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This study sought to assess the cardiorespiratory safety of parenteral olanzapine and benzodiazepine combination treatment compared to parenteral droperidol or haloperidol and benzodiazepine combination treatment. This was a retrospective chart review conducted in adult emergency department patients who received intramuscular (IM) or intravenous (IV) droperidol, haloperidol, or olanzapine within one hour of IM or IV benzodiazepine. Patients were stratified into groups based on whether they received either olanzapine in combination with a benzodiazepine (n = 48) or droperidol or haloperidol in combination with a benzodiazepine (n = 48). Patients in each group had a decrease in their systolic blood pressure (SBP) after IM/IV olanzapine and IM/IV droperidol or haloperidol when used in combination with an IM/IV benzodiazepine ((Olanzapine + benzodiazepine (mmHg), median (IQR): Pre-SBP: 132 (117–151) vs. Post-SBP: 117 (99–131), p < 0.01) (Droperidol or haloperidol + benzodiazepine (mmHg), median (IQR): Pre-SBP: 138 (122–149) vs. Post-SBP: 106 (98–127), p < 0.01)). Both groups had similar percent SBP decreases post-combination treatment (Olanzapine + benzodiazepine (15.6 %) vs. Droperidol or haloperidol + benzodiazepine (15.2 %); p = 0.55). We did not observe any statistically significant between group differences for hypotension (Olanzapine + benzodiazepine: 1/48, 2.1 % vs. Droperidol or haloperidol + benzodiazepine: 3/48, 6.3 %; p = 0.62)), escalation in oxygen requirements (Olanzapine + benzodiazepine: 7/48, 14.6 %) vs. Droperidol or haloperidol + benzodiazepine: 5/48, 10.4 %; p = 0.76)), or intubation due to cardiorespiratory depression (Olanzapine + benzodiazepine: 0/0, 0 % vs. Droperidol or haloperidol + benzodiazepine: 0/0, 0 %; p = 1.00)). This study found decreases in SBP after administering parenteral olanzapine and parenteral droperidol or haloperidol in combination with a parenteral benzodiazepine. The percent change in SBP and the frequency of hypotensive episodes post-combination treatment were not different between groups. There were also no differences between groups in need of increased oxygen requirements post-combination treatment or need for intubation due to cardiorespiratory depression. This study suggests parenteral olanzapine in combination with a parenteral benzodiazepine may have comparable cardiorespiratory safety versus parenteral droperidol or haloperidol in combination with a parenteral benzodiazepine when treating agitation in the adult ED. [ABSTRACT FROM AUTHOR]

• What is the primary question addressed by this study? What are the patterns of chemical sedation and physical restraint use in the geriatric population in emergency department settings? • What is the main finding of this study? This retrospective, cross-sectional study found that there is an increased odds of chemical sedation and physical restraint use with increasing older age as well as Black race and Hispanic/Latinx ethnicity. • What is the meaning of the finding? Within the geriatric population, older adults and those from historically marginalized backgrounds may be more vulnerable to sedation and restraint use in the emergency settings, which may make these already high-risk populations even more susceptible to worse health outcomes. Older adults may present to the emergency department (ED) with agitation, a symptom often resulting in chemical sedation and physical restraint use which carry significant risks and side effects for the geriatric population. To date, limited literature describes the patterns of differential restraint use in this population. This retrospective cross-sectional study used electronic health records data from ED visits by older adults (age ≥65 years) ranging 2015–2022 across nine hospital sites in a regional hospital network. Logistic regression models were estimated to determine the association between patient-level characteristics and the primary outcomes of chemical sedation and physical restraint. Among 872,587 ED visits during the study period, 11,875 (1.4%) and 32,658 (3.7%) encounters involved the use of chemical sedation and physical restraints respectively. The populations aged 75-84, 85-94, 95+ years had increasingly higher odds of chemical sedation [adjusted odds ratios (AORs) 1.35 (95% CI 1.29–1.42); 1.82 (1.73–1.91); 2.35 (2.15–2.57) respectively] as well as physical restraint compared to the 65-74 group [AOR 1.31 (1.27–1.34); 1.55 (1.50–1.60); 1.69 (1.59–1.79)]. Compared to the White Non-Hispanic group, the Black Non-Hispanic and Hispanic/Latinx groups had significantly higher odds of chemical sedation [AOR 1.26 (1.18–1.35); AOR 1.22 (1.15–1.29)] and physical restraint [AOR 1.12 (95% CI 1.07–1.16); 1.22 (1.18–1.26)]. Approximately one in 20 ED visits among older adults resulted in chemical sedation or physical restraint use. Minoritized group status was associated with increasing use of chemical sedation and physical restraint, particularly among the oldest old. These results may indicate the need for further research in agitation management for historically marginalized populations in older adults. [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]

Several large paddle impellers developed by Japanese companies are recognized for their excellent mixing performance across a wide range of fluid viscosities. Consequently, they are utilized in mixing operations involving changes in fluid physical properties, such as polymerization reactions. However, the mixing performance of various large paddle impellers has not been evaluated under identical power consumption conditions. The authors compared the mixing performance of various large impellers under the same power consumption and elucidated the mixing efficiency of a newly developed home base impeller (HB impeller). A decolourization method using iodine and sodium thiosulphate was used to evaluate mixing performance, and a torque meter was used to measure mixing power consumption. The HB impeller demonstrated superior and stable mixing performance over a wide range of Reynolds numbers, particularly in the absence of baffles. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Methods Results Conclusions The Broset Violence Checklist (BVC) can stratify the risk of violence and aggression in EDs. The aim of the present study was to report the initial uptake of introducing this checklist and associations with unplanned alerts to potential or actual violence in two EDs.The BVC was recommended in all patient care episodes. This retrospective review included routinely collected data from an adult tertiary referral hospital and a suburban mixed paediatric and adult ED over a 12‐month period. The primary outcome variable was completion of at least one BVC score and the secondary outcome was unplanned alerts to potential or actual violence episodes within the EDs.There were 121 330 presentations, of which 108 274 were included in the present study. The BVC was completed for 42 675 (39.4%) presentations. Using a cut‐off score of 3, BVC had a specificity of 99.2% (95% confidence interval [CI] 99.1–99.2) and a sensitivity of 15.6% (95% CI 12.5–19.3) for unplanned alerts to potential or actual violence events. Completion of a BVC was independently associated with more unplanned alerts to potential or actual violence events (adjusted odds ratio 1.37; 95% CI 1.12–1.66).The BVC was highly specific for violence and aggression but had low sensitivity. Completion of the BVC was associated with more frequent unplanned alerts to potential or actual violence events, suggesting that high‐risk patients might be identified intuitively, without formal scoring. Further exploration of the utility of the BVC in the ED is indicated with a focus on strategies to prevent violence and aggression. [ABSTRACT FROM AUTHOR]

