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Introduction & objectivesMethodsResultsConclusionsAgitation is a common complication after an acute TBI in ICU patients. Professionals have a range of strategies to address agitation. Yet the absence of evidence-based guidelines and how these strategies are implemented complicates the management and safety may often be compromised for both ICU professionals and patients. This project explores experiences and attitudes of ICU-nurses to better understand the management of agitated behaviors in acute TBI-patients.Semi-structured interviews were conducted with 12 ICU-nurses from two Level-1 trauma centers in Canada. The interviews explored experiences and perceptions of managing agitation in critically ill TBI-patients. Interviews were analyzed using thematic analysis, facilitating the examination of how management practices interface with contextual variables and clinical strategies.Five themes were identified: (1) a variety of symptoms differing according to patient profile and time since awakening, (2) different agitation management approaches stem from different concerns, (3) strategies used by nurses to manage agitation, (4) contextual factors influence management, and (5) potential opportunities to improve integrated care model.This research describes nurses’ perceptions and helps understand management of agitation, by considering underlying contexts and factors affecting TBI-agitated patients management, how ICU itself contributes to agitation and potential areas for improvement. [ABSTRACT FROM AUTHOR]

The study's purpose was to analyze outcomes of patients with severe behavioural disturbances after acquired brain injury (ABI) in order to identify predictors of discharge destination from a specialized unit (SU) of a Swiss neurorehabilitation facility. Retrospective analysis of 85 patients. Potential predictors of the main outcome discharge destination were assessed with a correlation analysis. The Agitation Behaviour Scale (ABS), Functional Independence Measure (FIM), length of stay (LOS) and pre-living situation were tested in a logistic regression analysis. Twenty-nine patients were institutionalized and 56 patients went home. Discharge destination was significantly correlated to ABS score at discharge from SU (rs = −.33, p =.002), total FIM score on admission to the SU (rs =.25, p =.022), total FIM score at discharge from the SU (rs =.37, p <.001), LOS at the SU (rs = −.36, p =.001), and LOS after discharge of the SU (rs =.36, p =.001). Multivariate analysis showed that FIM scores at discharge (OR = 1.03, p =.008), and LOS at SU (OR = 0.98, p =.017) predicted discharge destination significantly. FIM or LOS may be important predictors in planning discharge destination in patients with severe behavioural disturbances. Further prospective studies are critically needed to better understand the complexity of interactions amongst important predictive factors. [ABSTRACT FROM AUTHOR]

Introduction: Agitation is a common and disruptive syndrome in dementia due to Alzheimer's disease (AD). Brexpiprazole was recently approved for this agitation of AD dementia and is the only therapy approved for this indication. Areas covered: The authors review the chemistry, pharmacokinetics, mechanism of action, and pharmacodynamics of brexpiprazole. Phase 2/3 and Phase 3 studies of brexpiprazole for the treatment of agitation in dementia due to AD are described. These studies demonstrated efficacy and safety for the 2 mg/d and 3 mg/d doses. Agitation reduction from baseline was significantly greater in the active treatment groups compared to the participants on placebo as measured by the Cohen-Mansfield Agitation Inventory, the primary outcome. Treatment benefit was demonstrated on the Clinician Global Impression – Severity, the key secondary outcome. Safety and tolerability were comparable in drug and placebo arms of the studies. Expert opinion: Approval by the Food and Drug Administration (FDA) of brexpiprazole for the treatment of agitation in dementia due to AD is an important milestone and regulatory precedent. This is the first approval for the treatment of any neuropsychiatric syndrome of AD. Brexpiprazole has a 'black box' warning for its use in psychosis caused by dementia due to an observed increase in mortality when using this class of antipsychotic agents in patients with dementia. Post-marketing surveillance will be key to understanding the safety profile of brexpiprazole. Brexpiprazole may be prioritized over the 'off label' use of other potential treatments for agitation. [ABSTRACT FROM AUTHOR]

Background: This study was designed to compare the effect of nalbuphine versus dexmedetomidine on the incidence of post-operative emergence agitation (EA) in pediatric patients undergoing elective lower abdominal surgical procedures during anesthesia with sevoflurane. Methods: A prospective, controlled trial of 135 children aged 3–6 years scheduled for elective lower abdominal surgery was randomly assigned to one of the three equal groups receiving either nalbuphine 0.1 mg/kg IV (Group N), dexmedetomidine 0.5 mic/kg IV in (Group D) or a saline solution (Group C) at 10 min before the end of surgery in a double-blind manner. Post-operative EA was assessed with pediatric anesthesia emergence delirium (PAED) scale. Results: The incidence of EA was significantly low in children in Group N and Group D compared to placebo group (p = 0.011) with no significant difference between Group N and Group D. The number of patients receiving nalbuphine and post-operative nalbuphine consumption during PACU stay were significantly higher in Group C than in Groups N and D (p = 0.024 and 0.001 respectively) with no significant differences between Group N and Group D. There was no significant difference regarding pain between the three groups at 5, 10, 20 and 30 min postoperatively. No significant difference among groups regarding the time to Aldrete score. The overall incidence of vomiting in our study was similar in the three groups. Conclusion: Nalbuphine 0.1 mg/kg was comparable to dexmedetomidine 0.5 mic/kg for decreasing the incidence and severity of EA in the PACU in sevoflurane-anesthetized children when administered intravenously 10 min before the end of surgery. Trial registration: This study was registered at ClinicalTrials.gov NCT05273671 (10/03/2022). [ABSTRACT FROM AUTHOR]

A randomized controlled trial was conducted to examine the effects of bright light therapy on agitation in older adults with dementia in Macao. This study involved 31 participants: 10 in the outdoor light treatment group, 11 in the indoor light-box treatment group, and 10 in the control group. Significant reductions in agitation were observed in the two treatment groups over four weeks compared to the control group. However, no statistical difference in cognitive function between experimental and control groups was found. This study supports the use of bright light therapy to reduce agitation in older people with dementia. [ABSTRACT FROM AUTHOR]

Introduction: Agitation, psychosis, and apathy are prevalent and highly distressing neuropsychiatric symptoms (NPS) of Alzheimer's disease (AD) that have been linked to numerous negative outcomes, including increased mortality, worsened cognitive decline, and caregiver burden. Current treatments for AD-associated agitation, namely atypical antipsychotics, provide some benefits but may increase the risk of serious adverse events and death. Meanwhile, no pharmacotherapies have been approved by regulatory agencies for the treatment of psychosis or apathy in AD. Over the past decade, many new and repurposed drugs have emerged as potential therapeutic options for managing these challenging NPS. Areas covered: This review aims to provide a comprehensive summary of pharmacotherapies that have recently been investigated in phase 2 and 3 clinical trials for the treatment of agitation, psychosis, or apathy in AD. Expert opinion: Novel atypical antipsychotics, serotonergic antidepressants, cannabinoids, and dextromethorphan combination drugs have shown promising results for alleviating agitation. Pimavanserin appears to be the most effective emerging therapy for psychosis, while methylphenidate has demonstrated good efficacy for apathy. Further research on biomarkers of NPS severity and treatment response, as well as continued improvements in methodological approaches are needed to advance the field. [ABSTRACT FROM AUTHOR]

