The effects of an ambulatory collaborative practice model on process and outcome of care for bipolar disorder

Background: Bipolar disorder is a chronic mental illness that affects 1% of the population. Persons with bipolar disorder have substantial rehabilitative potential, although research has shown that such mood disorders are undertreated.Objectives: The objective was to determine the effect of a high-intensity collaborative practice ambulatory program on process and outcome of care: specifically, patient satisfaction, intensity of medication treatment, and the amount and patterns of service use.Study Design: The Bipolar Disorders Program was structured for easy patient access by assigning clinical nurse specialists as primary caregivers to each patient supported by psychiatrist backup. The first 76 patients enrolled in the Bipolar Disorders Program who completed 6 months served as the sample. A quasiexperimental study was used. A mirror image design was used where relevant measurements before admission to the Bipolar Disorders Program were compared with data during the first 6 months of enrollment.Results: Patients showed significant increases in satisfaction with care, increases in intensity of medication treatment, and trends toward decreases in neuroleptic exposure. Annualized service use data revealed significant decreases in emergency department use, psychiatric triage use, and psychiatric hospitalization days.Conclusions: These data indicated that high-intensity ambulatory treatment for bipolar disorder may have increased both treatment intensity and patient satisfaction and decreased use of costly mental health services.     

DFT and AFIR study on the copper(i)-catalyzed mechanism of 5-enamine-trisubstituted-1,2,3-triazole synthesis via C–N cross-coupling and the origin of ring-opening of 2H-azirines

Understanding the synthesis mechanism of substituted 1,2,3-triazoles is an important and state-of-the-art research area of contemporary copper(i)-catalyzed terminal alkyne and organic azide click reaction (CuAAC), which has invoked increasing close collaborations between experiment and theory including copper catalyzed interrupted click reaction. In this study, the mechanism of Cu(i)-catalyzed 5-enamine-functionalized fully substituted 1,2,3-triazole synthesis was rationalized via density functional theory (DFT) and multicomponent artificial force-induced reaction (MC-AFIR) methods. The reasonable reaction route consists of (a) di-copper catalyzed ring-opening of 2H-azirines, (b) alkyne hydrogen atom transfer, (c) [3 + 2] ring cycloaddition, and (d) C–N bond formation through reductive elimination. The MC-AFIR method was used for the systematic determination of transition states for the C/N–Cu bond formation, C–N bond coupling and crossing points between singlet and triplet states. Our survey on the prereactant complexes suggested that the dicopper-catalyzed 2H-azirine ring-opening and alkyne hydrogen activation are both thermodynamically feasible via a singlet/triplet crossing point. This explains why Et₃N is critical for alkyne hydrogen transfer (HT) before the [3 + 2] cycloaddition reaction, and the C–N cross-coupling product instead of the click product (byproduct). Our DFT results indicate that the transmetalation process is the rate determination step along the triplet state potential energy surface. This study provides important mechanistic insights for the interrupted CuAAC reaction to form 5-enamine-fully-substituted-1,2,3-triazoles. Further insight prediction interprets that solvent and extra strong ligand coordination play a certain role in competitive reactions.

The Cu(i)-catalyzed mechanism of 5-enamined-functionalized fully substituted 1,2,3-triazole synthesis was rationalized by interrupted copper(i)-catalyzed terminal alkynes and organic azides click reaction (CuAAC).     

Rapid and sensitive determination of doxorubicin in human whole blood by vertically-ordered mesoporous silica film modified electrochemically pretreated glassy carbon electrodes