Introduction: This study reviewed the situation of physical restraints in 50 hospitals covered by the Osaka Psychiatric Hospitals Association in Osaka Prefecture. Subjects and Methods: Study I data included diagnoses, admission date, reasons for restraint, date and time of restraint initiation, site of restraint, date and time of partial or temporal release, and date and time of final release. In addition (Study II), to understand why elderly restraints are more common in Japan, we studied the admission routes of elderly admitted to Psychiatric Hospitals. Results and Discussion: (Study I) Each of the 901 patients underwent a 30-day study. 42 hospitals (84%) participated. More males were included than females, and 51.0% were over 65 years of age. F codes (the International Classification of Diseases, 10th Revision, diagnoses) included F2 in 39.5% and F0 in 33.1%. The dates of restraint initiation and admission were on the same day for 36.2% of patients, and the restraint was initiated after the day following the admission date for 63.8%. This study was not limited to emergency admissions; those who were given restraint on different and the same days in the emergency or acute care ward admissions were approximately equal. This suggests that efforts were made to see how the patient was doing without restraint at the time of admission; however, restraint was initiated when this was not possible. Restlessness or agitation were the most common reasons for restraint, but this state includes various psychopathological reasons. Therefore, defining these reasons further is necessary. Giving or releasing the restraint must be ordered only by the Designated Mental Health Physicians under the Act on Mental Health and Welfare for Persons with Mental Disorders or Disabilities in Japan. The time needed to initiate partial release should be thought of as the end of restraint because the study showed that efforts are made to reduce restraint through partial releases. If restraints are necessary again, other positions than Designated Mental Health Physicians should be allowed to issue restraint orders. The decision should be confirmed by Designated Mental Health Physicians within a certain time frame, as in other countries. Constant, or continuous observation should be prepared to further reduce restraint. (Study II) As a result of Study II, 310 patients had restraint orders on the study date, and 118 patients (38%) were transferred from other facilities due to psychiatric symptoms requiring physical restraint. Of these, 81 (68.6%) were from other medical facilities and 35 (29.7%) were from elderly care facilities. The most common disease codes were F0, including delirium, at 61.7% and 85.7%, respectively, and the most common reasons for restraint were restlessness or agitation at 49.4% and 80.0%, respectively. The results showed the following: restraints are legally acceptable only in Psychiatric Hospitals under the order of Designated Mental Health Physicians. Nearly 40% of the subjects came from other facilities, and as in Study I, the reason for this was the same unclear reason of "restlessness or agitation". Conclusion: It has been 36 years since the Designated Mental Health Physicians system was established, which is not the case in any other country. Although education and training has been conducted to increase the number of Designated Mental Health Physicians, there are not enough Designated Mental Health Physicians in all Psychiatric Hospitals to immediately comply with the act when enforcing behavioral restrictions such as seclusion and restraints. The largest increase of 261% is seen in psychiatric clinics (no responsibility for the right of inpatients at anytime), then this is nothing short of a structural and historical error in policy. [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]

The effect of agitation during the early-age hydration on thixotropy and morphology of cement paste prepared with and without superplasticizers (SP) is investigated by applying penetration test, small amplitude oscillatory shear sweep test (SAOS), isothermal calorimetric test, scanning electron microscopy (SEM) and energy dispersive X-ray analyses (EDX). The results show that the agitation of cement paste during the induction period increases the heat flow rate and destroys existing structures of samples without changing the mineral composition of samples. Yet, if the agitation is applied during the acceleration period, the heat flow rate is significantly lowered and the morphology and mineral composition of samples undergo irreversible change, freshly formed syngenite is destroyed and no longer restored. The penetration force and the static yield stress grow linearly during the induction period and exponentially during the acceleration period. Agitation during the induction period destroys the structure, which causes the static yield stress and the penetration force values becoming nearly equal to zero. However, during the acceleration period, even after agitation the static yield stress and the penetration force exhibit high residual values, which indicates the impact of hydration to the structural build-up. [ABSTRACT FROM AUTHOR]

The search for new synthesis methodologies based on the principles of green chemistry has led to various studies for the production of silver nanoparticles (AgNPs) using extracts from different parts of plants. Based on this, the present study aims to carry out green synthesis (biosynthesis), characterization, and antibacterial evaluation of reduced and stabilized silver nanoparticles (AgNPs) with aqueous extracts of Minthostachys acris in a simple, ecological, and environmentally safe manner. The extraction process of the organic components is performed using two methods: immersion and the agitation of the leaves of Minthostachys acris Schmidt Lebuhn (Muña) at 0.1% for different times (0.5, 1, 3, 6, and 10 min). Compounds such as hydroxycinnamic acid derivatives, quinic, caffeic, rosmarinic acids, and flavonols present in the Muña extract facilitate the formation of AgNPs; this compounds act as a coating and stabilizing agent. The bioactive components from natural resources facilitate the formation of AgNPs, partially or completely replacing the contaminating and toxic elements present in chemical reagents. The biosynthesis is carried out at room temperature for pH 7 and 8. The synthesized AgNPs are characterized by UV-visible spectroscopy to identify the surface plasmon resonance (SPR) band, which shows an absorption peak around 419 nm and 423 nm for pH 7 and p.H 8, respectively, and Fourier-transform infrared spectroscopy (FTIR) to identify the possible biomolecules responsible for bioreduction and stabilization, with a peak at 1634 cm−1. Dynamic light scattering (DLS) shows the hydrodynamic size of the colloidal nanoparticles between 11 and 200 nm, and scanning electron microscopy (SEM) reveals monodisperse AgNPs of different morphologies, mostly nanospheres, while Laser-Induced Breakdown Spectroscopy (LIBS) demonstrates the presence of Ag in the colloidal solution. The evaluation of the bactericidal activity of the AgNPs using the disk diffusion method against Escherichia coli (E. coli) and Staphylococus aureus (S.aureus) shows that the synthesized AgNPs have effective antibacterial activity against E. coli for the extracts obtained at 6 min for both the immersion and agitation methods, respectively. The significance of this work lies in the use of bioactive components from plants to obtain AgNPs in a simple, rapid, and economical way, with potential applications in biomedical fields. [ABSTRACT FROM AUTHOR]

