Discontinuation Period Research Articles

Antidepressant prescribing patterns in Australia.

The Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders (MDcpg2015 and MDcpg2020) provide evidence-based and consensus-based recommendations for managing mood disorders. We examined Australian real-world prescribing habits to determine whether management in clinical practice aligned with MDcpg2015 recommendations. A retrospective analysis of a cohort of patients ≥16 years old who had been dispensed a Pharmaceutical Benefits Scheme (PBS)-listed antidepressant between July 2013 and June 2019 was conducted using Australian Commonwealth Department of Human Services PBS 10% sample data. Between July 2013 and June 2019, 239 944 patients in Australia commenced antidepressant treatment. Of these, 22% (52 694 patients) received a second treatment (a new class of treatment after a period of discontinuation or additional antipsychotic therapy) and 6% (15 741 patients) received a third treatment. Patients were initially prescribed primarily selective serotonin reuptake inhibitors (SSRIs; 52% of prescriptions) or tricyclic antidepressants (TCAs; 25%), even though TCAs are not recommended for first-line treatment. Fewer than one-quarter of patients were prescribed serotonin-noradrenaline reuptake inhibitors (13%) or other agents (10%). General practitioners (GPs) were more likely to initiate TCAs than psychiatrists (22% v. 7%).Once initiated, the overall median time patients remained on treatment was 4.5 months; this was highest with SSRIs (5.8 months) and lowest with TCAs (0.9 months). First-line prescribing broadly follows guidelines. GP and psychiatrist prescribing patterns differ, perhaps reflecting different patient groups and the need to tailor treatment to individuals. Future guidelines should aim to capture the different presentations and complexity of depression.

Clinical Outcomes of Repeated Radioactive Iodine Therapy for Graves' Disease.

Background Radioactive iodine (RAI) therapy is a successful therapeutic modality for Graves’ disease. However, RAI therapy can fail, and RAI therapy after antithyroid drugs (ATDs) has a lower remission rate. Therefore, many patients require repeated RAI therapy. This study investigated the clinical outcomes of repeated RAI therapy for Graves’ disease.Methods Patients who underwent RAI therapy as second-line therapy after failure of ATD treatment between 2001 and 2015 were reviewed. Remission was defined as hypothyroid or euthyroid status without ATD, and with or without levothyroxine at 12 months after RAI therapy.Results The 1-year remission rate after 2nd RAI therapy (66%, 152/230) is significantly higher than that after 1st RAI therapy (48%, 393/815) or long-term ATD treatment after 1st RAI therapy failure (42%). The clinical response to 2nd RAI therapy was more rapid. The median time intervals from the 2nd RAI therapy to ATD discontinuation (1.3 months) and to the start of levothyroxine replacement (2.5 months) were significantly shorter than those for the 1st RAI therapy. A smaller goiter size, a longer time interval between the 1st and 2nd RAI therapies, and a longer ATD discontinuation period predicted remission after the 2nd RAI therapy. Finally, in 78 patients who failed the 2nd RAI therapy, the mean ATD dosage significantly reduced 5.1 mg over 12 months.Conclusion Repeated RAI therapy can be a good therapeutic option, especially in patients with smaller goiters and those who are more responsive to the 1st RAI therapy.

Genealogy of Conflict among Bone and Luwu Students in Makassar City

The phenomenon of conflict among students that have occurred recently raises several questions. Is this conflict in accordance with the specific factors of each case or has certain socio-cultural roots. If that so, why do conflicts occur more often against certain areas. Why does the conflict always recur even though reconciliation has been carried out every time the conflict occurs. This research has some purposes: firstly, finding out the social and cultural roots of conflict among Bone and Luwu students. Secondly; finding how to handle regional conflicts among students. This research is descriptive qualitative by using knowledge geneaology approach from Michel Foucault. Research data obtained through observation, in-depth interviews and documentations. The results showed that a) the phenomenon of conflict among Bone and Luwu students had socio-cultural roots that were produced in the form of internal knowledge from generation to generation. The birth of the local organization of commissariat on campus marked a period of significant discontinuity producing inter-regional conflict. In addition, the functional of regional organizations as regeneration spaces that perpetuate fanaticism; b) regional organizations need to encourage an inclusive regeneration curriculum. In addition, it is very important to carry out social and spatial engineering that allows inclusive activities to live on campus by strengthening student institutions.

