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author:("wyatt, T.")
1.  Mental Health Care Use in Relation to Depressive Symptoms among Pregnant Women in the United States 
Archives of women's mental health  2015;19(1):187-191.
We examined mental health care use in relation to depressive symptoms (PHQ-9 ≥10) among a nationally representative sample of pregnant women using data from the National Health and Nutrition Examination Survey 2005–2012. Logistic regression models estimated crude and adjusted odds ratios for mental health care use in past year in relation to depressive symptoms. While 8.2% (95% CI: 4.6–11.8) of pregnant women were depressed, only 12% (95% CI: 1.8–22.1) of these women reported mental health care use in past year.
PMCID: PMC5515586  PMID: 25846018
pregnancy; depression; mental health care; treatment; access
2.  PRogram In Support of Moms (PRISM): Development and Beta-Testing 
The majority of women with perinatal depression do not receive depression treatment. We describe the development and beta-testing of a new program, PRogram in Support of Moms (PRISM). PRISM aimed at improving perinatal depression treatment in obstetric practices. A multidisciplinary work group of perinatal and behavioral health professionals (n=7) was convened to design, refine, and beta test PRISM in an obstetric practice. Iterative feedback and problem solving facilitated development of PRISM components which include provider training/toolkit, screening procedures, implementation assistance, and access to immediate psychiatric consultation. Beta-testing with 50 patients over a two month period demonstrated feasibility of implementation and suggests PRISM may improve provider screening rates and self-efficacy to address depression. Based on lessons learned, PRISM will be enhanced to integrate proactive patient engagement and monitoring into obstetric practices. PRISM is feasible and may help overcome patient, provider, and systems level barriers to managing perinatal depression in obstetric settings.
PMCID: PMC5515590  PMID: 27079994
4.  Education Mitigates the Relationship of Stress and Mental Disorders Among Rural Indian Women 
Annals of global health  2016;82(5):779-787.
Common mental disorders (CMD) are a constellation of mental health conditions that include depression, anxiety, and other related nonpsychotic affective disorders. Qualitative explanatory models of mental health among reproductive-aged women in India reveal that distress is strongly associated with CMD. The relationship of perceived stress and CMD might be attenuated or exacerbated based on an individual’s sociodemographic characteristics.
To screen for Common Mental Disorders (CMD) among reproductive-aged women from rural western India and explore how the relationship between perceived stress and CMD screening status varies by sociodemographic characteristics.
Cross-sectional survey of 700 women from rural Gujarat, India. CMD screening status was assessed using Self-Reported Questionnaire 20 (SRQ-20). Factors associated with CMD screening status were evaluated using multivariable logistic regression. Effect modification for the relationship of perceived stress and CMD screening status was assessed using interaction terms and interpreted in terms of predicted probabilities.
The analytic cohort included 663 women, with roughly 1 in 4 screening positive for CMD (157, 23.7%). Poor income, low education, food insecurity, and recurrent thoughts after traumatic events were associated with increased risk of positive CMD screen. Perceived stress was closely associated with CMD screening status. Higher education attenuated the relationship between high levels of stress and CMD screening status (82.3%, 88.8%, 32.9%; P value for trend: 0.03). Increasing income and age attenuated the link between moderate stress and CMD.
Our findings suggest a high burden of possible CMD among reproductive-aged women from rural western India. Higher education might mitigate the association between elevated stress and CMD. Future efforts to improve mental health in rural India should focus on preventing CMD by enhancing rural women’s self-efficacy and problem-solving capabilities to overcome challenging life events and stressors, thereby reducing the risk of CMD.