Doll therapy is a psychosocial intervention that has been commonly used within dementia care for many decades. The practice of doll therapy involves supporting people with dementia to engage with a therapeutic doll and this has been associated with positive changes in a person's wellbeing and behavior. While there have been several systematic reviews that have focused on behavioral outcomes, limited reviews have explored the broader psychosocial outcomes associated with doll therapy in care home settings. A scoping review of the literature was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews (PRISMA-ScR). Four electronic databases were searched systematically (CINAHL Plus, Medline, PsycINFO, and PubMed). Twelve primary research studies from the past ten years (2013–2023) were included in this review. Primary data were synthesized using a narrative synthesis methodology. The three main themes from this review relate to a reduction in levels of behavioral and psychological symptoms of dementia (BPSD), increased communication skills, and a reduction in caregiver distress. Doll therapy has the potential to be an effective person-centered intervention that can enhance quality of life for people living with dementia in care home settings. [ABSTRACT FROM AUTHOR]

Agitation is a common complication of Alzheimer's dementia (Agit-AD) associated with substantial morbidity, high healthcare service utilization, and adverse emotional and physical impact on care partners. There are currently no FDA-approved pharmacological treatments for Agit-AD. We present the study design and baseline data for an ongoing multisite, three-week, double-blind, placebo-controlled, randomized clinical trial of dronabinol (synthetic tetrahydrocannabinol [THC]), titrated to a dose of 10 mg daily, in 80 participants to examine the safety and efficacy of dronabinol as an adjunctive treatment for Agit-AD. Preliminary findings for 44 participants enrolled thus far show a predominately female, white sample with advanced cognitive impairment (Mini Mental Status Examination mean 7.8) and agitation (Neuropsychiatric Inventory-Clinician Agitation subscale mean 14.1). Adjustments to study design in light of the COVID-19 pandemic are described. Findings from this study will provide guidance for the clinical utility of dronabinol for Agit-AD. ClinicalTrials.gov Identifier: NCT02792257. [ABSTRACT FROM AUTHOR]

Palm oil mill effluent (POME) can be transformed into biogas. Acidogenesis, as a fermentation process, involves decomposition of hydrolysis products into simpler organic products in the form of acetate, hydrogen and carbon dioxide. Intermediate products from acidogenesis form of volatile fatty acids (VFA), such as propionate, butyrate, valerate, and their isoforms, which require further metabolic processes to produce biogas. The aim of the research was to determine the suitable kinetics model that describes microbial growth (from volatile suspended solid (VSS) values) and production in the acidogenesis process. The reactor used in this acidogenesis process was a stirred tank reactor with a volume of 6 L and operates in a batch system. This research was conducted with a variable agitation rate variation (200; 250; and 300 rpm) at a temperature of 30 °C and 55 °C. The pH was varied, including 5; 5.5; and 6. The kinetic models used in this study were Modified Gompertz, Monod, and Logistic. The best effect of pH on VSS was obtained at pH 5.5, agitation rate on VSS was obtained at agitation rate of 250 rpm and operating conditions for acidogenesis process was achieved under thermophilic conditions (55 °C). Logistic kinetic model is the best kinetic model that can describe VSS and VFA in this study. [ABSTRACT FROM AUTHOR]

Introduction: Schizophrenia is a severe mental disorder associated with deterioration in the functions of daily life and social functions because it can reduce a person’s quality of life. In the acute phase, many schizophrenic patients have agitated behavior where this behavior will risk injuring themselves and others because of that treatment costs increase. to determine the risk factors for agitation in schizophrenic patients in terms of age, gender, marital status, occupation, genetic history, and presence or absence of stressors. Methods: This research is a descriptive analytic using a cross-sectional design. The population in this study were schizophrenic patients at Dr. Amino Gondohutomo Semarang Regional Psychiatric Hospital. Research subjects will be taken using consecutive sampling techniques that meet the inclusion and exclusion criteria. Data collection used medical record data and the PANNS EC score to determine whether there was agitation. Data analysis included descriptive analysis with frequency and percentage distributions as well as hypothesis testing using the Chi Square test and logistic regression. Results: From the results of the Chi Square test and logistic regression, it was found that the factors of young age, male sex, unmarried, and unemployed were significant for PANSS EC with a prevalence value of 3.40 (1.13 – 10.22), 2.01 (1.14 – 3.56), 2.39 (1.36 – 4.20), and 2.07 (1.12 – 3.83). Conclusion: Factors of young age <40 years, male sex, unmarried, and unemployed are risk factors for the occurrence of agitation in schizophrenic patients at Dr. Amino Gondohutomo Semarang Regional Psychiatric Hospital. [ABSTRACT FROM AUTHOR]

Background: Patients in intensive care units experience high symptom burden during mechanical ventilation (MV). Pharmacologic symptom management is associated with side effects and increased morbidity. Music-based interventions (MBIs) have been associated with reductions in both anxiety in MV adults and pain for critically ill adults, yet their use for the management of other burdensome symptoms has not been evaluated. The purpose of this scoping review is to map the state of evidence for the use of prerecorded music listening MBIs for symptom management in MV adults. Methods: A systematic search of the literature was conducted across four electronic databases (PubMed, EMBASE, CINAHL, and Web of Science) for experimental designed studies that measured the efficacy of MBIs for the management of physical and psychological symptoms including anxiety, sedation/agitation, dyspnea, distress, delirium, sleep, stress, fear, loneliness, or depression in critically ill, MV adults between January 1, 1998, and April 18, 2023. Results: A total of 643 abstracts and 29 clinical trials were included. Overall, the risk of bias, assessed using the Evidence Project tool, was moderate. MBIs were mostly delivered with headphones using music selected either by investigators or from a limited selection. MBIs were associated with reduced pain, agitation, dyspnea, distress and anxiety, and improved tolerance of MV and sedative weaning. Outcomes of delirium were mixed. No studies explored sleep disturbances, fear, or loneliness. Conclusions: Use of MBIs improved symptom experience for critically ill adults during MV. Future studies employing unrestricted patient-preferred music selections and exploring outcomes of sleep quality, psychological distress, and delirium are needed in this highly symptomatic patient population. [ABSTRACT FROM AUTHOR]