Listening to the silent struggles of bipolar disorder through sonification of iMoodJournal data.

Listening to the silent struggles of bipolar disorder through sonification of iMoodJournal data.

Effects of methylphenidate after a long period of discontinuation include changes in exploratory behavior and increases brain activities of Na+,K+-ATPase and acetylcholinesterase

Methylphenidate (MPH) has been widely misused by children and adolescents who do not meet all diagnostic criteria for attention-deficit/hyperactivity disorder. Since it is not yet known whether MPH can be administered in childhood without consequences in adulthood, in the present study we proposed to investigate the effects of chronic early treatment with MPH after a long period of discontinuation. Wistar male rats were injected with MPH (2 mg/kg, intraperitoneally) or saline solution once daily from 15th to 44th day of life. Two months after the last MPH administration, we evaluated the animal’s performances on a battery of behavior tests. We also tested Na+,K+-ATPase and acetylcholinesterase activities in prefrontal cortex and hippocampus, which may be associated with behavior. Rats treated with MPH during peri-adolescence show changes in exploratory behavior in adulthood in the open field but not in the elevated plus maze and light–dark transition tests. MPH-treated rats showed a lower latency to find the platform in the training phase, as well as a better performance in the test phase in the Morris water maze test. No differences were observed in the object recognition index and working memory. Acetylcholinesterase was increased in prefrontal cortex and hippocampus, while Na+,K+-ATPase was increased only in hippocampus. These findings provide additional evidence that early-life exposure to MPH can have complex effects in adulthood and new basis for understanding the behavioral and neurochemical consequences associated with chronic use of MPH during the development of central nervous system.

PD36-03 CHRONIC MARIJUANA USE IMPACTS TESTICULAR VOLUME AND MALE REPRODUCTIVE HEALTH IN RHESUS MACAQUES

You have accessJournal of UrologyCME1 May 2022PD36-03 CHRONIC MARIJUANA USE IMPACTS TESTICULAR VOLUME AND MALE REPRODUCTIVE HEALTH IN RHESUS MACAQUES Jasper C. Bash, Jason C. Hedges, Emily R. Boniface, Victoria H. J. Roberts, Carol B. Hannah, and Jamie O. Lo Jasper C. BashJasper C. Bash More articles by this author , Jason C. HedgesJason C. Hedges More articles by this author , Emily R. BonifaceEmily R. Boniface More articles by this author , Victoria H. J. RobertsVictoria H. J. Roberts More articles by this author , Carol B. HannahCarol B. Hannah More articles by this author , and Jamie O. LoJamie O. Lo More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002594.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Marijuana is the most commonly used federally illegal drug in the US, but our understanding of its effects on male fertility is limited. The objective of our study was to determine the dose-response effect of chronic contemporary marijuana (delta-9-tetrahydrocannabinol, THC) use on male testes and reproductive health in a non-human primate (NHP) model. METHODS: Adult reproductive age male rhesus macaques (n=6) of similar weight and prior proven fertility were on a standard chow diet with a daily THC edible. All animals were titrated to 2.5 mg/7 kg/day of THC (equivalent to a heavy human medical marijuana dose) over 280 days. Testicular volume, serum hormones, and semen samples were assessed at pre-THC, moderate-THC and heavy-THC dosing timepoints. A subcohort of animals (n=3) also underwent a 140 day period of THC discontinuation with testicular, serum and semen evaluations at 70 and 140 days. Random intercept mixed effects models with a linear spline at start of THC abstinence were used to determine the average change in testes, serum, and semen measurements with increasing THC dose and after discontinuation. RESULTS: For every 1 mg/7 kg/day increase in THC dosing, there was a significant decrease in total testicular volume bilaterally by 13 cm3 (95% CI -15.40- -10.9, p <0.001 (Fig. 1A). A similar dose-response significant decrease in liquid semen ejaculate volume (p=0.043), mean total testosterone (p <0.001) and estradiol (p <0.001), but significant increase in FSH (p=0.017), LH (p=0.013), and prolactin (p=0.01) was observed (Fig 1B). No other significant changes in semen parameters were present (Fig 1C).Every 70 days of THC abstinence (n=3), total testicular volume increased significantly by 5 cm3 (95% CI 3.2-6.9, p<0.001) to 82% of its original volume by 140 days after THC discontinuation (Fig. 1D). Serum T (p=0.001) and LH (p=0.019) both rose significantly, and FSH (p=0.008) decreased significantly (Fig. 1E). There were no significant changes to semen parameters after THC discontinuation (Fig. 1F). CONCLUSIONS: Chronic THC use in rhesus macaques resulted in significant dose-response testicular atrophy, increased gonadotropins, decreased serum sex steroids, and semen volume. Abstinence from THC resulted in incomplete recovery of testicular volume. Source of Funding: ASRM, NIH/NICHD K12 HD00849, Medical Research Foundation - OHSU © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e633 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jasper C. Bash More articles by this author Jason C. Hedges More articles by this author Emily R. Boniface More articles by this author Victoria H. J. Roberts More articles by this author Carol B. Hannah More articles by this author Jamie O. Lo More articles by this author Expand All Advertisement PDF DownloadLoading ...