PMCID: PMC5485235  PMID: 28283129
common mental disorders; epidemiology; perceived stress; rural India; SRQ-20; women’s health
5.  RAHI–SATHI Indo-U.S. Collaboration: The Evolution of a Trainee-Led Twinning Model in Global Health Into a Multidisciplinary Collaborative Program 
RAHI–SATHI presents an innovative twinning model of global health academic partnership, resulting in a number of successful research activities, that features trainees or students as the driving force, complemented by strategic institutional support from both sides of the partnership. Others can promote similar student-led initiatives by: (1) accepting an expanded role for trainees in global health programs, (2) creating structured research and program opportunities for trainees, (3) developing a network of faculty and trainees interested in global health, (4) sharing extramural global health funding opportunities with faculty and trainees, and (5) offering seed funding.
RAHI–SATHI presents an innovative twinning model of global health academic partnership, resulting in a number of successful research activities, that features trainees or students as the driving force, complemented by strategic institutional support from both sides of the partnership. Others can promote similar student-led initiatives by: (1) accepting an expanded role for trainees in global health programs, (2) creating structured research and program opportunities for trainees, (3) developing a network of faculty and trainees interested in global health, (4) sharing extramural global health funding opportunities with faculty and trainees, and (5) offering seed funding.
In recent years there has been a surge in the number of global health programs operated by academic institutions. However, most of the existing programs describe partnerships that are primarily faculty-driven and supported by extramural funding.
Program Description:
Research and Advocacy for Health in India (RAHI, or “pathfinder” in Hindi) and Support and Action Towards Health-Equity in India (SATHI, or “partnership” in Hindi) are 2 interconnected, collaborative efforts between the University of Massachusetts Medical School (UMMS) and Charutar Arogya Mandal (CAM), a medical college and a tertiary care center in rural western India. The RAHI–SATHI program is the culmination of a series of student/trainee-led research and capacity strengthening initiatives that received institutional support in the form of faculty mentorship and seed funding. RAHI–SATHI's trainee-led twinning approach overcomes traditional barriers faced by global health programs. Trainees help mitigate geographical barriers by acting as a bridge between members from different institutions, garner cultural insight through their ability to immerse themselves in a community, and overcome expertise limitations through pre-planned structured mentorship from faculty of both institutions. Trainees play a central role in cultivating trust among the team members and, in the process, they acquire personal leadership skills that may benefit them in their future careers.
This paradigm of trainee-led twinning partnership promotes sustainability in an uncertain funding climate and provides a roadmap for conducting foundational work that is essential for the development of a broad, university-wide global health program.
PMCID: PMC5482068  PMID: 28351882
6.  Enhancing Participation in Depression Care in Outpatient Perinatal Care Settings: A Systematic Review 
Obstetrics and gynecology  2015;126(5):1048-1058.
To examine a wide range of study designs and outcomes to estimate the extent to which interventions in outpatient perinatal care settings are associated with an increase in the uptake of depression care.
Data Sources
PubMed, CINAHL, PsycINFO,, and Scopus (EMBASE) were searched for studies published between 1999 and 2014 that evaluated mental health care use after screening for depression in perinatal care settings.
Methods of Study Selection
Inclusion criteria were: 1) English language; 2) pregnant and postpartum women who screened positive for depression; 3) exposure (validated depression screening in outpatient perinatal care setting); and, 4) outcome (mental health care use). Searches yielded 392 articles, 42 met criteria for full text review, and 17 met inclusion criteria. Study quality was assessed using a modified Downs and Black scale.
Tabulation, Integration, and Results
Articles were independently reviewed by two abstractors and consensus reached. Study design, intervention components and mental health care use were defined and categorized. Seventeen articles representing a range of study designs, including one randomized controlled trial (RCT) and one cluster RCT, were included. The average quality rating was 61% (31.0-90.0%). When no intervention was in place, an average of 22% (13.8-33.0%) of women who screened positive for depression had at least one mental health visit. The average rate of mental health care use was associated with a doubling of this rate with patient engagement strategies (44%, 29.0-90.0%), on-site assessments (49%, 25.2-90.0%), and perinatal care provider training (54%, 1.0-90.0%). High rates of mental health care use (81%, 72.0-90.0%) was associated with implementation of additional interventions, including resource provision to women, perinatal care provider training, on-site assessment, and access to mental health consultation for perinatal care providers.