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Objective: We aimed to examine associations between neuropsychiatric symptoms (NPS) and white matter hyperintensities (WMH) status in older adults without dementia under the hypothesis that WMH increased the odds of having NPS. Design: Longitudinal analysis of data acquired from the National Alzheimer's Coordinating Center Uniform Data Set. Settings: Data were derived from 46 National Institute on Aging – funded Alzheimer's Disease Research Centers. Participants: NACC participants aged ≥50 years with available data on WMH severity with a diagnosis of mild cognitive impairment (MCI) or who were cognitively unimpaired (CU) were studied. Among 4617 CU participants, 376 had moderate and 54 extensive WMH. Among 3170 participants with MCI, 471 had moderate and 88 had extensive WMH. Measurements: Using Cardiovascular Health Study (CHS) scores, WMH were coded as no to mild (CHS score: 0–4), moderate (score: 5–6) or extensive (score: 7–8). NPS were quantified on the Neuropsychiatric Inventory Questionnaire. Binary logistic regression models estimated the odds of reporting each of 12 NPS by WMH status separately for individuals with MCI or who were CU. Results: Compared to CU individuals with no to mild WMH, the odds of having elation [9.87, (2.63–37.10)], disinhibition [4.42, (1.28–15.32)], agitation [3.51, (1.29–9.54)] or anxiety [2.74, (1.28–5.88)] were higher for the extensive WMH group, whereas the odds of having disinhibition were higher for the moderate WMH group [1.94, (1.05–3.61)]. In the MCI group, he odds of NPS did not vary by WMH status. Conclusions: Extensive WMH were associated with higher odds of NPS in CU older adults but not in those with MCI. [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).

The search for new synthesis methodologies based on the principles of green chemistry has led to various studies for the production of silver nanoparticles (AgNPs) using extracts from different parts of plants. Based on this, the present study aims to carry out green synthesis (biosynthesis), characterization, and antibacterial evaluation of reduced and stabilized silver nanoparticles (AgNPs) with aqueous extracts of Minthostachys acris in a simple, ecological, and environmentally safe manner. The extraction process of the organic components is performed using two methods: immersion and the agitation of the leaves of Minthostachys acris Schmidt Lebuhn (Muña) at 0.1% for different times (0.5, 1, 3, 6, and 10 min). Compounds such as hydroxycinnamic acid derivatives, quinic, caffeic, rosmarinic acids, and flavonols present in the Muña extract facilitate the formation of AgNPs; this compounds act as a coating and stabilizing agent. The bioactive components from natural resources facilitate the formation of AgNPs, partially or completely replacing the contaminating and toxic elements present in chemical reagents. The biosynthesis is carried out at room temperature for pH 7 and 8. The synthesized AgNPs are characterized by UV-visible spectroscopy to identify the surface plasmon resonance (SPR) band, which shows an absorption peak around 419 nm and 423 nm for pH 7 and p.H 8, respectively, and Fourier-transform infrared spectroscopy (FTIR) to identify the possible biomolecules responsible for bioreduction and stabilization, with a peak at 1634 cm−1. Dynamic light scattering (DLS) shows the hydrodynamic size of the colloidal nanoparticles between 11 and 200 nm, and scanning electron microscopy (SEM) reveals monodisperse AgNPs of different morphologies, mostly nanospheres, while Laser-Induced Breakdown Spectroscopy (LIBS) demonstrates the presence of Ag in the colloidal solution. The evaluation of the bactericidal activity of the AgNPs using the disk diffusion method against Escherichia coli (E. coli) and Staphylococus aureus (S.aureus) shows that the synthesized AgNPs have effective antibacterial activity against E. coli for the extracts obtained at 6 min for both the immersion and agitation methods, respectively. The significance of this work lies in the use of bioactive components from plants to obtain AgNPs in a simple, rapid, and economical way, with potential applications in biomedical fields.

BackgroundAgitated behaviour in male patients with schizophrenia can lead to serious consequences for the individual and the society. Non-invasive drug delivery may help to rapidly control agitation and improve the overall patient satisfaction， but there are limited studies on the efficacy of olanzapine oral soluble film for the treatment of agitated behaviour in patients with schizophrenia.ObjectiveTo compare the efficacy and safety profile of olanzapine oral soluble film versus intramuscular haloperidol against agitated behaviour in male patients with schizophrenia， so as to provide a reference for the treatment of agitated behaviour.MethodsFrom May 2022 to July 2023， a consecutive sample of schizophrenic patients （n=44） with agitated behaviour who met the Diagnostic and Statistical Manual of Mental Disorders， fifth edition （DSM-5） were recruited in the male psychiatric closed ward of the Third People's Hospital of Fuyang. Patients were assigned into two groups using the random number table method， each with 22 cases. Study group was treated with olanzapine oral soluble film 10 mg/d， while control group was given intramuscular haloperidol 8 mg/d. The severity of agitated behaviour was determined using Positive and Negative Syndrome Scale-Excited Component （PANSS-EC） and Agitation Calmness Evaluation Scale （ACES） at the baseline and after 6 h of drug administration. The treatment response rate was calculated based on the reduction of PANSS-EC score， and the drug side effects were assessed using Rating Scale for Extrapyramidal Side Effects （RSESE） and Barnes Akathisia Rating Scale （BARS） after 6 h of drug administration.ResultsAfter 6 h of drug administration， no statistical difference was reported in PANSS-EC score and ACES score between two groups （F=0.039， 0.082， P>0.05）， and the treatment response rate yielded no statistical difference between two groups （χ2=0.419， P=0.517）， while study group reported a lower incidence rate of adverse reactions compared with control group， with statistically significant difference （P=0.031）. BARS scores noted no statistical significant difference between two groups （t=0.587， P=0.561）， whereas study group scored lower on RSES compared to control group， with a statistical difference （t=-7.367， P

Alzheimer disease (AD), commonly known as senile dementia, is the most common type of dementia, resulting in progressive impairment of cognitive function, and is often accompanied by a variety of psychiatric symptoms, such as agitation. Agitated symptoms in AD patients often cause an increasing burden on caregivers, and current psychiatric medications may exacerbate adverse effects such as cognitive impairment and motor retardation in patients. Therefore, non-drug intervention is a very important adjuvant treatment option. This article reviews the clinical manifestations, possible mechanisms, drug therapy and non-drug intervention measures of agitation in order to provide reference for more effective treatment of AD.

