final grade placement in a computer-assisted instruction curriculum from the time the student spends taking lessons. Using data from approximately 2,000 elementary students, the models are tested both for ability to predict final grade placement and for ability to describe all points observed throughout the year. Two of the simplest models, using only the most recent point and parameters estimated for the whole group, are best at prediction. The power function model with all parameters estimated individually for each student, while relatively poor at prediction, is best for describing all observed points. Several methods for predicting the amount of time a student will spend taking lessons during a year are also tested. (4 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Noncatalytic polymerization of ethylene glycol and epoxy molecules for rigid polyurethane foam applications

The study investigated an approach to incorporate modified epoxidized soy‐based vegetable oil polyol as a replacement for petroleum‐based polyether polyol and to substantially reduce the isocyanate loading in the rigid foam formulation. Noncatalytic polymerization of epoxidized bodied soybean oil and ethylene glycol (EG) was carried out in a closed batch reaction. Cleavage of the oxirane rings and hydroxyl group attachment at optimum conditions provided the desired polyol products. The polyols were characterized based on its hydroxyl numbers, acidity, viscosity, iodine number, and Gardner color index for quality purposes. Reactions of oxirane ring and EG were verified by spectroscopic FTIR. Crosslinking performance was evaluated by extractability analysis on the polyurethane (PU) elastomer wafers. Rigid foaming performed at 50 and 75% petroleum‐based polyether polyol replacements have shown excellent thermoinsulating and mechanical properties compared with epoxidized soybean oil (ESBO) alone or petroleum‐based polyether polyol alone. A reduction of up to 8% of the polymeric diphenylmethane diisocyanate was achieved using the synthesized ESBO‐EG‐based polyols. A higher average functionality polyol is key component to the reduction of isocyanate in PU synthesis. © 2009 Wiley Periodicals, Inc. J Appl Polym Sci, 2009