Screening alone was associated with 22% mental health care use among women who screened positive for depression; however, implementation of additional interventions was associated with a 2-4 fold increased use of mental health care. While definitive studies are still needed, screening done in conjunction with interventions that target patient, provider and practice-level barriers are associated with increased improved rates of depression detection, assessment, referral, and treatment in perinatal care settings.
PMCID: PMC4618720  PMID: 26444130
7.  Association of common mental disorder symptoms with health and healthcare factors among women in rural western India: results of a cross-sectional survey 
BMJ Open  2016;6(7):e010834.
Information about common mental disorders (CMD) is needed to guide policy and clinical interventions in low-income and middle-income countries. This study's purpose was to characterise the association of CMD symptoms with 3 inter-related health and healthcare factors among women from rural western India based on a representative, cross-sectional survey.
Surveys were conducted in the waiting area of various outpatient clinics at a tertiary care hospital and in 16 rural villages in the Anand district of Gujarat, India.
700 Gujarati-speaking women between the ages of 18–45 years who resided in the Anand district of Gujarat, India, were recruited in a quasi-randomised manner.
Primary and secondary outcomes measures
CMD symptoms, ascertained using WHO's Self-Reporting Questionnaire-20 (SRQ-20), were associated with self-reported (1) number of healthcare visits in the prior year; (2) health status and (3) portion of yearly income expended on healthcare.
Data from 658 participants were used in this analysis; 19 surveys were excluded due to incompleteness, 18 surveys were excluded because the participants were visiting hospitalised patients and 5 surveys were classified as outliers. Overall, 155 (22·8%) participants screened positive for CMD symptoms (SRQ-20 score ≥8) with most (81.9%) not previously diagnosed despite contact with healthcare provider in the prior year. On adjusted analyses, screening positive for CMD symptoms was associated with worse category in self-reported health status (cumulative OR=9.39; 95% CI 5·97 to 14·76), higher portion of household income expended on healthcare (cumulative OR=2·31; 95% CL 1·52 to 3.52) and increased healthcare visits in the prior year (incidence rate ratio=1·24; 95% CI 1·07 to 1·44).
The high prevalence of potential CMD among women in rural India that is unrecognised and associated with adverse health and financial indicators highlights the individual and public health burden of CMD.
PMCID: PMC4947826  PMID: 27388353
8.  Infertility and Perinatal Loss: When the Bough Breaks 
Current psychiatry reports  2016;18(3):31.
Infertility and perinatal loss are common, and associated with lower quality of life, marital discord, complicated grief, major depressive disorder, anxiety disorders, and posttraumatic stress disorder. Young women, who lack social supports, have experienced recurrent pregnancy loss or a history of trauma and / or preexisting psychiatric illness are at a higher risk of experiencing psychiatric illnesses or symptoms after a perinatal loss or during infertility. It is especially important to detect, assess, and treat depression, anxiety, or other psychiatric symptoms because infertility or perinatal loss may be caused or perpetuated by such symptoms. Screening, psychoeducation, provision of resources and referrals, and an opportunity to discuss their loss and plan for future pregnancies can facilitate addressing mental health concerns that arise. Women at risk of or who are currently experiencing psychiatric symptoms should receive a comprehensive treatment plan that includes the following: (1) proactive clinical monitoring, (2) evidence-based approaches to psychotherapy, and (3) discussion of risks, benefits, and alternatives of medication treatment during preconception and pregnancy.
PMCID: PMC4896304  PMID: 26847216
Infertility; Perinatal loss; Depression; Anxiety
9.  Decisional Capacity in Pregnancy: A Complex Case of Pregnancy Termination 
Psychosomatics  2014;56(3):292-297.
PMCID: PMC4400254  PMID: 25591494
10.  Prevalence and Molecular Identification of Nematode and Dipteran Parasites in an Australian Alpine Grasshopper (Kosciuscola tristis) 
PLoS ONE  2015;10(4):e0121685.