Ruwai galena ore contains a high amount of lead (Pb) and a higher silver (Ag) content than similar ores. It indicates that Ruwai galena ore has excellent potential to be utilized as a prospective source of Ag . However, recovery of Ag from the galena ore is quite challenging due to the very high iron (Fe) and zinc (Zn) content. For this reason, separating both elements from the main galena ore needs to be performed. This study examines the performance of the froth flotation process using agitation to obtain ore (or tailings) rich in Ag so that the Ag leaching process becomes more efficient. The flotation process was conducted by varying the flotation time, the concentration of KEX (potassium ethyl xanthate, as a collector), and MIBC (methyl isobutyl carbinol, as a frother). The flotation results showed that 85% Pb was successfully floated at 120 minutes, the KEX concentration of 80 ppm, and the MIBC concentration of 30 ppm. In this condition, Zn was 48%, Fe was 38% recovered, while 49% of Ag was detected.

Agitation is one of the most common and persistent behavioral and psychological symptoms among persons with dementia (PWD) in residential aged care facilities (RACFs). While most studies have explored the general impact of COVID-19 on the mental health and well-being of aged care residents, there has been limited research on the pandemic’s impact on agitation in dementia within RACFs. This knowledge is crucial to ensuring that RACFs are better equipped to handle future public health emergencies. Therefore, this retrospective cohort study investigates the impact of the pandemic on agitation incidents within 40 Australian RACFs. Using Python, we extracted agitation symptoms from nursing notes and compared the frequency and percentage of symptom occurrence pre-pandemic versus during-pandemic. Chi-square tests examined any significant change in the prevalence of dementia and agitation in dementia between the comparative groups and periods. Dementia prevalence dropped significantly during the second year of the pandemic, with a concurrent increase in early-onset dementia cases. Overall, agitation symptoms decreased by 20.1%, but six symptoms significantly increased: resisting (28.98%), wandering (11.78%), restlessness (3.19%), complaining (10.1%), arguing (2.36%), and outbursts (1.74%). Conversely, pacing decreased by 15.88% and speaking loudly decreased by 10.9%. Over half of the care recipients with dementia experienced agitation symptoms 2–5 times each year, increasing from 50.56% in 2019 to 58.28% in 2021. Despite the co-occurrence of symptoms such as falls, confusion, and weakness, there was no evidence to suggest that these comorbidities were specific to COVID-19; rather, they appeared to be prevalent even before the pandemic. Persons with agitation in dementia had a significantly higher death rate during the COVID-19 pandemic than otherwise.

Abstract Aim Brexpiprazole is the first FDA‐approved treatment for agitation associated with dementia due to Alzheimer's disease. Agitation in Alzheimer's dementia (AAD) occurs in high prevalence and is a great burden for patients and caregivers. Efficacy, safety, and tolerability of brexpiprazole were demonstrated in the AAD clinical trials. To demonstrate the agitation‐ameliorating effect of brexpiprazole in animals, we evaluated brexpiprazole in two AAD mouse models. Methods The resident–intruder test was conducted in 5‐ to 6‐month‐old Tg2576 mice, given vehicle or brexpiprazole (0.01 or 0.03 mg/kg) orally 1 h before the test. Locomotor activity was measured in 6‐month‐old APPSL‐Tg mice given vehicle or brexpiprazole (0.01 or 0.03 mg/kg) orally the evening before the start of locomotor measurement for 3 days. Results In the resident–intruder test, Tg2576 mice showed significantly higher attack number and shorter latency to first attack compared to non‐Tg mice. In the Tg mice, brexpiprazole treatment (0.03 mg/kg) significantly delayed the latency to first attack and showed a trend toward a decrease in attack number. APPSL‐Tg mice (≧6 months old) showed significantly higher locomotion during dark period Phase II (Zeitgeber time [ZT] 16–20) and Phase III (ZT20‐24) compared to non‐Tg mice, correlating with the clinical observations of late afternoon agitation in Alzheimer's disease. Brexpiprazole treatment (0.01 and 0.03 mg/kg) significantly decreased hyperlocomotion during the Phase III in APPSL‐Tg mice. Conclusion The suppression of attack behavior and the reduction of nocturnal hyperlocomotion in these Tg mice may be indicative of the therapeutic effect of brexpiprazole on AAD, as demonstrated in the clinical trials.

Abstract Background Severe psychomotor agitation and aggression often require immediate pharmacological intervention, but clear evidence-based recommendations for choosing among the multiple options are lacking. To address this gap, we plan a systematic review and individual-participant-data network meta-analysis to investigate their comparative effectiveness in real-world emergency settings with increased precision. Methods We will include randomized controlled trials investigating intramuscular or intravenous pharmacological interventions, as monotherapy or in combination, in adults with severe psychomotor agitation irrespective of the underlying diagnosis and requiring rapid tranquilization in general or psychiatric emergency settings. We will exclude studies before 2002, those focusing on specific reasons for agitation and placebo-controlled trials to avoid concerns related to the transitivity assumption and potential selection biases. We will search for eligible studies in BIOSIS, CENTRAL, CINAHL Plus, Embase, LILACS, MEDLINE via Ovid, PubMed, ProQuest, PsycINFO, ClinicalTrials.gov, and WHO-ICTRP. Individual-participant data will be requested from the study authors and harmonized into a uniform format, and aggregated data will also be extracted from the studies. At least two independent reviewers will conduct the study selection, data extraction, risk-of-bias assessment using RoB 2, and applicability evaluation using the RITES tool. The primary outcome will be the number of patients achieving adequate sedation within 30 min after treatment, with secondary outcomes including the need for additional interventions and adverse events, using odds ratios as the effect size. If enough individual-participant data will be collected, we will synthesize them in a network meta-regression model within a Bayesian framework, incorporating study- and participant-level characteristics to explore potential sources of heterogeneity. In cases where individual-participant data are unavailable, potential data availability bias will be explored, and models allowing for the inclusion of studies reporting only aggregated data will be considered. We will assess the confidence in the evidence using the Confidence in Network Meta-Analysis (CINeMA) approach. Discussion This individual-participant-data network meta-analysis aims to provide a fine-tuned synthesis of the evidence on the comparative effectiveness of pharmacological interventions for severe psychomotor agitation in real-world emergency settings. The findings from this study can greatly be provided clearer evidence-based guidance on the most effective treatments. Systematic review registration PROSPERO CRD42023402365.