Managing agitation and other behaviours that challenge is a significant dementia care challenge. The priority is to find effective non-pharmacological interventions as drug treatments can have significant side effects. This review evaluates the effectiveness of structured physical activity on agitation in dementia. Our rapid review searched four electronic databases, Cochrane CENTRAL, MEDLINE, CINAHL and Embase, for interventional studies using a structured physical activity programme in people with dementia and studied the effect of this activity on behaviours that challenge. Study quality was assessed using CASP criteria and data was narratively synthesised. We included 13 studies in this review (four rated as high quality), involving a total of 1546 participants. Results were analysed according to exercise type, frequency and intensity of the intervention. Exercise is effective in reducing agitation and studies with higher adherence to exercise demonstrated more positive effects on agitation and behaviours that challenge. Physical activity can be effective in reducing agitation in older adults with dementia. Further research is needed to clarify the type of intervention that is most beneficial. Strategies to make physical activity more acceptable and available to people with dementia need to be established. [ABSTRACT FROM AUTHOR]

In traumatic brain injury patients (TBI) admitted to the intensive care unit (ICU), agitation can lead to accidental removal of catheters, devices as well as self-extubation and falls. Actigraphy could be a potential tool to continuously monitor agitation. The objectives of this study were to assess the feasibility of monitoring agitation with actigraphs and to compare activity levels in agitated and non-agitated critically ill TBI patients. Actigraphs were placed on patients' wrists; 24-hour monitoring was continued until ICU discharge or limitation of therapeutic efforts. Feasibility was assessed by actigraphy recording duration and missing activity count per day. Data from 25 patients were analyzed. The mean number of completed day of actigraphy per patient was 6.5 ± 5.1. The mean missing activity count was 20.3 minutes (±81.7) per day. The mean level of activity measured by raw actigraphy counts per minute over 24 hours was higher in participants with agitation than without agitation. This study supports the feasibility of actigraphy use in TBI patients in the ICU. In the acute phase of TBI, agitated patients have higher levels of activity, confirming the potential of actigraphy to monitor agitation. [ABSTRACT FROM AUTHOR]

Alpha-2 agonists are under-recognized for their class effects yet offer potential benefit in specialty palliative care via decreasing sympathetic output, inducing sedation, and modulating pain. Especially in clinical contexts where agitation predominates and patients are intolerant of oral medication route, transdermal medication delivery is advantageous. We report a case of agitated behaviors in setting of mixed Alzheimer/vascular-type dementia limiting hospital discharge to nursing facility that were ameliorated with transdermal clonidine. We suggest palliative clinicians routinely conceptualize the seemingly disparate alpha-2 agonists as a class for effective symptom palliation especially as new clinical evidence becomes available. [ABSTRACT FROM AUTHOR]

During the early recovery period after traumatic brain injury (TBI), referred to as post-traumatic amnesia (PTA), approximately 44% of individuals may exhibit agitated behaviours. Agitation can impede recovery and poses a significant management challenge for healthcare services. As families provide significant support for their injured relatives during this time, this study aimed to explore the family's experience during PTA to better understand their role in agitation management. There were 20 qualitative semi-structured interviews conducted with 24 family members of patients exhibiting agitation during early TBI recovery (75% female, aged 30–71 years), predominantly parents (n = 12), spouses (n = 7) and children (n = 3). The interviews explored the family's experience of supporting their relative exhibiting agitation during PTA. The interviews were analyzed using reflexive thematic analysis, which revealed three key themes: family contributions to patient care, expectations of the health care service and supporting families to support patients. This study emphasized the significant role of families in managing agitation during early TBI recovery and highlighted that families who are well-informed and well-supported have the potential to minimize their relative's agitation during PTA, which may reduce the burden on healthcare staff and promote patient recovery. [ABSTRACT FROM AUTHOR]

Acute metamfetamine toxicity is characterized by stimulant effects and neuropsychiatric disturbance, which is attenuated by gamma-aminobutyric acid type A receptor agonists including benzodiazepines. We utilized clinical registry data to examine the effect of co-exposure to a gamma-aminobutyric acid type B receptor agonist (gamma-hydroxybutyrate) in illicit drug cases with analytically confirmed exposure to metamfetamine. The Emerging Drugs Network of Australia Victoria is an ethics board-approved prospective registry collecting clinical and analytical data (utilising blood samples) on emergency department illicit drug presentations. Comparison groups were defined by analytically confirmed exposure: lone metamfetamine, metamfetamine plus gamma-hydroxybutyrate, metamfetamine plus benzodiazepine, metamfetamine plus gamma-hydroxybutyrate plus benzodiazepine. Cases with co-exposure to other stimulants or sedatives were excluded. Median metamfetamine blood concentrations were significantly greater in metamfetamine plus gamma-hydroxybutyrate (n = 153, median = 0.20 mg/L, interquartile range: 0.10–0.32 mg/L, 95 per cent confidence interval: 0.20–0.23 mg/L) and metamfetamine plus gamma-hydroxybutyrate plus benzodiazepine (n = 160, median = 0.20 mg/L, interquartile range: 0.10–0.30 mg/L, 95 per cent confidence interval: 0.20–0.30 mg/L) positive groups compared to gamma-hydroxybutyrate negative groups including metamfetamine (n = 81, median = 0.10 mg/L, interquartile range: 0.05–0.21 mg/L, 95 per cent confidence interval: 0.09–0.18 mg/L) and metamfetamine plus benzodiazepine (n = 73, median = 0.10 mg/L, interquartile range: 0.06–0.20 mg/L, 95 per cent confidence interval: 0.09–0.20 mg/L) groups (P < 0.0004). Presenting heart rate in metamfetamine plus gamma-hydroxybutyrate cases (n = 153, median = 72 beats per minute, interquartile range: 63–86 beats per minute, 95 per cent confidence interval: 70–78 beats per minute) was significantly lower than metamfetamine plus benzodiazepine cases (n = 73, median = 84 beats per minute, interquartile range: 73–98 beats per minute, 95 per cent confidence interval: 80–90 beats per minute, P < 0.0001), and lone metamfetamine cases (n = 81, median = 110 beats per minute, interquartile range: 87–131 beats per minute, 95 per cent confidence interval: 93–120 beats per minute, P < 0.0001). Presenting temperature in metamfetamine plus gamma-hydroxybutyrate cases (median = 35.8 °C, interquartile range: 35.0–36.2 °C, 95 per cent confidence interval 35.6–35.9 °C) was significantly lower than metamfetamine plus benzodiazepine cases (median 36.2 °C, interquartile range 35.7–36.6 °C, 95 per cent confidence interval, 36.0–36.4 °C, P = 0.017), and lone metamfetamine cases (median = 36.5 °C, interquartile range: 35.8–37.1 °C, 95 per cent confidence interval: 36.2–36.7 °C, P < 0.0001). Median presenting systolic blood pressure was significantly (P ≤ 0.001) lower in benzodiazepine positive groups (metamfetamine plus benzodiazepine median = 120 mmHg, interquartile range: 109–132 mmHg, 95 per cent confidence interval: 116–124 mmHg and metamfetamine plus benzodiazepine plus gamma-hydroxybutyrate median = 124 mmHg, interquartile range: 110–137 mmHg, 95 per cent confidence interval: 120–129 mmHg). Incidence of sedation (Glasgow Coma Scale less than 9) was significantly greater in metamfetamine plus gamma-hydroxybutyrate cases (63 per cent) compared to metamfetamine plus benzodiazepine cases (27 per cent, P < 0.0001) and lone metamfetamine cases (15 per cent, P < 0.0001). Incidence of agitation was significantly lower in metamfetamine plus gamma-hydroxybutyrate plus benzodiazepine cases (17 per cent, P < 0.0001) and metamfetamine plus gamma-hydroxybutyrate cases (34 per cent, P = 0.0004) compared to lone metamfetamine cases (58 per cent). Differences in gamma-aminobutyric acid type A and B receptor physiology may offer a gamma-aminobutyric acid type B agonist-facilitated alternative pharmacodynamic mechanism able to attenuate metamfetamine stimulant and neuropsychiatric toxicity. Metamfetamine intoxicated patients with analytically confirmed co-exposure to gamma-hydroxybutyrate had significantly reduced heart rate, body temperature and incidence of agitation compared to patients with lone metamfetamine exposure. Metamfetamine intoxicated patients with analytically confirmed co-exposure to a benzodiazepine had significantly reduced systolic blood pressure compared to patients with lone metamfetamine exposure. We hypothesize that gamma-aminobutyric acid type B receptor agonists may be beneficial in the management of acute metamfetamine toxicity. [ABSTRACT FROM AUTHOR]