In alpine Australia, Orthoptera are abundant, dominant herbivores, important prey species, and hosts for parasites and parasitoids. Despite the central role of orthopterans in alpine ecosystems, the impact of parasites on orthopteran populations is under-explored. In this study we describe the relationship between parasite prevalence and host sex, body size and year of collection. We accessed an existing, preserved collection of 640 Kosciuscola tristis collected from across its range between 2007 and 2011. Upon dissection we collected juvenile parasites and used molecular tools to identify them to three families (Nematoda; Mermithidae, and Arthropoda: Diptera: Tachinidae and Sarcophagidae). The prevalence of nematodes ranged from 3.5% to 25.0% and dipterans from 2.4% to 20.0%. Contrary to predictions, we found no associations between parasite prevalence and grasshopper sex or size. Although there was an association between prevalence of both nematodes and dipterans with year of collection, this is likely driven by a small sample size in the first year. Our results provide a foundation for future studies into parasite prevalence within the alpine environment and the abiotic factors that might influence these associations.
PMCID: PMC4412563  PMID: 25919745
11.  Depression and anxiety among high-risk obstetric inpatients☆ 
General hospital psychiatry  2014;36(6):644-649.
To assess the following among women hospitalized antenatally due to high-risk pregnancies: (1) rates of depression symptoms and anxiety symptoms, (2) changes in depression symptoms and anxiety symptoms and, (3) rates of mental health treatment.
Sixty-two participants hospitalized for high-risk obstetrical complications completed the Edinburgh Postnatal Depression Scale (EPDS), Generalized Anxiety Disorder 7-item scale (GAD-7) and Short-Form 12 weekly until delivery or discharge, and once postpartum.
Average length of total hospital stay was 8.3±7.6days for women who completed an initial admission survey (n=62) and 16.3±8.9 (n=34), 25.4±10.2 (n=17) and 35±10.9 days (n=9) for those who completed 2, 3 and 4 surveys, respectively. EPDS was ≥10 in 27% (n=17) and GAD-7 was ≥10 in 13% (n=8) of participants at initial survey. Mean anxiety (4.2±6.5 vs. 5.2±5.1, p=.011) and depression (4.4±5.6 vs. 6.9±4.8, p=.011) scores were lower postpartum compared to initial survey. Past mental health diagnosis predicted depression symptoms [odds ratio (OR)=4.54; 95% confidence interval (CI) 1.91–7.17] and anxiety symptoms (OR=5.95; 95% CI 3.04–8.86) atinitial survey; however, 21% (n=10) with no diagnostic history had EPDS ≥10. Five percent (n=3) received mental health treatment during pregnancy.
Hospitalized high-risk obstetrical patients may commonly experience depression symptoms and/or anxiety symptoms and not receive treatment. A history of mental health treatment or diagnosis was associated with depression symptoms or anxiety symptoms in pregnancy. Of women with an EPDS ≥10, >50% did not report a past mental health diagnosis.
PMCID: PMC4399814  PMID: 25149040
Pregnancy; Depression; Anxiety; Hospitalization; High-risk
12.  What Happens to Mental Health Treatment During Pregnancy? Women’s Experience with Prescribing Providers 
The Psychiatric quarterly  2014;85(3):349-355.
This exploratory study completed interviews with 25 depressed pregnant women who had prior depression, and when becoming pregnant, were receiving depression medication or tried to get mental health care. Seventy one percent of women were more than 25 weeks gestation at the time of the interview. Thirty-five percent of women were not receiving treatment. While 94 % told their provider of their pregnancy, 36 % had no opportunity to discuss the risks and benefits of continued pharmacotherapy; 42 % had no opportunity to continue pharmacotherapy. Some providers may be reluctant to treat depressed pregnant women, creating a potential barrier to their receipt of needed care.