The management of schizophrenia necessitates a comprehensive treatment paradigm that considers individual patient nuances and the efficacy of lurasidone in addressing schizophrenia symptoms, particularly at elevated dosages. Numerous randomized trials have affirmed the efficacy of lurasidone across various dimensions of schizophrenia, demonstrating marked enhancements in positive, negative and cognitive symptoms compared to a placebo. In addition, lurasidone exhibits potential in ameliorating agitation amongst acutely ill patients, showcasing greater efficacy at higher doses. However, despite the favourable outcomes observed with higher lurasidone doses, routine clinical practice often opts for lower doses, potentially limiting its maximal therapeutic impact. Furthermore, lurasidone also shows efficacy in reducing post-psychotic depression in dual psychosis. Moreover, practical insights into lurasidone usage encompass swift dose escalation within a 1–5-day span and recommended combination strategies with other medications such as benzodiazepines for insomnia or agitation, beta-blockers for akathisia, and antihistamines or antimuscarinic drugs for patients transitioning rapidly from antipsychotics with substantial antihistamine and/or anticholinergic effects. Finally, a series of clinical cases is presented, highlighting benefits of lurasidone in terms of cognitive function, functional recovery and other therapeutic aspects for the management of schizophrenia.

Introduction There is no consensus on the optimal antipsychotic for acute agitation. Whereas haloperidol is frequently used and has proven efficacy, second generation antipsychotics show similar efficacy and improved safety and tolerability. This study aimed to determine the effectiveness of short-acting intramuscular (IM) haloperidol versus other IM antipsychotics for acute agitation in adults admitted to an inpatient psychiatry unit. Methods This was a retrospective medical record review of patients who received 1 or more doses of a short-acting IM antipsychotic, including chlorpromazine, haloperidol, olanzapine, or ziprasidone. The primary endpoint was the need for subsequent IM antipsychotic(s) or physical restraint within 2 hours of the initial IM antipsychotic. Secondary endpoints assessed outcomes at 24 hours and adverse events. Results One hundred six patients were included. Four patients in the haloperidol group and 0 patients in the other antipsychotic group received an additional IM antipsychotic or required physical restraints within 2 hours (5.3% versus 0%, p = .319). More patients in the other antipsychotic group required an additional dose of IM antipsychotic within 24 hours compared with the haloperidol group (p = .0096). More adverse events were seen in patients who received haloperidol. Discussion Haloperidol was used more frequently than other short-acting IM antipsychotics. Whereas the effectiveness at 2 hours was not significantly different between groups, patients who received haloperidol were more likely to experience adverse events and were more often subjected to polypharmacy with benzodiazepines and/or diphenhydramine. This study further supports the use of olanzapine and ziprasidone for acute agitation in patients hospitalized in inpatient psychiatry.

Background: Schizophrenia is one of the most severe mental disorders, frequently associated with aggression and violence, particularly in male patients. The underlying mechanisms of violent behavior in these patients remain unclear, limiting effective treatment options and highlighting the need for further research into interventions for impulsive behaviors. This study aims to evaluate the clinical efficacy of neurofeedback treatment in hospitalized male schizophrenia patients exhibiting impulsive behaviors. Methods: The study was designed as a single-center, randomized, single-blind, sham-controlled parallel trial. Eighty patients were randomly assigned to either a study group or a control group. The control group received risperidone and sham neurofeedback,while the study group received risperidone and active neurofeedback therapy. Both groups underwent training five timesperweek,with eachsession lasting 20 minutes, over a six-week period. Clinical symptoms were assessed at baseline, threeweeks and six weeks using the Positive andNegative Syndrome Scale (PANSS), theModified Overt Aggression Scale (MOAS), and the Rating Scale for Extrapyramidal Side Effects (RSESE). Statistical analyses were conducted to compare the therapeutic effects between the two groups at the study's conclusion. Results: Initial comparisons showed no significant differences in baseline data, except for the number of prior hospitalizations (P<0.018). By the end of the study, the study group demonstrate significant improvements in MOAS and PANSS scores (including the Excited, Positive, Cognitive, and Depressive/Anxiety Components), with no significant changes in RSESE scores. Discussion: Both time and group interactions were significant across most outcomes, underscoring the efficacy of neurofeedback in reducing the severity of impulsive behaviors and associated schizophrenia symptoms. [ABSTRACT FROM AUTHOR]

Objective: In this study, we aimed to determine the clinical experiences and preferences of Turkish psychiatrists regarding rapid tranquilization of acutely agitated individuals and to evaluate the variables affecting these approaches. Method: A cross-sectional online survey was conducted between November 2019 and March 2020. The survey link was mailed to a sample of 131 Turkish psychiatrists. A significant proportion of the study sample worked in academic institutions like universities. The questionnaire consisted of mostly single-choice questions about rapid tranquilization, the use of zuclopenthixol acetate, and experiences with intravenous haloperidol. Results: Only 34.4% of the clinicians adhered to a guideline and almost half of the clinicians did not follow up with the patients after the rapid tranquilization. Intramuscular drug administration was preferred to a greater extent, and haloperidol was the most preferred first-line agent. Simultaneous anticholinergic administration was an almost established practice. The most preferred use of zuclopenthixol acetate was sedation whereas intravenous haloperidol was applied most frequently for delirium. Discussion: In Turkey, mental health resources are still limited. Moreover, some pharmacological agents or different administration forms are not available. These difficulties seem to increase improper use of rapid tranquilization approaches. A national consensus text is needed and clinicians should be invited to periodic courses. Since the study's sample tends to be clustered in certain institutions, the findings should be evaluated with caution refraining from overgeneralization. [ABSTRACT FROM AUTHOR]