The impact of the biophysical environment on the platelet storage lesion (PSL) has mainly focused on reduced temperature storage, overlooking the significance of storage-induced shear stress. Shear stress in platelet storage refers to the frictional force acting parallel to the bag surface and exists solely through the implementation of agitation. This study investigates whether minimizing exposure to agitation-induced shear stress can alleviate the unexplained loss of function in stored platelet concentrates for neonatal transfusion (neonatal PCs). Using particle tracking analysis, fluid motion was measured in neonatal and adult platelet storage bags under agitation frequencies ranging from 20–60 rpm. Platelets stored at 20-60 rpm agitation over 8 days were examined by biochemical analysis, aggregation, and expression of activation markers. Results indicate that neonatal PCs experience significantly higher storage-induced shear stress compared to adult doses, leading to reduced functionality and increased activation from day 2 of storage. Adjusting the neonatal PC agitation frequency to 20 rpm improved functionality in early storage, while 40 rpm maintains this improvement throughout storage with reduced activation, compared to 60 rpm storage. This study confirms that small volume PC storage for neonatal use contributes to the PSL through the induction of shear stress, suggesting further evaluation of the recommended agitation frequency for neonatal PCs or postponement of the production of neonatal PCs until requested for neonatal transfusion.Context Approximately 1–5% of all neonates and up to 50% of critically ill newborns, present with low platelet counts, and will require platelet transfusion support. Platelet concentrates stored for neonatal transfusion have previously shown an accelerated reduction in quality during storage compared to platelet concentrates stored for adult transfusion and therefore may not provide as effective a therapeutic product. The current study hypothesized this loss of function over storage (known as the platelet storage lesion) to be a result of shear stress induced by agitation, exacerbated by the use of smaller bags in the neonatal preparation. Findings Our findings show that storage of platelet concentrates as smaller bags suitable for neonatal transfusion accelerates the platelet storage lesion, which experience a 4-fold greater shear stress than the adult preparation. The shear stress experienced by platelet concentrates stored for neonatal transfusion could be reduced by reducing the speed of agitation, thereby reducing the extent of the platelet storage lesion. Impact This study provides evidence that small volume storage promotes shear stress in platelet concentrates stored for neonatal transfusion, and optimizing storage conditions to reduce the shear stress induced by agitation can help to offset the platelet storage lesion. Further evaluation is required to establish a recommended agitation frequency for platelet concentrates stored for neonatal transfusion. An alternative strategy might include postponement of the production of platelet concentrates for neonatal transfusion until a neonatal transfusion is requested. [ABSTRACT FROM AUTHOR]

Aims: To describe and compare clinical characteristics, healthcare costs, and institutionalization/mortality outcomes among patients with and without agitation associated with Alzheimer's dementia (AAD). Methods: Data from the Reliant Medical Group database (01/01/2016-03/31/2020) were used, including claims, electronic medical records, and clinical information/physician notes abstracted from medical charts. Patients aged ≥55 years with Alzheimer's dementia (AD) were observed during a randomly selected 12-month study period after AD diagnosis. Using information recorded in medical charts, patients were classified into cohorts based on experiencing (agitation cohort) and not experiencing (no agitation cohort) agitated behaviours during the study period. Entropy balancing was used to create reweighted cohorts with similar characteristics. Study outcomes (patient demographic and clinical characteristics, treatments received, healthcare costs, institutionalization and death events) were compared between cohorts; agitation characteristics were described for the agitation cohort only. Results: Among 711 patients included in the study, 240 were classified in the agitation cohort and 471 in the no agitation cohort. After reweighting, several comorbidities were more frequently observed in the agitation versus no agitation cohort, including infection, depression, and altered mental status. Use of antidepressants, anticonvulsants, antipsychotics, and antianxiety medications was more common in the agitation versus no agitation cohort. Common agitated behaviours included hitting (20.8%), pacing/aimless wandering (17.5%), and cursing/verbal aggression (15.0%). Total all-cause healthcare costs were $4287 per-patient-per-year higher in the agitation cohort versus no agitation cohort (p = 0.04), driven by higher inpatient costs. Death was more common and time to death and institutionalization were shorter in the agitation versus no agitation cohort. Limitations: Results may not be generalizable to the US population with AD. Conclusions: Among patients with AD, agitation was associated with shorter time to death/institutionalization and increased comorbidities, medication use, and healthcare costs, highlighting the additional clinical and economic burden that agitation poses to patients and the healthcare system. [ABSTRACT FROM AUTHOR]

Agitated behaviours pose a significant challenge during early recovery following traumatic brain injury (TBI). This study aimed to gain a deeper understanding of how clinicians worldwide manage post-TBI agitation. Understanding the factors that influence how clinicians manage agitation can help inform the use of consistent and effective management strategies for reducing agitation in TBI care. Using a qualitative design, semi-structured interviews were conducted with 33 clinicians (58% female, aged 23–71 years) from 16 countries who had experience working with agitated patients. The interviews explored the approaches used to manage agitation during early TBI recovery. Interviews were analysed using thematic analysis. The central theme of the interviews was the effective management of agitation, consisting of three sub-themes: managing the safety of staff and patients, reducing triggers for agitation, and implementing behavioural principles for managing agitation. Two overarching themes influenced the effective management of agitation: clinician-related factors and systemic factors. This study highlighted key approaches for effective agitation management during early TBI recovery, as described by clinicians working with these patients worldwide. There were similarities in the strategies described, although there were many challenges that impeded the consistent implementation of such strategies in TBI care settings. Effective management of agitation during early traumatic brain injury (TBI) recovery continues to pose a significant challenge for clinicians worldwide. Healthcare services may improve the management of agitation by involving the patient's family in care delivery and implementing low-cost less-restrictive non-pharmacological interventions to reduce reliance on pharmacological interventions. Proactively addressing and removing potential sources of agitation (patient-related and environmental) may help reduce the risk of agitation occurring. The use of simple behaviour management strategies may be effective for reducing agitation, but strategies need to be implemented consistently and the approach should be flexible and tailored to the patient. Clinicians should develop an understanding of a patient's premorbid behaviours and interests to best inform the management approach. Management of agitation may be improved by increasing clinicians' agency in responding to agitated behaviours, through the provision of information and resources, ongoing training and skill development, supervision and support. [ABSTRACT FROM AUTHOR]