PMCID: PMC4399820  PMID: 24682626
Mental Health; Depression; Perinatal mental health; Maternal depression; Pregnancy
13.  Down syndrome and leukemia: insights into leukemogenesis and translational targets 
Translational Pediatrics  2015;4(2):76-92.
Children with Down syndrome (DS) have a significantly increased risk of childhood leukemia, in particular acute megakaryoblastic leukemia (AMKL) and acute lymphoblastic leukemia (DS-ALL). A pre-leukemia, called transient myeloproliferative disorder (TMD), characterised by a GATA binding protein 1 (GATA1) mutation, affects up to 30% of newborns with DS. In most cases, the pre-leukemia regresses spontaneously, however one-quarter of these children will go on to develop AMKL or myelodysplastic syndrome (MDS) . AMKL and MDS occurring in young children with DS and a GATA1 somatic mutation are collectively termed myeloid leukemia of Down syndrome (ML-DS). This model represents an important multi-step process of leukemogenesis, and further study is required to identify therapeutic targets to potentially prevent development of leukemia. DS-ALL is a high-risk leukemia and mutations in the JAK-STAT pathway are frequently observed. JAK inhibitors may improve outcome for this type of leukemia. Genetic and epigenetic studies have revealed likely candidate drivers involved in development of ML-DS and DS-ALL. Overall this review aims to identify potential impacts of new research on how we manage children with DS, pre-leukemia and leukemia.
PMCID: PMC4729084  PMID: 26835364
(3-5)-MeSH headings; Down syndrome (DS); children; leukemia; transient myeloproliferative disorder (TMD) of Down syndrome; preleukemia
15.  Depression and anxiety among high-risk obstetric inpatients 
General hospital psychiatry  2012;35(2):112-116.
To assess the following among women hospitalized antenatally due to high-risk pregnancies: (1) rates of depression symptoms and anxiety symptoms; (2) changes in depression symptoms and anxiety symptoms; and, (3) rates of mental health treatment.
Sixty-two participants hospitalized for high-risk obstetrical complications completed the Edinburgh Postnatal Depression Scale (EPDS), Generalized Anxiety Disorder 7-item scale (GAD-7), and Short-Form 12 (SF-12) weekly until delivery or discharge, and once postpartum.
Average length of total hospital stay was 8.3±7.6 days for women who completed an initial admission survey (n=62) and 16.3±8.9 (n=34), 25.4±10.2 (n=17) and 35±10.9 days (n=9) for those who completed 2, 3 and 4 surveys, respectively. EPDS was ≥ 10 in 27% (n=17) and GAD-7 was ≥ 10 in 13% (n=8) of participants at initial survey. Mean anxiety (4.2±6.5 vs. 5.2±5.1, p=0.011) and depression (4.4±5.6 vs. 6.9±4.8, p=0.011) scores were lower postpartum compared to initial survey. Past mental health diagnosis predicted depression symptoms (OR=4.54; 95% CI 1.91–7.17) and anxiety symptoms (OR=5.95; 95% CI 3.04–8.86) at initial survey; however, 21% (n=10) with no diagnostic history had EPDS ≥ 10. Five percent (n=3) received mental health treatment during pregnancy.
Hospitalized high-risk obstetrical patients may commonly experience depression symptoms and/or anxiety symptoms and not receive treatment. A history of mental health treatment or diagnosis was associated with depression symptoms or anxiety symptoms in pregnancy. Of women with an EPDS ≥ 10, > 50% did not report a past mental health diagnosis.
PMCID: PMC4157064  PMID: 23265951
Pregnancy; Depression; Anxiety; Hospitalization; High-risk
16.  Patient’s views on depression care in obstetric settings: how do they compare to the views of perinatal health care professionals?☆ 
General hospital psychiatry  2013;35(6):598-604.
The objectives were to examine patients’ perspectives on patient-, provider- and systems-level barriers and facilitators to addressing perinatal depression in outpatient obstetric settings. We also compare the views of patients and perinatal health care professionals.