Floral resource continuity boosts bumble bee colony performance relative to variable floral resources

Abstract Centuries of landscape changes associated with agriculture have dramatically reduced the amount and increased the temporal variability of the floral resources that support key pollinating insects such as bumble bees. Adapting to these novel resource conditions is important to ensure the persistence of bumble bee species. While several species appear to be in decline in modern agricultural landscapes, others have thrived, suggesting adaptation to exploit highly variable floral resources. Bombus impatiens, the common eastern bumble bee, is a prime example of such a species. We designed an experiment to compare how free‐foraging colonies of B. impatiens performed adjacent to areas with either temporally continuous or variable (pulsed) patches of purple tansy (Phacelia tanacetifolia) plantings. We found that colonies in Phacelia landscapes grew faster, had gained more mass, and produced more gynes than did colonies in reference landscapes with no Phacelia. Comparing colony responses between pulsed and continuous flowering resources showed that total mass gain at the end of the experiment was greater with continuous flowering resources. In contrast, colony growth rate and total gyne production were comparable for colonies adjacent to Phacelia plantings that were continuous versus pulsed. While low in statistical replication, given the scale of the experimental manipulation, our experiment shows that although B. impatiens colonies can exploit periods of resource discontinuity and gain mass, these continuously available floral resources appear important for colony growth and benefit gyne production.

Immune response to the third COVID-19 vaccine dose is related to lymphocyte count in multiple sclerosis patients treated with fingolimod.

BackgroundThe majority of multiple sclerosis [MS] patients treated with fingolimod fail to develop a protective level of IgG humoral and adaptive cellular immune responses following full BNT162b2 SARS-CoV-2 vaccination.ObjectiveTo compare the efficacy of the third COVID-19 vaccine dose in vaccine non-responders fingolimod-treated MS patients.Study designThis is a prospective 3-month, single-center, randomized clinical trial.MethodsTwenty relapsing MS patients who had been on fingolimod therapy ≥ 12 months and failed to develop humoral IgG immune response to 2-dose Pfizer BNT162b2 COVID-19 vaccination were randomized into two groups: fingolimod-continuation group and fingolimod-discontinuation group. Humoral and memory cellular immune responses were assessed within 1 and 3 months following the third Pfizer BNT162b2 vaccine dose and compared between the groups.ResultsA higher rate of patients in the fingolimod-discontinuation group [n = 8/10] compared to fingolimod-continuation group [n = 2/10] developed positive SARS-COV-2 IgG. Median IgG titer 1 month following the third dose was 202.3 BAU/ml vs. 26.4 BAU/ml, respectively, p = 0.022. The development of IgG humoral response correlated with absolute lymphocyte count. Specific SARS-COV-2 memory B cell and T cell immune responses were not detected in both groups, either at 1 month or 3 months following the third COVID-19 vaccine dose.ConclusionsShort period of fingolimod treatment discontinuation was associated with the development of humoral protection but not with adaptive cellular immunity.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00415-022-11030-0.

How do type of preoperative P2Y12 receptor inhibitor and withdrawal time affect bleeding? Protocol of a systematic review and individual patient data meta-analysis

IntroductionIn order to reduce the risk of bleeding in patients on P2Y12 receptor inhibitors presenting for non-emergent coronary artery bypass grafting (CABG), current guidelines recommend a preoperative discontinuation period of...