Agitation and aggression are common following traumatic brain injury. The challenges related to these disorders affect all stages of recovery, from the acute hospital to the community setting. The aim of this literature review is to provide an updated overview of the current state of post-traumatic agitation research. We performed a PubMed literature review which included recent confirmatory and novel research as well as classic and historical studies to integrate past and future concepts. Areas explored include the personal and societal effects of post-traumatic agitation, methods for defining and diagnosing several neurobehavioral disorders, and pathophysiology and management of agitation and aggression. Target areas for future study are identified and discussed. While much progress has been made in understanding post-traumatic agitation, there remain several key areas that require further elucidation to support the care and treatment for people with traumatic brain injury. [ABSTRACT FROM AUTHOR]

This study aimed to determine the impact of safety challenges on professional journalistic reporting of IPOB protests in Nigeria. A total of 400 Nigerian journalists who were covering IPOB activities were surveyed. Data were analysed using multivariate analysis of variance (MANOVA), multivariate analysis of covariance (MANCOVA) and correlational analysis. The result of the study showed that journalists recovering IPOB activities in South East Nigeria faced safety challenges both online (verbal abuse, threat of attack, personal messages of harassment and reputational threats) and offline (physical attacks, harassment, damage to working devices) safety challenges. Additional results showed that women faced more safety challenges online than men, but men faced more offline safety challenges than women. Put together, women faced both online and offline safety challenges more than men. Also, journalists in private media outfits faced offline challenges than their counterparts in public media stations who faced more online safety challenges. Put together, journalists in private media stations faced more safety challenges than those in public media outfits. Safety challenges impact professional journalistic reporting in the area of routines, orientation and autonomy. Training was found to be an efficient way of assisting journalists to better handle risky assignments. [ABSTRACT FROM AUTHOR]

Objectives: Sensory-based interventions are commonly used to reduce the occurrence of agitation in people with dementia over extended periods. However, the evidence regarding their immediate de-escalation effects is unclear. The objectives of this systematic review are to (a) identify which sensory-based interventions have been used for de-escalating agitation and (b) examine the immediate effects of these interventions on de-escalating agitation in people with dementia. Methods: A systematic review was performed in accordance with PRISMA guidelines. Data sources were identified by searching Embase, Medline, PsycINFO, and CINAHL for publications up to 2 March 2022. The de-escalating agitation effect had to be measured during the intervention or within 15 min after commencing the treatment. Only randomized controlled trials or quasi-experimental studies published in English were included. Results: Nine studies met the inclusion criteria: two randomized controlled trials, one cross-over study, and six quasi-experimental studies. All were conducted in Western countries, involving a total of 246 participants. Music-related interventions were investigated in seven studies, and a positive effect on de-escalating agitation was found, with no side-effects. All of the studies had methodological limitations, including a single group design, blinding, an insufficient sample size, and imprecisely reported results. Conclusion: There is a profound dearth of rigorous studies examining the immediate agitation de-escalating effects of sensory-based interventions on people with dementia. However, the limited evidence on music-related interventions is encouraging. More rigorous research is recommended to confirm the effects. [ABSTRACT FROM AUTHOR]

Neuropsychiatric symptoms (NPS) in Alzheimer's Disease (AD) are associated with negative outcomes for patients and their care partners. Agitation is a common and distressing NPS, without safe and effective treatments. Nonpharmacological interventions are first line treatment, but not effective or appropriate for every patient. Current pharmacological treatments of agitation in AD include off-label use of antipsychotics, sedative/hypnotics, anxiolytics, mood-stabilizing anticonvulsants, acetylcholinesterase inhibitors, NMDA receptor antagonists, and antidepressants. Despite prevalent use, efficacy and safety concerns remain. Better understanding of neurobiological mechanisms of agitation have fueled recent clinical trials. This article is an update to our 2017 review. Comprehensive search of ClinicalTrials.gov was completed from January 2017 to February 2023 using the search terms "Alzheimer's Disease" and "Agitation". Subsequent scoping review was completed in PubMed and Google Scholar. Several agents were identified, including: brexpiprazole, cannabinoids, dexmedetomidine, dextromethorphan, escitalopram, masupirdine, and prazosin. Clinical trials utilize both novel and repurposed agents for agitation in AD. With increasing understanding of the neurobiological mechanisms that fuel development of agitation in AD, use of enahanced trial design and conduct, advanced statistical approaches, and accelerated pathways for regulatory approval, we advance closer to safe and efficacious treatment options for agitation in AD. [ABSTRACT FROM AUTHOR]

To characterize all hospitalizations held in mainland Portugal (2010–2015) with dementia-related agitation based on International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) coding, and to investigate whether there is a relationship between agitation and hospitalization outcomes. A retrospective observational study was conducted using an administrative dataset containing data from all mainland Portuguese public hospitals. Only hospitalization episodes for patients aged over 65 years who have received a dementia diagnosis ascertained by an ICD-9-CM code of dementia with behavioral disturbance (294.11 and 294.21) and dementia without behavioral disturbance (294.10 and 294.20) were selected. Episodes were further grouped according to the presence of an agitation code. For each episode, demographic data and hospitalization outcomes, including length of stay (LoS), in-hospital mortality, discharge destination and all-cause hospital readmissions, were sourced from the dataset. Comparative analyses were performed and multivariable logistic methods were used to estimate the adjusted associations between agitation (exposure) and outcomes. Overall, 53,156 episodes were selected, of which 6,586 had an agitation code. These were mostly related to male, younger inpatients (mean 81.19 vs. 83.29 years, p < 0.001), had a higher comorbidity burden, stayed longer at the hospital (median 9.00 vs. 8.00 days, p < 0.001) and frequently ended being transferred to another facility with inpatient care. Agitation was shown to independently increase LoS (aOR = 1.385; 95%CI:1.314–1.461), but not the risk of a fatal outcome (aOR = 0.648; 95%CI:0.600–0.700). These results support the importance of detecting and managing agitation early on admission, since its prompt management may prevent lengthy disruptive hospitalizations. [ABSTRACT FROM AUTHOR]

Especially when acutely ill, individuals with schizophrenia and bipolar disorder can present with agitated behavior. The initial approach to agitation management are non-pharmacologic strategies such as verbal de-escalation techniques; however, pharmacologic interventions may be needed. Dexmedetomidine is a selective alpha-2 adrenergic receptor agonist, and a sublingual formulation has been approved in the US for the treatment of agitation associated with schizophrenia and bipolar disorder in adults. The authors review the published literature on sublingual dexmedetomidine using the US National Library of Medicine's PubMed.gov resource. Pharmacodynamics, pharmacokinetics, and efficacy and tolerability findings are summarized. The authors also provide a discussion to its potential place in the treatment armamentarium. Sublingual dexmedetomidine is an effective and well-tolerated pharmacologic option for the treatment of agitation associated with schizophrenia and bipolar disorder. The sublingual method of administration allows for a rapid onset of action with treatment effects beginning as early as 20 minutes after administration. Adverse effects include somnolence, hypotension, oral paresthesia, hypoesthesia, and dry mouth. Further study will be needed to evaluate sublingual dexmedetomidine in real-world patients receiving concomitant psychotropic medications. [ABSTRACT FROM AUTHOR]