Direct and accurate detection of doxorubicin (DOX) in unprocessed human whole blood is of vital importance in medical diagnosis and monitoring. In this work, we demonstrate the utilization of electrochemically pretreated glassy carbon electrodes (p-GCE) modified with vertically-ordered mesoporous silica films (VMSF) for rapid and sensitive electrochemical detection of DOX. The electrochemically pretreated process is a simple, cost-effective and environmentally friendly approach for improving interface catalytic properties and introducing oxygen-containing groups into the GCE surface, which could be suitable for stably growing VMSF without any adhesive layer simultaneously retaining the underlying electrode activity. Benefiting from the highly sensitive electrode substrate of p-GCE and electrostatic preconcentration effect of VMSF, the present VMSF/p-GCE sensor was able to determine DOX with an ultrahigh sensitivity (23.94 μA μM⁻¹) and a relatively low limit of detection (0.2 nM) and a rather wide linear range (0.5 nM to 23 μM). Furthermore, direct and reliable electrochemical detection of DOX in human whole blood without complicated sample pretreatments was achieved owing to the excellent anti-fouling and anti-interference ability of VMSF.

Direct and accurate detection of doxorubicin (DOX) in unprocessed human whole blood is of vital importance in medical diagnosis and monitoring.     

Selective sorption of PAHs from TX100 solution by resin SP850: effects of TX100 concentrations and PAHs solubility

Recycling of washing effluent by selective sorption using resins is a feasible method to lower the operation costs of surfactant enhanced remediation (SER). In this study, correlations capable of predicting the selective sorption removal of polycyclic aromatic hydrocarbons (PAHs) by resin SP850 from TX100 solution to recycle washing effluent in SER were developed. A negative relationship of sorption coefficients (log K_f) of PAHs by resin SP850 with TX100 initial concentrations (log C_0,TX100) and water solubilities (log S_w) of PAHs was observed, which indicated that solubility enhancement of PAHs in TX100 micelles was responsible for the decreasing of the selective sorption. Freundlich exponential coefficients (1/n) of PAHs were relatively constant (0.775 ± 0.012), suggesting that the sorption of PAHs by SP850 in the presence of surfactant is a surface adsorption process. The modified selectivity parameter (S*), having a relationship with log C_0,TX100 and PAHs log S_w as well, could be employed to evaluate the efficiency of the selective sorption process and select the optimal TX100 concentration in washing effluents. For example, at the given SP850 dose of 1.0 g L⁻¹, the optimal TX100 concentrations (C_opTX100) for naphthalene, acenaphthene, phenanthrene, pyrene, anthracene and benzanthracene were about 4200, 7100, 8000, 10 000, 18 000 and 19 500 mg L⁻¹, respectively, having a negative relationship with their log S_w. Moreover, the C_opTX100 was independent of the solid-to-solution ratio of SP850 and TX100 solution containing PAHs. These correlations would be helpful for the application of SER in contaminated soils by giving a method to quantitatively predict the selective sorption behaviors of PAHs by SP850 from TX100 solution, especially for the C_opTX100, using the S_w of organic compounds and surfactant concentrations.

Quantitative correlations of S* and C_opTX100, capable for predicting selective sorption of PAHs by SP850 from TX100 solution were established.     

A Comparison of β-Amyloid Deposition in the Medial Temporal Lobe in Sporadic Alzheimer's Disease,Down's Syndrome and Normal Elderly Brains

The density of β-amyloid (Aβ) deposits was studied in the medial temporal lobe in non-demented individuals and in sporadic Alzheimer's disease (SAD) and Down's syndrome (DS). No Aβdeposits were recorded in six of the non-demented cases, while in a further eight cases, these were confined to either the lateral occipitotemporal or parahippocampal gyrus. The mean density of Aβ deposits in the cortex was greater in SAD and DS than in non-demented cases but with overlap between patient groups. The mean density of Aβ deposits was greater in DS than SAD consistent with a gene dosage effect. The ratio of primitive to diffuse Aβ deposits was greater in DS and in non-demented cases than in SAD and the ratio of classic to diffuse deposits was lowest in DS. In all groups, Aβ deposits occurred in clusters which were often regularly distributed. In the cortex, the dimension of the Aβ clusters was greater in SAD than in the non-demented cases and DS. The data suggest that the development of Aβ pathology in the hippocampus could be a factor in the development of DS and SAD. Furthermore, the high density of Aβ deposits, and in particular the high proportion of primitive type deposits, may be important in DS while the development of large clusters of Aβ deposits may be a factor in SAD.