Abstract 7: Use of growth hormone therapy in short patients born small for gestational age: Data from real-life French clinical practice

Background: A national French registry was created to address the absence of data on final height and safety following long-term exposure to supraphysiological doses of growth hormone (GH) in children born small for gestational age (SGA).Methods: This observational, non-interventional study (NCT01578135) included GH-naïve and non-naïve SGA children treated with GH at 126 sites in France. The inclusion period was 2005–2010 with follow-up until 2018 or until final adult (FA) height (height velocity <2 cm/year). The primary endpoints were proportion of patients with normal (>–2) height standard deviation score (HSDS) at last visit, and with normal FA HSDS. Secondary endpoints included change from baseline in HSDS and safety. Multivariate logistic regression analysis with stepwise elimination was used to identify factors associated with achieving normal HSDS.Results: Of the 1408 registered patients, every fifth child was randomly selected (n = 291) for inclusion in this long-term follow-up study. For the full population and subpopulation, mean (SD) baseline age was 8.79 (3.53) and 8.08 (3.32) years; HSDS was –2.55 (0.95) and –3.07 (0.86); 48.4% and 46.0% were female, respectively. Normal HSDS was reached in 193/291 children (66.3%). Among the 24.7% of patients who achieved FA height at last visit, 66.7% had FA HSDS >–2. Mean change from start of treatment to last visit in HSDS was +1.35 (0.97). Factors associated with reaching normal HSDS were baseline HSDS (taller better; odds ratio [95% confidence interval]: 5.65 [3.22;9.92], P < 0.0001); age at treatment start (younger better; 0.88 [0.79;0.98], P=0.0166); treatment duration excluding discontinuation periods (longer better; 1.20 [1.04;1.38], P=0.0166); and absence of a chronic disease (0.43 [0.21;0.87], P=0.0188). The majority (70.0%) of adverse events (AEs) were non-serious; 39.0% of all AEs and 7.0% of serious AEs were considered possibly/probably related to GH treatment. The most common AEs (% of patients) were increased insulin-like growth factor-I (IGF-I; 17.2%), headache (9.3%) and arthralgia (4.5%). Sixteen patients (5.5%) discontinued treatment prematurely, most commonly because of increased IGF-I (n = 4). One malignant tumour (nephroblastoma) with a fatal outcome was reported and considered unrelated to GH treatment.Conclusions: GH therapy was effective in most short children born SGA. No new safety concerns were observed. The likelihood of achieving normal HSDS with GH therapy increased with greater baseline HSDS, longer duration of GH treatment, absence of a chronic disease and younger baseline age, reinforcing the importance of early identification and treatment of short patients born SGA.

Evidence of a dietary shift by the Florida manatee (Trichechus manatus latirostris) in the Indian River Lagoon inferred from stomach content analyses

Investigating the long-term fluctuations of the feeding ecology of megaherbivores such as sirenians is important, as any changes could be indicative of shifts in resource availability. The Indian River Lagoon (IRL), eastern Florida, USA, is a critical habitat for the Florida manatee (Trichechus manatus latirostris). However, the IRL has experienced a substantial decline in seagrass due to the persistence of several harmful algal blooms. Using microhistological analysis, we examined the diet of manatees over a discontinuous sampling period spanning over 38 years using stomach contents collected from carcasses recovered in the IRL. Samples collected between 2013–2015 (post-seagrass die-off, n = 90) were compared to archived stomach samples collected between 1977–1989 (pre-seagrass die-off, n = 103). Samples analyzed from 1977–1989 contained primarily seagrasses (61.7%), followed by algae (28.4%) and vascular plants (1.7%). In contrast, stomach samples from the post-seagrass die-off primarily contained algae (49.5%), followed by seagrasses (34%) and vascular plants (2.7%). Between 1977–1989 and 2013–2015, manatees in the IRL experienced a 44.9% decline in seagrass consumption, and a 74.3% increase in algal consumption. This dietary shift was not influenced by body length, a proxy of age, or sex. Our results indicate that the dietary shift experienced by manatees is due to the decline of available seagrass forage in the IRL, and highlight the dietary plasticity of manatees in the face of changes in resource availability. However, the individual health and population-level consequences of this dietary shift are unknown. An increase in mortality due to undetermined causes in this region since 2012 can be associated with deteriorating body conditions of manatees in the IRL, possibly resulting from a lack of seagrass diet. Future research should further investigate behavioral changes affecting manatees in relation to seagrass decline in the IRL, including the energetic costs of this dietary change.