Four 90-min focus groups were conducted with women 3–36 months after delivery (n=27) who experienced symptoms of perinatal depression, anxiety or emotional distress. Focus groups were transcribed, and resulting data were analyzed using a grounded theory approach.
Barriers to addressing perinatal depression included fear of stigma and loss of parental rights, negative experiences with perinatal health care providers and lack of depression management knowledge/skills among professionals. Facilitators included psychoeducation, peer support and training for professionals.
Patients perceive many multilevel barriers to treatment that are similar to those found in our previous similar study of perinatal health care professionals’ perspectives. However, patients and professionals do differ in their perceptions of one another. Interventions would need to close these gaps and include an empathic screening and referral process that facilitates discussion of mental health concerns. Interventions should leverage strategies identified by both patients and professionals, including empowering both via education, resources and access to varied mental health care options.
PMCID: PMC4107904  PMID: 23969144
Depression; Barriers; Facilitators; Perinatal; Treatment
17.  Pharmacotherapy for Mood Disorders in Pregnancy 
Pharmacotherapy for mood disorders during pregnancy is often complicated by pregnancy-related pharmacokinetic changes and the need for dose adjustments. The objectives of this review are to summarize the evidence for change in perinatal pharmacokinetics of commonly used pharmacotherapies for mood disorders, discuss the implications for clinical and therapeutic drug monitoring (TDM), and make clinical recommendations.
The English-language literature indexed on MEDLINE/PubMed was searched for original observational studies (controlled and uncontrolled, prospective and retrospective), case reports, and case series that evaluated or described pharmacokinetic changes or TDM during pregnancy or the postpartum period.
Pregnancy-associated changes in absorption, distribution, metabolism, and elimination may result in lowered psychotropic drug levels and possible treatment effects, particularly in late pregnancy. Mechanisms include changes in both phase 1 hepatic cytochrome P450 and phase 2 uridine diphosphate glucuronosyltransferase enzyme activities, changes in hepatic and renal blood flow, and glomerular filtration rate. Therapeutic drug monitoring, in combination with clinical monitoring, is indicated for tricyclic antidepressants and mood stabilizers during the perinatal period.
Substantial pharmacokinetic changes can occur during pregnancy in a number of commonly used antidepressants and mood stabilizers. Dose increases may be indicated for antidepressants including citalopram, clomipramine, imipramine, fluoxetine, fluvoxamine, nortriptyline, paroxetine, and sertraline, especially late in pregnancy. Antenatal dose increases may also be needed for lithium, lamotrigine, and valproic acid because of perinatal changes in metabolism. Close clinical monitoring of perinatal mood disorders and TDM of tricyclic antidepressants and mood stabilizers are recommended.
PMCID: PMC4105343  PMID: 24525634
pharmacokinetics; pregnancy; antidepressants; mood stabilizers
18.  Antidepressant Use in Pregnancy: A Critical Review Focused on Risks and Controversies 
Acta psychiatrica Scandinavica  2012;127(2):94-114.
Conflicting data have led to controversy regarding antidepressant use during pregnancy. The objectives of this paper are to: (1) review the risks of untreated depression and anxiety; (2) review the literature on risks of exposure to antidepressants during pregnancy; (3) discuss the strengths and weaknesses of the different study designs used to evaluate those risks; and, (4) provide clinical recommendations.
MEDLINE/PubMed was searched for reports and studies on the risk of first trimester teratogenicity, post natal adaptation syndrome (PNAS), and persistent pulmonary hypertension (PPHN) with in utero antidepressant exposure.
While some individual studies suggest associations between some specific major malformations, the findings are inconsistent. Therefore, the absolute risks appear small. PNAS occurs in up to 30% of neonates exposed to antidepressants. In some studies, PPHN has been weakly associated with in utero antidepressant exposure, while in other studies there has been no association.
Exposures of concern include that of untreated maternal illness as well as medication exposure. It is vital to have a careful discussion, tailored to each patient, which incorporates the evidence to date, and considers methodological and statistical limitations. Past medication trials, previous success with symptom remission, and women’s preference should guide treatment decisions.