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25B-NBOH is a synthetic hallucinogen closely related to the "NBOMe" family of N-substituted 2C phenethylamine derivatives. There have been no published reports documenting the clinical toxicity of NBOH derivatives. Five patients presented to the Emergency Department (ED) with altered conscious state following exposure to powder sold as "powdered LSD" at a party. A 24-year-old male who ingested the powder developed mydriasis, tachycardia, hypertension, and severe agitation requiring parenteral sedation. A 22-year-old male who insufflated the powder developed status epilepticus requiring intubation. Both patients developed acute kidney injury and one had rhabdomyolysis. In both cases, blood analysis detected 25-NBOH and no other illicit/licit drugs. Three other patients developed mild hallucinations. Hyperthermia was not documented in any case. Exposure to 25B-NBOH in a powdered form produced sympathomimetic toxicity, including hallucinations. Insufflation of 25B-NBOH led to rapid onset of status epilepticus in one case. Toxicity in all cases resolved within 12 h. Despite in vitro evidence of 5-HT2A receptor agonism, hyperthermia was not observed. Potent hallucinogens are often delivered via blotter paper to avoid excessive dosing. The severe clinical toxicity documented in these cases highlights the potential for development of adverse health effects with exposure to apparent small volumes of potent sympathomimetics. [ABSTRACT FROM AUTHOR]

Acute behavioral disturbances in psychosis, including agitation, comprise a heterogeneous group of manifestations varying in intensity and duration they last for. They require rapid, non-coercive treatments ranging from verbal de-escalation to the calming effect of pharmacological agents. The treatment goals are reduction of patient suffering and prevention of disease deterioration. Stabilizing rather than sedating is preferred to ensure improved compliance and a stronger therapeutic alliance. Furthermore, animal pharmacology and clinical studies on agitation reveal the robust calming and anxiolytic properties of loxapine. This review covers the pharmacological and clinical history of loxapine along with research developments. It emphasizes the advantages of its multiple formulations ranging from injectable forms and tablets to orally inhaled forms to attain rapid and fine-tuned tranquilization. Rapid tranquillization is achieved within 2–6 hours using liquid orally-consumed loxapine, and within an hour or less with its IM or orally inhaled forms. Loxapine has been adopted in the management of a wide range of acute disturbances, such as agitation in psychosis. In the context of personalized medicine, key cellular and molecular elements of the schizophrenia phenotype were recently shown to be improved with loxapine. [ABSTRACT FROM AUTHOR]

This pilot study assessed clinical outcomes and quality care for persons with dementia in an acute hospital with PCC, compared with usual care. Forty-seven consented persons 60 years and over with dementia were assigned to PCC (n = 26) or usual care (control) (n = 21). Hospital nurses and allied health staff received 3 h of face-to-face education in PCC, and practice support by four PCC-trained nurse champions. Control group staff received 3 h of face-to-face education on dementia and delirium care clinical guidelines. Primary outcomes behavioral/neuropsychiatric symptoms and care quality were analyzed based on repeated measures at baseline (Time 1), 4–5 days after baseline (Time 2) and day 8–10 after baseline (Time 3) where available. Compared with controls, at Time 2 PCC produced statistically significant improvements in behavioral/neuropsychiatric symptoms (adjusted p =.036) and care quality (adjusted p =.044). Where length of stay exceeded 8 days after baseline (Time 3), there was a sustained improvement in quality care (p =.007), but not in behavioral/neuropsychiatric symptoms (p =.27). PCC can improve care quality for persons with dementia; nursing; agitation; paid caregivers with dementia and reduce behavioral/neuropsychiatric symptoms during short hospital stays. Hospital systems need to support PCC to reduce behavioral/neuropsychiatric symptoms in dementia during long hospital stays. [ABSTRACT FROM AUTHOR]

There is a lack of robust epidemiological evidence on antipsychotic (AP) use in patients with agitation in Alzheimer's disease (AD). Authors studied AP use in patients with AD and agitation and compared their use with patients with other or no neuropsychiatric symptoms (NPS). A retrospective cohort study in the UK Clinical Practice Research Datalink, included patients with AD between January 1st, 2015, and December 31st, 2017. AP use was compared between patients with agitation, other types of NPS and no NPS. There were 24,464 patients with AD, median follow-up of 1.1 years (interquartile range [IQR] 0.5–2.1), and median age 83 years (78–88). A larger percentage of patients with agitation (n = 2432) were prescribed APs (38.2%) than other NPS (n = 13,076, 20.4%) and no NPS (n = 11,816, 12.2%). Compared to patients with no NPS, adjusted hazard ratios for AP use were 3.45 (95% CI 2.86–4.17) for patients with agitation and 1.31 (95% CI 1.19–1.44) for patients with other NPS. Among users of APs, the treatment discontinuation rate at six months was 44.8% in patients with agitation (other NPS 57.1%; no NPS 63.5%). Patients with AD and agitation were frequently prescribed APs and for long periods in routine clinical practice in the UK. The high real-life usage of APs suggests that physicians prefer using APs for the treatment of agitation despite recommendations against their long-term use. These data support a need for AP therapies that better address known safety concerns with currently used APs to treat agitation in elderly patients with AD. [ABSTRACT FROM AUTHOR]

Punjabi singers produced music in support of the farmers and took on-the-ground initiatives to join the protests alongside protesters at the Delhi border and in local protests. This paper analyzes Punjabi Sikh uses of music throughout history and compares them to the music that emerged in the Farmers' Protests. This paper uses Serge Denisoff's criteria for protest music to cross-examine Punjabi protest music produced in various time periods. The Farmers' protest music and musician involvement in the protests is then scrutinized to understand its significance to the protests and to understand the relationship between Punjabi singers and their audiences. [ABSTRACT FROM AUTHOR]

A modification of a dispersive liquid-liquid microextraction (DLLME) procedure through the introduction a less dense binary-solvent mixture that floats on the surface of the aqueous solution for the extraction of polycyclic aromatic hydrocarbons from river water samples is presented in this study. The extracts were analyzed by gas chromatography coupled to mass spectrometry followed by partial validation and application of the method to real water samples collected near a dumpsite. This modified extraction was optimized for selected parameters which were deemed important and uses 50 µL of 25% tetrachloromethane in dodecane spiked into 1.5 mL aqueous solutions containing 10% NaCl. This technique yielded excellent solvent recovery as opposed to unmodified DLLME where solvent losses of up to 95% have been reported. Notwithstanding, the method demonstrated enrichment factors between 179 and 301, sufficient linearity (R2 ≥ 0.9880), repeatability with %RSD 5.6 - 14.3%, n = 27, as well as low limits of detection (34 – 73 ng/L) except for only two compounds, benzo(b)fluoranthene (190 ng/L) and dibenz(a,h)anthracene (250 ng/L). The recoveries in spiked water samples ranged from 97 to 115%. This report presents yet another candidate in the pool of method applicable for analyses of PAHs from aqueous matrices. [ABSTRACT FROM AUTHOR]

Water injection is a common method for enhancing oil recovery from oil reservoirs. However, there is a possibility of forming different precipitations when the injected water and the formation water are combined and this will result in serious problems in the reservoirs. In this study, we investigated the behavior of calcium carbonate precipitation in different conditions of temperature and agitation. At 25 °C and without agitation, it took 6 hours to reach the maximum amount of precipitation. With increasing the temperature to 80 °C, this time decreased to 2 hours. At 25 °C and 80 °C in with agitation condition, the maximum amount of precipitation formed in 2 hours. The results showed that increasing temperature and agitation will result in more amount of calcium carbonate precipitation in less time. The SEM (Scanning Electron Microscope) and EDX (Energy Dispersive X-Ray) analyses were used to identify type, size of the crystals, and elements of the obtained precipitations. The SEM analysis showed that agitation and temperature can decrease the size of the crystals. The results of this study help us to choose the appropriate strategy to prevent the negative consequences such as reservoir permeability reduction and blockage in surface facilities and aquifer areas. [ABSTRACT FROM AUTHOR]