Background Internationally, person-centred care (PCC) is embedded in the language of regulations and mandated to be practised in residential aged care (RAC). Despite this, PCC has not been fully adopted in RAC in Australia and internationally, and concerns about the quality of care persist. Over the past 2 decades, Montessori for dementia and ageing has been introduced in RAC to support and inform a cultural change towards PCC. This study aimed to examine the intersection between the goals and approaches of Montessori and PCC in RAC. Methods This qualitative descriptive study reports on a secondary analysis of qualitative data from focus groups (FGs) and interviews with residents, family-members, staff, and volunteers from eight RAC homes in Victoria, Australia. Sixteen FGs and 36 interviews were conducted. A qualitative deductive approach using researcher-developed Montessori for dementia and ageing framework for data analysis was applied. Results Findings provide support for the intersection between PCC and Montessori with participants' descriptions of PCC aligning with many of the goals and approaches of Montessori. Participants most commonly described Montessori approaches of engagement in daily tasks with purposeful roles and promoting cognitive abilities through multi-sensory stimulation. Least frequently-described approaches included focusing on residents' strengths/abilities, maintaining function, using familiar objects, and guided repetition. Conclusions Findings have important implications for practice to use Montessori as a vehicle that supports and upskills the workforce to deliver care that is person-centred. Future research must examine the resources required to support the implementation and sustainability of Montessori as a vehicle for PCC. [ABSTRACT FROM AUTHOR]

Background: According to scientific literature, some 99% of patients affected by Alzheimer's disease (AD) suffer from behavioral and psychological symptoms of dementia (BPSD), also known as neuropsychiatric symptoms (NPSs). In particular, agitation is one of the most difficult disorders to treat. States of agitation represent a very serious problem as they make these subjects dangerous for themselves and others and worsen as the disease advances. To date, there are no specific solutions for treating agitation. The only authorized drug is risperidone (as well as brexpiprazole, approved by the FDA on 11 May 2023), which can be used for no longer than 6–12 weeks because it increases the risk of death—owing to cardiocerebrovascular accidents—by 1.6–1.7 times. Methods: In order to address the latter noteworthy unmet medical need, NanoBEO was produced. The aim of the present work is to generate the health technology assessment (HTA) of this nanotechnological device. The latter consists of a controlled release system, based on solid lipid nanoparticles loaded with bergamot essential oil (BEO). Results: The results of the present research assessed the current evidence in the field of non-pharmacological treatments for this condition, including relevant primary preclinical and clinical data studies supporting the use of this device and the production of the operative plan for its launch on the market. The findings offer recommendations for decision-making on its implementation in dementia. Conclusions: NanoBEO represents a public-worth innovation in this neglected area, marking a significant advancement in the history of dementia, moving from academic research to product development. [ABSTRACT FROM AUTHOR]

Introduction: At the end of life, the prevalence of delirium and pain is high. Current therapy is not satisfactory. Dexmedetomidine could be useful in the control of delirium and pain but is not approved outside of intensive care setting. Our objectives are to evaluate existing evidence in the literature that assessed the efficacy of dexmedetomidine in pain and delirium control and its safety in palliative care patients outside intensive care units. This systematic review was prospectively registered with PROSPERO and included a risk of bias assessment. Methods: PubMed and SCOPUS were examined for literature published until 2023. Experimental, cohort, cross-sectional, case–control studies, and case series/reports were included if they evaluate the use of dexmedetomidine in delirium and/or pain management in hospitalized palliative care adult patients. Studies were excluded if they were carried out in intensive care units. Results: Of the initial 529 records, 14 were included. Although only two studies were randomized trials, most were small and only one had low risk of bias. In most case reports and in the two retrospective cohort studies, dexmedetomidine appears to be a better option for these symptoms, although differences were not significant in the randomized trials. Discussion: Dexmedetomidine seems to be a promising option for refractory pain and delirium and may contribute to a reduction in opioid administration to control pain. This is the first systematic review of dexmedetomidine in palliative care. Quality evidence is limited, but clinical properties of dexmedetomidine justify the conduction of controlled trials in palliative care. [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]

Alzheimer's dementia (AD) is a progressive, neurodegenerative disease often accompanied by neuropsychiatric symptoms that profoundly impact both patients and caregivers. Agitation is among the most prevalent and distressing of these symptoms and often requires treatment. Appropriate therapeutic interventions depend on understanding the biological basis of agitation and how it may be affected by treatment. This narrative review discusses a proposed pathophysiology of agitation in Alzheimer's dementia based on convergent evidence across research approaches. Available data indicate that agitation in Alzheimer's dementia is associated with an imbalance of activity between key prefrontal and subcortical brain regions. The monoamine neurotransmitter systems serve as key modulators of activity within these brain regions and circuits and are rendered abnormal in AD. Patients with AD who exhibited agitation symptoms during life have alterations in neurotransmitter nuclei and related systems when the brain is examined at autopsy. The authors present a model of agitation in Alzheimer's dementia in which noradrenergic hyperactivity along with serotonergic deficits and dysregulated striatal dopamine release contribute to agitated and aggressive behaviors. [ABSTRACT FROM AUTHOR]

The older population is susceptible to dementia, Alzheimer's and depression. A growing elderly population poses a burden on caregivers and society. If their cognitive and psychological health is maintained, they may not need to depend on others for their needs, thereby reducing the burden on caregivers. This, in turn, may lead to a decrease in the necessity for consulting healthcare providers for psychological health, subsequently reducing the overall cost of healthcare. There are numerous options for improving cognitive and mental health in the elderly, one of which is music therapy (MT). In this systematic review, we aim to demonstrate the efficacy of MT in enhancing psychological health among the geriatric population afflicted with dementia and depression. A systematic search was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines across PubMed, Scopus, ScienceDirect, and Cochrane databases. The inclusion criteria were randomized controlled trials (RCTs) that explored the use of MT in elderly patients with or without depression, dementia, or Alzheimer's. Non-RCTs, retrospective and prospective observational studies, case reports, and case series were excluded. Out of 76 records identified, eight articles were selected for qualitative synthesis and three for meta-analysis. These studies, conducted between 2010 and 2020, involved a total of 605 subjects, with 330 receiving MT and the remainder serving as controls. The interventions varied in terms of music type, duration, and setting, with outcome measures including depression scales, quality of life assessments, and cognitive examinations. The meta-analysis of depression scores indicated a positive effect of MT, though a wide confidence interval warrants caution. The quality assessment revealed varying risks of bias, highlighting the need for further research to confirm the positive role of MT. In conclusion, MT emerges as a promising intervention, but it is accompanied by considerable limitations and heterogeneity among studies. This emphasizes the need for further RCTs that specifically address the identified limitations, including issues related to sample size, control group selection, and potential confounding factors. Conducting more robust research in these areas is crucial to establishing a clearer understanding of the therapeutic benefits of music in the elderly population. [ABSTRACT FROM AUTHOR]