PMCID: PMC4006272  PMID: 23240634
Antidepressant; In utero; Teratogenicity; Post natal adaptation syndrome; Persistent pulmonary hypertension
19.  Search for lepton flavour violation in the eμ continuum with the ATLAS detector in \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$\sqrt{s} = 7~\mbox{TeV}$\end{document}pp collisions at the LHC 
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This paper presents a search for the t-channel exchange of an R-parity violating scalar top quark (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$\tilde{t}$\end{document}) in the e±μ∓ continuum using 2.1 fb−1 of data collected by the ATLAS detector in \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$\sqrt{s}=7~\mbox{TeV}$\end{document}pp collisions at the Large Hadron Collider. Data are found to be consistent with the expectation from the Standard Model backgrounds. Limits on R-parity-violating couplings at 95 % C.L. are calculated as a function of the scalar top mass (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$m_{\tilde{t}}$\end{document}). The upper limits on the production cross section for pp→eμX, through the t-channel exchange of a scalar top quark, ranges from 170 fb for \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$m_{\tilde{t}}=95~\mbox{GeV}$\end{document} to 30 fb for \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$m_{\tilde{t}}=1000~\mbox{GeV}$\end{document}.
PMCID: PMC4370899  PMID: 25814838
21.  Dehydration in the terminally ill--iatrogenic insult or natural process? 
Postgraduate Medical Journal  1997;73(862):476-480.
The question of whether terminally ill patients should artificially be given fluids has been debated since before palliative care became a recognised specialty. Arguments have been adduced from physiological, comfort, legal psychological, and emotional perspectives. Palliative care specialists agree that the priority is preventing the symptoms associated with dehydration, rather than the dehydration itself. However, the majority of terminally ill patients are cared for in settings outside hospices, and those admitted to hospital will tend to be exposed to a more technical approach. There are no randomised controlled trials in this area, and although an ethical minefield, we should not be afraid to manage individual patients according to the principles of palliative care where control of symptoms, not normalising of physiological variables, is the primary objective.
PMCID: PMC2431358  PMID: 9307738
22.  Cardiopulmonary resuscitation. 
BMJ : British Medical Journal  1994;309(6952):475-476.
PMCID: PMC2540916  PMID: 7920149
23.  Diuretics and electrolyte disturbances in 1000 consecutive geriatric admissions. 
Old people are commonly receiving diuretics on admission to hospital. Diuretics are recognized as a risk factor for electrolyte disturbances; controversy exists about the relative risks of different combinations (in particular, co-amilozide [Moduretic]). We recorded the drug history and serum electrolytes in 1000 consecutive admissions to a geriatric hospital, and examined the relative prescribing rates of various diuretics in the community. Full results were obtained in 929 patients. A history of diuretic prescription was present in 353 (38%) of the patients; the mean serum sodium in this group (95% CI 136.0-137.1 mmol/l) was lower than in the 586 not prescribed diuretics (137.1-137.9 mmol/l). The difference was small but statistically significant (95% CI difference = 0.3-1.6 mmol/l; P less than 0.01). Hyponatraemia (serum sodium less than 130 mmol/l) was not significantly commoner in the 41 patients prescribed co-amilozide than in patients prescribed other diuretics. In general patients prescribed potassium-retaining diuretics had a lower serum sodium than the others. There was a significant positive correlation between the serum potassium and the log [serum urea] (r = 0.26, P less than 0.001) and a weak negative correlation existed between sodium and potassium (r = -0.14; P less than 0.001). There was an association between the prescription of potassium-retaining diuretics and a higher serum potassium; also an association between the prescription of a loop or thiazide diuretic and a lower serum potassium. These interactions were shown by multiple regression analysis to be independent and additive.(ABSTRACT TRUNCATED AT 250 WORDS)
PMCID: PMC1292918  PMID: 2250268

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