The process of formulating in the area of dementia care is at an early stage of development. A review published in 2016, identified 14 different types of formulation-based approaches for the management of Behavioural and Psychological Symptoms of Dementia (BPSD). The present study examines professionals' views about the use of systematic formulations for choosing first-line non-pharmacological interventions for BPSD. A 34-item online survey, with six items about formulation-based interventions for the management of BPSD, was circulated to multi-disciplinary UK dementia networks. Quantitative data were examined for the use of formulation-based frameworks in practice. Thematic analyses provided insight into the practicalities of using formulations. The majority of the 355 participants responding to the questions stated they used formulation-led models to inform interventions, but 24% stated they did not. Thirty-two types of formulation frameworks were named, and there was a diverse spread across the UK. The Newcastle model was the most frequently used framework, with fifty percent of the participants who formulated reporting using this framework. Four themes regarding the use of formulation emerged, relating to function, process, reported outcomes and obstacles. Formulation-based approaches to targeting intervention are becoming popular in dementia care in the UK. More types of formulation frameworks are used in practice compared with the 2016 review. The use of formulations are seen as key to offering an alternative to pharmacological treatments. Understanding both the value of formulation-led approaches and the obstacles to their use are important to implementing NICE 2018 recommendations. [ABSTRACT FROM AUTHOR]

This article presents some issues for consideration before scaling from a pilot study to a larger investigation in longitudinal observational studies of traumatic brain injury (TBI) rehabilitation. We present a case to discuss protocol improvements in longitudinal TBI-rehabilitation studies. The case was a pilot study conducted at two university hospitals in Denmark investigating 1-year outcomes related to sleep disturbance and agitation during neurointensive care. We included patients with moderate and severe TBI determined by the Glasgow Coma Scale, sleep disturbance was assessed using actigraphy, and agitation was assessed using the Agitated Behavior Scale. Patients (n = 29) were more severely ill and had poorer six-month outcomes in Eastern vs. Western Denmark. Recovery was similar at one-year follow-up. Protocol improvements were needed in relation to inclusion criteria, intervention delivery, patient assessment, and follow-up outcomes. In TBI-rehabilitation studies, we suggest adding the severity of disease score to the initial GCS score and a delirium detection score to the ABS score. Actigraphy should not be used during deep sedation. Established procedures should be in place along all stages of the study protocol, including preparation and periodic assessment of study nurses to optimize data quality. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the impact of a music-based intervention on depression, agitation, and positive emotions among 23 persons with dementia, using a crossover design. Along with a caregiver, each participant received a total of 16 sessions of individualized music listening. All sessions were filmed, resulting in 362 videos, and the content was analyzed. Depression scores decreased significantly over time while agitated behavior showed a constant moderate level without any significant decreases. Positive emotions occurred significantly more often than negative emotions during the music listening. Individualized music listening induced positive emotions and reduced depression scores over time. [ABSTRACT FROM AUTHOR]

Background: Adenotonsillectomy is considered one of the most common surgical procedures in preschool age children. Postoperative emergence agitation (EA) is a major problem that faces anesthesiologist and can be managed by different drugs as opioids, sedatives and propofol. The present prospective, randomized double blinded study was designed to evaluate the effect of intraoperative 0.5 µg/kg dexmedetomidine infusion versus 0.1 mg/kg nalbuphine IV for prevention of postoperative emergence agitation. Methods: After ethical committee's approval and written informed consent, 160 patients were enrolled in the study, 80 in each group. Patients enrolled in the study were randomized into dexmedetomidine 0.5 µg/kg infusion (DEX group) or nalbuphine 0.1 mg/kg IV (NAL group). Both groups were under standard anesthetic regimen with sevoflurane anesthesia. Postoperative measurements included pediatric anesthesia emergence delirium (PAED) score, Ramsay sedation score, hemodynamic changes at arrival to post anesthesia care unit (PACU) 5, 10 minutes then every 10 minutes till discharge from PACU. Results: After ethical committee approval and written informed consent, 160 patients were enrolled in the study, 80 in each group. PAED score was significantly higher in NAL group than DEX group (13(12–16) vs. 12(11–13), respectively (p value <0.001). Number of patients needed rescue sedation was statistically higher in NAL than DEX group (12 vs. 3), respectively (p value 0.027). Ramsay sedation score was statistically higher in DEX group than NAL group at 10 and 20 minutes at PACU (p value <0.001). Both groups had similar length of stay in PACU. Conclusion: Dexmedetomidine is better than nalbuphine in prevention of postoperative EA in preschool children, with more postoperative sedation and similar stay in PACU. [ABSTRACT FROM AUTHOR]

Research has linked agitation and low body trust to suicidal thoughts and behaviors. We investigated a pathway with agitation accounting for the relationship between body trust and suicidality. 511 individuals recruited via MTurk (Study 1) and 167 undergraduate students (62.9% with suicide attempt history) (Study 2) completed measures of study variables. For ideation, the proposed pathway was significant across samples, as was a pathway with agitation predicting and body trust mediating. In Study 1, agitation explained the relationship between body trust and attempt history. In Study 2, neither independent variable was related to attempt history. Results suggest body trust is independently associated with suicidal ideation. Results were discrepant regarding suicide attempt history, necessitating future studies. [ABSTRACT FROM AUTHOR]

Agitation is common during the post-traumatic amnesia (PTA) period after traumatic brain injury (TBI), although our knowledge of what causes or predicts agitation is limited. The current study aimed to examine the association of agitation in PTA with the concurrent impairments in orientation and memory while controlling for covariates of agitation. Participants were 125 patients in PTA following moderate to extremely severe TBI recruited from an inpatient brain injury rehabilitation service who were assessed throughout PTA on the Agitated Behavior Scale (ABS) and the Westmead PTA Scale (WPTAS). Agitation was observed in 42.4% of participants (ABS score > 21), with disinhibited behaviours (e.g., distractibility and impulsivity) most common. Multilevel modelling found daily ABS scores to be associated with daily scores on the WPTAS but in a non-linear pattern. Analysis of covariates found that shorter time post-admission, younger age, presence of infection and higher antipsychotic doses were associated with higher ABS scores. These results support a relationship between agitation and the concurrent cognitive impairment during PTA. While a causal link cannot yet be inferred, management strategies that can potentially interfere with cognition (e.g., sedating medications, environmental changes) should be used cautiously in case they exacerbate agitation. [ABSTRACT FROM AUTHOR]

Introduction: Rapid sedation of severely agitated patients is often necessary to ensure the safety of patients and healthcare workers. Intramuscular (IM) ketamine 4–6 mg/kg was previously studied but may carry an increased risk of intubation and other adverse effects. Therefore, the purpose of this case series was to describe the efficacy and safety of a reduced-dose (2 mg/kg) IM ketamine guideline. Methods: Consecutive patients receiving IM ketamine for agitation in the emergency department via our reduced-dose guideline were included. Successful sedation of the agitated patient was defined as documentation from a healthcare provider, a lack of additional sedating medication administration for 30 min following administration of IM ketamine, or ability to complete necessary procedure. Results: Of 15 patients included in this case series, 13 (87%) were adequately sedated with no subsequent intubations due to excess ketamine. The median total dose administered was 157.5 mg and the median weight-based dose was 2 mg/kg. In 11 of the 15 cases, reduced-dose ketamine was used as a second-line agent. Conclusion: Reduced-dose IM ketamine may be effective for severe agitation, particularly when used as a second-line agent. [ABSTRACT FROM AUTHOR]