Maximum Dose Food Challenges Reveal Transient Sustained Unresponsiveness in Peanut Oral Immunotherapy (POIMD Study)

The maximum tolerated dose of peanut protein following peanut oral immunotherapy (POIT) is unknown because most research studies have not examined very high thresholds. To define the maximum dose tolerated by patients on POIT and severity of allergic reactions after a 1-month period of treatment discontinuation. In a phase 2 3-year POIT open-label study, we enrolled participants age 5 to 13 years with a 1-year build-up period followed by a 2-year daily maintenance dose of 3900 mg with assessment of the maximum tolerated dose using double-blind placebo-controlled food challenges (DBPCFCs) of 26,225 mg cumulative dose of peanut protein. The DBPCFC was performed at baseline, after 12-month build-up, at 2 year of maintenance, and after a 1-month period of treatment discontinuation. Biomarkers were assessed every 6 weeks for the first 6 months of therapy. A general linear mixed model was used for analysis. The mean maximum cumulative tolerated dose after 12 months increased by 12,063 mg (P < .001) (n= 12), slightly decreased during maintenance (n= 11), and significantly decreased by 7593 mg after avoidance for 1 month (P= .03) (n= 6). Biomarker analysis revealed decreases in cytokine expression within the first 6 weeks of initiation of POIT and decreased peanut-IgG4 and increased cytokine expression after 1 month of discontinuation. The DBPCFC reaction severity, examined through a symptom score with 1 point for each defined symptom, decreased after 12 months, but did not significantly change after 1 month of POIT discontinuation. The evaluation of POIT and sustained unresponsiveness by maximum tolerated dose by DBPCFCs in this small phase 2 trial showed that desensitization is diminished, with 100% loss of tolerated dose after 1 month of avoidance following 3 years of treatment.

A mechanism-based proof of concept study on the effects of duloxetine in patients with painful knee osteoarthritis

BackgroundThe global burden of osteoarthritis (OA) is steadily increasing due to demographic and lifestyle changes. The nervous system can undergo peripheral and central neuroplastic changes (sensitization) in patients with OA impacting the options to manage the pain adequately. As a result of sensitization, patients with OA show lower pressure pain thresholds (PPTs), facilitated temporal summation of pain (TSP), and impaired conditioned pain modulation (CPM). As traditional analgesics (acetaminophen and non-steroidal anti-inflammatory drugs) are not recommended for long-term use in OA, more fundamental knowledge related to other possible management regimes are needed. Duloxetine is a serotonin-noradrenalin reuptake inhibitor, and analgesic effects are documented in patients with OA although the underlying fundamental mechanisms remain unclear. The descending pain inhibitory control system is believed to be dependent on serotonin and noradrenalin. We hypothesized that the analgesic effect of duloxetine could act through these pathways and consequently indirectly reduce pain and sensitization. The aim of this mechanistic study is to investigate if PPTs, TSP, CPM, and clinical pain parameters are modulated by duloxetine.MethodsThis proof of concept study is a randomized, placebo-controlled, double-blinded, crossover trial, which compares PPTs, TSP, and CPM before and after 18 weeks of duloxetine and placebo in forty patients with knee OA. The intervention periods include a titration period (2 weeks), treatment period (60 mg daily for 14 weeks), and a discontinuation period (2 weeks). Intervention periods are separated by 2 weeks.DiscussionDuloxetine is recommended for the treatment of chronic pain, but the underlying mechanisms of the analgesic effects are currently unknown. This study will investigate if duloxetine can modify central pain mechanisms and thereby provide insights into the underlying mechanisms of the analgesic effect.Trial registrationClinicalTrials.govNCT04224584. Registered on January 6, 2020. EudraCT 2019-003437-42. Registered on October 22, 2019. The North Denmark Region Committee on Health Research Ethics N-20190055. Registered on October 31, 2019.

Monuments and Monumentality in a Changing Socio-Political Landscape: A View from Udaypura

This work intends to explore the nature of socio-political change in historical periods usually referred to as interregnal which, for the purposes of this paper, is defined as a period of discontinuity or gap in political and social organization. It traces the survival of a historical monument through two interregnal centuries of medieval Indian sub-continental history (11th–12th and 14th) to argue that modern historiographical templates which study these periods as precursors or remnants of succeeding and preceding centuries, respectively, do not sufficiently explore the socio-political possibilities innate in these periods of distributed political agency. In the context of Indian history, while historians have focused on the confrontational aspect of Hindu-Muslim polities or communities in interregnal centuries, I suggest that these periods provided fertile ground for political innovation and negotiation, thus breaking the confrontational stasis usually associated with regnal centuries.