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A silence in the resurgence of scholarship on W. E. B. Du Bois has been his work as an instructor. This article uses Du Bois's early teaching experiences and reflections on the "ugly" progress of schooling to ask: What should guide the pedagogy of sociology instructors when racial progress is so ugly? I sketch here a pedagogy inspired by Du Bois—who was the teacher denied —which is motivated by a positive notion of propaganda. Du Bois was a radical pedagogue whose mixed-methods instructional agenda informed a critical Black Sociology and bridges recent calls by American Sociological Association leadership for a discipline that is more emancipatory and educative. Embracing the right to propaganda gives pedagogical teeth to honest appraisals on racial progress. Triangulating art, science, and agitation in our pedagogy offers a general compass, and my article concludes with one direction that compass might lead: a classroom assignment where my undergraduate students became "print propagandists." [ABSTRACT FROM AUTHOR]

Objective: This study aims to systematically review the literature on using electroconvulsive therapy (ECT) in patients with dementia/major NCD (Neuro cognitive disorder) presenting with behavioral symptoms. Design: We conducted a PRISMA-guided systematic review of the literature. We searched five major databases, including PubMed, Medline, Embase, Cochrane, and registry (ClinicalTrials.gov), collaborating with "ECT" and "dementia/major NCD" as our search terms. Measurements: Out of 445 published papers and four clinical trials, only 43 papers and three clinical trials met the criteria. There were 22 case reports, 14 case series, 4 retrospective chart reviews, 1 retrospective case–control study, 1 randomized controlled trial, and 2 ongoing trials. We evaluated existing evidence for using ECT in dementia/major NCD patients with depressive symptoms, agitation and aggression, psychotic symptoms, catatonia, Lewy body dementia/major NCD, manic symptoms, and a combination of these symptoms. Settings: The studies were conducted in the in-patient setting. Participants: Seven hundred and ninety total patients over the age of 60 years were added. Results: All reviewed studies reported symptomatic benefits in treating behavioral symptoms in individuals with dementia/major NCD. While transient confusion, short-term memory loss, and cognitive impairment were common side effects, most studies found no serious side effects from ECT use. Conclusion: Current evidence from a systematic review of 46 studies indicates that ECT benefits specific individuals with dementia/major NCD and behavioral symptoms, but sometimes adverse events may limit its use in these vulnerable individuals. [ABSTRACT FROM AUTHOR]

SATAKE MultiMix Corporation developed a new type of pitched paddle impeller for low power consumption turbulent mixing for wastewater treatment and its performance was evaluated by measuring power consumption, mixing time, and particle suspension. The power number of the new impeller was lower than that of the existing pitched paddle, which could be constructed by modifying the correlation equation. For the same power consumption per unit volume, the mixing performance was almost the same as that of other axial flow impellers. The particle suspension performance was also the same as that of other axial flow impellers. [ABSTRACT FROM AUTHOR]

Background: OnabotulinumtoxinA (OnaA) injection in glabella area appears to be a promising treatment for major depression. However, one major concern of placebo‐controlled studies on botulinum toxin injections is to ensure adequate blinding. Patients and Methods: In this context, all subjects of this trial received the active product (OnaA). After randomization, 58 patients with resistant major depressive disorder (MDD) received OnaA either in the glabella area (N = 29) or in the crow's feet area (N = 29). Subjects were blinded to the supposedly effective area against resistant depression and the examiner was not aware of the injected area. The primary outcome measure was the proportion of responders (50% or greater decrease in MADRS [Montgomery and Asberg Depression Rating Scale] score from baseline) in glabella group versus crow's feet group at week 6 after the OnaA injection. Results: The number of responders was significantly higher in the glabella group than in the crow's feet group with 13 responders out of 29 patients (44.8%) in the glabella group and five out of 28 patients (17.9%) in the crow's feet group (p = 0.029). The rate of psychomotor agitation as measured by item 9 of the Hamilton Depression Rating Scale (HAM‐D), associated with a shorter span of psychiatric disorder, was a potent positive predictive factor of positive response to treatment. Conclusion: We conclude that OnaA injected in the glabella muscles is an effective and well‐tolerated treatment for MDD. We suggest that patients with a high score at item 9 of the HAM‐D might be a subgroup of best responders. We assume that OnaA may act as a modulator of the activity of the primary sensorimotor cortex and then of the amygdala. Trial Registration: ClinicalTrials.gov identifier: NCT03484754 [ABSTRACT FROM AUTHOR]

Delirium is a significant concern in end-of-life care. Continuous monitoring of agitation levels using objective methods may have advantages over existing measurement scales. To examine whether an objective measure of activity scores measured using a sheet-type non-wearable sensor (Nemuri SCAN [NSCAN]) was correlated with agitation levels measured using the modified Richmond Agitation-Sedation Scale (RASS) in terminally ill patients with cancer. We conducted a single-center, prospective, observational study in a palliative care unit using the NSCAN to measure activity scores and the RASS to assess agitation levels. RASS scores were prospectively measured by ward nurses blinded to the NSCAN variables. A database was created to pair the RASS scores and activity scores at night on the same day. During the observation period, 1209 patients were hospitalized, and 3028 pairs of assessments of 971 patients were analyzed. The NSCAN activity scores significantly increased with increasing RASS scores (Jonckheere–Terpstra test, p < 0.001). The mean values of the activity scores for each RASS score were RASS −5, 28.9; RASS −4, 36.4; RASS −3, 41.7; RASS −2, 57.4; RASS −1, 58.8; RASS 0, 62.6; RASS 1, 79.6; RASS 2, 106.5; and RASS 3, 118.7. The NSCAN activity significantly correlated with modified RASS agitation scores. Real-time NSCAN data on agitation may aid timely interventions for optimal symptom control. To improve outcomes for patients suffering from terminal delirium, more research on monitoring tools is warranted. [ABSTRACT FROM AUTHOR]