Elderspeak refers to adapting one's language to a perceived language decline of an older interlocutor. Earlier studies have explored different features of elderspeak; some of these studies attribute positive outcomes to using elderspeak that facilitates communication, but other studies consider elderspeak a negative way of communicating that should be avoided. The aim of this study is to investigate a largely unexplored feature of elderspeak, namely sound prolongation in a multilingual context. There are five participants in this study: three carers and two care recipients in a residential care unit. The carers and care recipients have limited access to a shared spoken language. The data consist of video- and audio recordings of interaction between the participants. The recordings have been transcribed and analysed in accordance with Conversation Analytical methodology. The analysis shows that the carers use sound prolongation as part of their interactional repertoire in order to manage situations of distress. We conclude that in some distressful situations carers' use of sound prolongation may help mitigating the care recipient's emotional concerns since the source of agitations has been addressed properly. In other situations, the use of sound prolongation may lead to an escalation in distress, if the source of agitation is not addressed adequately. Our results bring to the fore that an interactional practice, such as the use of sound prolongation in the context of expressed distress must be interpreted in relation to the complexity of each and every situation participants find themselves in, their level of understanding, and the task/activity at hand. [ABSTRACT FROM AUTHOR]

Objective: Disrupted sleep is common during acute recovery from traumatic brain injury (TBI) and has been linked to daytime agitation. This study investigated the relationship among nighttime sleep efficiency (SE), total sleep time (TST), wakefulness after sleep onset (WASO), and number of wake bouts (NWB) as measured by actigraphy to observer ratings of agitation for patients with TBI who were undergoing inpatient rehabilitation. Methods: This is a retrospective, observational study of a convenience sample of 65 individuals admitted to TBI inpatient rehabilitation who were monitored with actigraphy and the Agitated Behaviour Scale (ABS) for the first 72 h. Each patient's average SE, TST, WASO, and NWB for the 72-h period was calculated using actigraphy for the rest interval from 2100 to 0700. Daily ABS scores were obtained for each day following the nighttime sleep period. Results: Patients were not significantly different on age, gender, etiology of injury, days post-injury, rehabilitation length of stay, or severity of injury as measured by length of posttraumatic amnesia (PTA). SE and TST were significantly lower for patients with agitation than for patients without agitation. Conclusions: This study suggests a relationship between disrupted sleep and agitation for patients with TBI who are undergoing inpatient rehabilitation. [ABSTRACT FROM AUTHOR]

Background/Aims: Neuropsychiatric symptoms (NPS) in dementia pose great challenges for residents and staff in nursing homes. The Targeted Interdisciplinary Model for Evaluation and Treatment of Neuropsychiatric Symptoms (TIME) has recently in a randomized controlled trial demonstrated reductions in NPS. We explored the participating staff's experiences with the model and how it meets the challenges when dealing with the complexity of NPS. Methods: Three to six months after the end of the intervention, we interviewed 32 of the caregivers, leaders, and physicians participating in the trial, in five focus groups. We used thematic content analysis. Results: The analysis yielded two main themes: (1) a systematic reflection method enhanced learning at work; (2) the structure of the approach helped staff to cope with NPS in residents with dementia. Conclusion: TIME shifts the way of learning for the staff from a traditional to a more innovative and reflection-based learning through a process of learning how to learn at work. The staff's experienced increased coping in their approach to complex problems. Our results emphasise the importance of a structured and biopsychosocial approach to NPS in clinical practice. Future research should explore models for integrating situated learning in daily routines in nursing homes. [ABSTRACT FROM AUTHOR]

Agitation following TBI commonly occurs during the acute recovery phase. The ABS is a valid measure of agitation in adults following TBI. The objective of the study was to determine if ABS scores accurately measure acute agitation in pediatric patients recovering from TBI. The ABS was completed twice daily for 4 days and mean ABS scores were calculated. Physicians assessed patients' agitation daily using a VAS. In addition, interventions for agitation were recorded. The association between ABS and VAS scores was assessed using Spearman's correlation. The relationship between the number of medication classes taken for agitation (0, 1–2, or ≥3) and ABS scores was assessed using one-way analysis of variance. Finally, the association between the use of hand restraints and ABS scores was examined using an unpaired two-sample t-test. Twenty-six pediatric patients with acute TBI were included. ABS scores significantly associated with VAS scores. Patients that required interventions for agitation (hand restraints or ≥3 medication classes) had higher ABS scores than patients that did not receive any intervention. The study supports the use of ABS scoring to measure agitation in pediatric patients with TBI. However, additional studies are warranted to further support the validity of this scale. Abbreviations: TBI: Traumatic brain injury; ABS: Agitated Behaviour Scale; VAS: visual analog scale; PCCU: Pediatric Critical Care Unit [ABSTRACT FROM AUTHOR]

Introduction: Antipsychotics have long been the mainstay of treatment for agitation and psychosis in Alzheimer’s disease. Despite their current use successive studies have shown that they only confer a modest benefit which must be balanced against their well-established serious side effects (extrapyramidal symptoms, stroke, accelerated cognitive decline and mortality). Areas covered: This review outlines the current guidance on antipsychotic usage and the evidence of their continued usage against a backdrop of emerging pharmacological treatments and an increasing emphasis on the importance of non-pharmacological interventions. Expert commentary: The current justification for antipsychotic use in the context of the changing landscape of prescribing and provide a view on the most promising alternative candidates to this class of drug are appraised. [ABSTRACT FROM AUTHOR]

Fermentation of xylose from hydrolysate of acid-treated corn cob by Pichia stipitis is inhibited by acetic acid and lignin derivatives. In the present study, we have designed and implemented an immobilized cell culture for xylose to ethanol conversion from acid-treated corn cob hydrolysate without the removal of fermentation inhibitors. In this study, cultivations of suspended and immobilized Pichia were compared in terms of ethanol yield and productivity to investigate whether the cell immobilization could improve resistance to inhibitors. Cell immobilization clearly favored the fermentative metabolism in nondetoxified corn cob hydrolysate leading to an improvement of twofold ethanol productivity as compared to that achieved with suspension culture. Calcium alginate as an immobilization matrix was selected to immobilize Pichia cells. Concentrations of sodium alginate, calcium chloride, and fermentor agitation speed were optimized for ethanol production using statistical method. Statistical analysis showed that agitation speed had maximum influence on ethanol production by immobilized Pichia cells. In comparison to suspension culture, immobilization had a positive impact on the fermentative metabolism of Pichia, improving the ethanol yield from 0.40 to 0.43 g/g and productivity from 0.31 to 0.51 g/L/h for acid-treated corn cob hydrolysate. [ABSTRACT FROM AUTHOR]