Genome-wide survey and identification of AP2/ERF genes involved in shoot and leaf development in Liriodendron chinense

BackgroundLiriodendron chinense is a distinctive ornamental tree species due to its unique leaves and tulip-like flowers. The discovery of genes involved in leaf development and morphogenesis is critical for uncovering the underlying genetic basis of these traits. Genes in the AP2/ERF family are recognized as plant-specific transcription factors that contribute to plant growth, hormone-induced development, ethylene response factors, and stress responses.ResultsIn this study, we identified 104 putative AP2/ERF genes in the recently released L. chinense genome and transcriptome database. In addition, all 104 genes were grouped into four subfamilies, the AP2, ERF, RAV, and Soloist subfamilies. This classification was further supported by the results of gene structure and conserved motif analyses. Intriguingly, after application of a series test of cluster analysis, three AP2 genes, LcERF 94, LcERF 96, and LcERF 98, were identified as tissue-specific in buds based on the expression profiles of various tissues. These results were further validated via RT-qPCR assays and were highly consistent with the STC analysis. We further investigated the dynamic changes of immature leaves by dissecting fresh shoots into seven discontinuous periods, which were empirically identified as shoot apical meristem (SAM), leaf primordia and tender leaf developmental stages according to the anatomic structure. Subsequently, these three candidates were highly expressed in SAM and leaf primordia but rarely in tender leaves, indicating that they were mainly involved in early leaf development and morphogenesis. Moreover, these three genes displayed nuclear subcellular localizations through the transient transformation of tobacco epidermal cells.ConclusionsOverall, we identified 104 AP2/ERF family members at the genome-wide level and discerned three candidate genes that might participate in the development and morphogenesis of the leaf primordium in L. chinense.

Older People and HIV Infection: An Experience of "Ageing Badly" Within the City of Abidjan (Côte D'Ivoire)

In Côte d'Ivoire, active ageing remains a worrying and topical subject which requires cross-sectional studies. The present study is a contribution to this reflection with a particular focus on the "ageing problem" in relation to HIV infection. In a qualitative approach, individual semi-directive interviews were conducted with 23 people aged between 60 and 67 years, including 17 women and 6 men infected with HIV. They are members of a Non-Governmental Organization (NGO) that provides assistance to people living with HIV (PLHIV). These respondents were selected for the study on a voluntary basis, based on availability and defined criteria. The interviews took place at the headquarters of this NGO over a discontinuous period from 26 April to 13 June 2021. The thematic analysis of the content of the speeches brought out the social representations of HIV/AIDS and of "ageing badly" among the respondents. The latter represent HIV/AIDS as "the disease of people with a bad lifestyle. They would have contracted it through a "spell" that would have been cast on them. They perceive being HIV-positive in old age and chronic geriatric illnesses as an expression of 'bad age'. Unprotected sex with multiple partners, infidelity within the couple and, indirectly, the use of aphrodisiacs are the risk factors that exposed them to the virus. HIV combined with underlying chronic illnesses has contributed to their fragility, social vulnerability and dependence. As they are victims of social rejection and stigmatization by their respective family members, the inclusion of older people living with HIV (PLWHA) in HIV/AIDS programs is essential. Similarly, sexuality education for older people is useful. It is therefore more than urgent to organize public solidarity around PLWHA in Côte d'Ivoire. Keywords: Older people, HIV, "Ageing badly", Côte d'Ivoire. DOI: 10.7176/RHSS/11-22-06 Publication date: November 30 th 2021

Communication strategy, change and the British Conservative Party

This paper asks how the British Conservative Party responded to changes in wider socio-political events and techno-cultural trends from 2010-20, under the leaderships of David Cameron (2005-16); Theresa May (2016-19); and Boris Johnson (2019- until the paper’s submission in 2021). Using secondary analysis of the author's earlier published work; and fresh analyses of evidence from news media and party-related archives (for example, ConservativeHome), the article aims to offer an indicative historical analysis of the party's development with a focus on key drivers of change, including Brexit and digital media in the context of the party’s communication strategy. Four key markers of analysis are used to focus the examination of several campaign case studies across a decade stretching from the 2010 general election period to the so called 'Brexit election' of 2019. The paper argues that, overall, across the decade, the party adapted to external factors, like Brexit and advances in digital communication; and a period of discontinuity in the party, from 2016 to 2019, contributed to punctuating the party’s wider evolution, following the fallout from the 2016 EU referendum and events in the run-up to the 2019 General Election.