Objective: To conduct a systematic review examining the effectiveness of pharmacological management of agitation among individuals with acquired brain injury (ABI). Data sources: MEDLINE, CINAHL, EMBASE, and PsycINFO databases were searched for all relevant articles published in English from 1980 to January 2016. Study selection: Studies were included for analysis all participants had moderate to severe ABI,n ≥ 3, and a pharmacological intervention was provided for the treatment of agitation and its effectiveness was assessed. Data extraction: Data extracted included participant demographics, inclusion and exclusion criteria, study design, outcome measure(s), and results. Study quality was assessed using the Physiotherapy Evidence Database assessment scale for randomized controlled trials (RCTs). A level of evidence was assigned to each intervention using a modified Sackett scale. Data synthesis: Among 165 retrieved studies, 19 met inclusion criteria. The included studies consisted of 6 RCTs and 13 observational studies. Antipsychotic medications were studied predominately (n = 6), followed by anticonvulsants (n = 4) and dopaminergic (n = 4), antidepressants (n = 3), and beta-blockers (n = 2). Dopaminergic medications, specifically amantadine, had the highest level of evidence (Level 1a). The antipsychotic lithium carbonate was shown to be effective but was not recommended for use due to high risk of neurotoxicity. Conclusions: Studies consistently demonstrated that pharmacological treatment was effective in reducing agitation post ABI; however, there was insufficient information to develop a conclusion due to the limited number of studies and overall weakness of evidence for each individual medication. [ABSTRACT FROM AUTHOR]

The influence of hydrodynamic conditions in the coacervation medium of the carotenoid-rich buriti oil using gelatin-alginate as wall materials was investigated. The stirring speed had strong influence on the size of the microcapsules, and Reynolds number higher than 70000 resulted in particle size D[4,3] lower than 200 μm. The carotenoid encapsulation efficiency was around 80%, with freeze-dried particles presenting intense yellow color. Although the size of the microparticles was highly dependent on the hydrodynamic conditions during coacervate formation, complex coacervation of gelatin and sodium alginate showed to be a feasible process to producing buriti oil microcapsules. [ABSTRACT FROM AUTHOR]

Research has established a link between agitation and insomnia, both of which are considered to be risk factors for suicide. The present study aimed to investigate the moderating role of agitation within the relationship between insomnia and current suicidal ideation in a sample of U.S. military personnel. Consistent with hypotheses, the relationship between insomnia and current suicidal ideation was significant only at high levels of agitation. Results support previous findings indicating that both insomnia and agitation are suicide risk factors. These findings clarify the role of known risk factors in the pathway to suicide and may contribute to the advancement of suicide detection and prevention, as these factors may be more easily identified in individuals unwilling to admit thoughts of death and suicide, such as many military personnel. [ABSTRACT FROM AUTHOR]

The progressive freeze concentration of sucrose solutions was tested. The effect of the initial concentration of the solution (C0), the temperature of the refrigerant (T), and the stirring speed (ω) on the final concentration of the solution (Cf) was determined. The effects were significant on the freeze concentration, for both individual and combined effects. The maximum concentration achieved in the progressive freeze concentration was 53°Brix, when the initial concentration was 35°Brix, at a speed of 800 rpm and a temperature of refrigerant of -20°C. The best values of the concentration index (CI) are obtained at low concentrations, high x, and low temperature. The average distribution coefficient K¯ increased with C0. The average yield parameter (WY) at different initial concentrations is around 0.6 kg ice · kg sol-1 · h-1. [ABSTRACT FROM AUTHOR]

Background and objective:Aggression and agitation are common after a stroke. The association between agitation/aggression following stroke and Health-Related Quality of Life (HRQoL) in stroke survivors is unknown. This study aimed to examine the association between agitation/aggression and HRQoL in Chinese stroke survivors. Methods:Three hundred and twenty-four stroke patients entered this cross-sectional study. Agitation/aggression was assessed using the Chinese version of Neuropsychiatric Inventory (CNPI). HRQoL was measured with the Stroke Specific Quality of Life (SSQoL). Results:Three months after the index stroke, agitation/aggression was found in 60 (18.5%) patients. In the agitation/aggression group, 44 patients (73.3%) showedpassiveagitation/aggression, whereas 16 (26.7%) displayedpassive and activeagitation/aggression. No patients showed only active agitation/aggression. Patients with agitation/aggression were more likely to have history of diabetes and greater severity of depression, as well as lower SSQoL total score and Personality Changes and Social Role scores. Controlling for diabetes and depression severity did not alter the above results. The Energy and Thinking scores of the SSQoL were significantly lower in the passive/active agitation/aggression group relative to the passive agitation/aggression group (adjusted for CNPI aggression/agitation score). Conclusion:In this study sample, agitation/aggression was preponderantly of the passive type and was associated with poorer HRQoL independently from depression or medical conditions. Patients with both passive and active agitation/aggression had lower Quality of Life (QoL) than patients with only passive agitation/aggression. The causality of the association between low QoL and agitation/aggression needs to be explored in future studies. [ABSTRACT FROM PUBLISHER]

The influence of electroplating parameters on throwing power (TP) is studied in additive-free silver cyanide solutions under direct current and pulse reverse electroplating conditions. It is found that the best TP is obtained when no agitation of the electrolyte is applied. The most important parameters for controlling the TP are the cathodic current density, the anodic to cathodic charge ratio, and the ratio between the anodic and cathodic current densities. Guidelines for process optimisation are given. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the effects of diffused lavender on the frequency of behavioral issues [BIs], defined as a composite of restlessness/wandering [RW], agitation [AGT], anger [ANG], and anxiety [ANX] in an adult day care center. Secondary objectives evaluate systematic differences on the frequency of BIs between age cohorts, gender, and individual behaviors. Design: Pre-post quasi-experimental study. Setting: Private nonprofit adult day care center for patients with dementia. Participants: Elderly patients older than 65 years of age with a clinical diagnosis of dementia, who require daytime monitoring. Intervention: Lavender aromatherapy twice a day for 20 min during a two-month period during active clinic days. Measurements: Behavioral issues were recorded using the behavior/intervention monthly flow record during the pre- and post-intervention periods. Results: There was no significant difference on frequency of BIs between pre-intervention and post-intervention periods (p =.06). There was a significant difference between pre-intervention and post-intervention total number of AGT occurrences (129 vs. 25; p value <.01). There was no significant difference between age cohorts for computed difference of RW, ANG, and ANX issues. There was a significant difference between age cohorts for computed difference of AGT (p value =.04) as the 70–85 age cohort showed less agitation compared to the 85–100 age cohort. Conclusion: The use of diffused lavender twice daily has shown to reduce the frequency of agitation in elderly patients with dementia, especially in the 70–85 age cohort. Though diffused lavender did not show statistical differences in the frequency of other behaviors (restlessness/wander, anger, anxiety), the study population may have been too small to find a difference. [ABSTRACT FROM AUTHOR]

Agitation is a very distressing problem that must be controlled as quickly as possible, but using a safe method. The authors conducted a comparison of two protocols: a combination of haloperidol and midazolam and haloperidol alone. The combination drug protocol controlled 101 out of 121 (84%) episodes of agitation with only the first dose, whereas the haloperidol alone protocol controlled 47 out of 74 (64%) episodes. This difference is statistically significant (P=.002), with a post hoc analyzed power of 0.88. The median time from the first dose to the control of agitation was 15 minutes (range: 5–210) with the combination and 60 minutes (range: 10–430) with the other protocol,P<.001. There were no complications other than some transient somnolence, mainly with the combination protocol. The authors conclude that the combination of haloperidol and midazolam is effective and safe for the control of agitation in palliative care and it is more effective than haloperidol alone. Therefore, the combination should be adopted as the preferred protocol. It would be helpful if the usefulness of this protocol is confirmed by others. [ABSTRACT FROM PUBLISHER]