Combining time varying filtering based empirical mode decomposition and machine learning to predict precipitation from nonlinear series

In recent years, due to the influence of human activities and changing climate conditions, precipitation time series have had increasing non-stationarity and randomness. Therefore, the scientific and accurate prediction of precipitation has become increasingly difficult. To improve precipitation prediction accuracy, nonlinear precipitation data was decomposed into several subcomponents via three decomposition methods (time varying filtering based empirical mode decomposition (TVF-EMD), wavelet transform (WT), and complementary ensemble empirical mode decomposition (CEEMD)). Then, the Elman neural network (ENN) was used to construct TVF-EMD-ENN, WT-ENN, and CEEMD-ENN models to predict the subcomponents of precipitation. Finally, these three models were applied to the monthly and daily precipitation series from different meteorological stations. The results showed that TVF-EMD-ENN made relatively stable predictions for monthly and daily precipitation, and was better than WT-ENN, CEEMD-ENN, and other models. Predictions for Turpan station were generally poor, likely due to the discontinuous resonance periods and abnormal resonance periods between precipitation and climate indices. Overall, the predictions by TVF-EMD-ENN were better, which was clearly reflected in the variance contribution rates (VCR) of high-frequency subcomponents, which were lower than those of WT and CEEMD. Parameter sensitivities of TVF-EMD indicated that the bandwidth threshold (BT) and the b-spline order (BSO) had a strong influence on model performance, and that BT and BSO should remain within 0.15–0.50 and 15–65, respectively. This study has provided a new approach to precipitation prediction that is better equipped to handle non-stationarity and randomness.

Adverse Drug Reactions and Their Impact on the Treatment of Pulmonary Tuberculosis

Background: Although there have been some reports about adverse drug reactions (ADRs) in pulmonary tuberculosis treatment, there are few detailed data and the effect of age among elderly patients on ADRs and the period of medication discontinuation due to ADRs is unknown. Purpose: We evaluated the difference in the incidence of ADRs necessitating discontinuation or a change of medication (dADR) among the different age groups and the period of discontinuation in elderly patients undergoing pulmonary tuberculosis treatment. Subjects and Methods: We conducted a retrospective medical record survey of patients who started anti-tuberculosis medication at our hospital from April 1st, 2018 to March 31st, 2020. Results: A total of 120 patients were recruited. There was no significant difference in the incidence of dADR among the different age groups every 10 years in patients ≥50 years of age (p=0.78). The median period of discontinuation was approximately 4 weeks for fever (29.5 days), approximately 3 weeks for rash (18.5 days), approximately 2 weeks for gastrointestinal disorders (16 days), and hepatocellular liver injury (15.5 days), and approximately 1 week for cholestatic liver injury (8 days) and eosinophilia (7 days). Conclusion: The incidence of dADR was not different among the age groups when patients of ≥50 years of age were compared by age. The median times of onset were 1–3 weeks after the start of treatment. The median periods of discontinuation were 1–4 weeks, and the period of discontinuation due to allergic reactions tended to be the longest

Factor V Leiden homozygous mutation: Recurrent venous thromboembolism during periods of discontinuation of anticoagulant therapy

Venous thromboembolism (VTE), also known as deep vein thrombosis and pulmonary thromboembolism, is a medical condition that has a high incidence and a multifactorial pathogenesis. One of the causes is a mutation of the Factor V Leiden (FVL), which is the most common inherited thrombotic disorder. A mutation inherited from both parents is found in about 0.05-0.5% of cases, making our case more medically interesting. We presented the case of a young male patient with recurrent VTE and few risk factors who was admitted to the hospital 4 times with VTE symptoms over a 5-year period. In the background, there was a homozygous FVL mutation and improper use of anticoagulant therapy. We examined the medical data, diagnostics, therapy, and precautions that were and are required.