Insomnia during pregnancy: Diagnosis and Rational Interventions.

UNLABELLED: Sleep disturbances are common in pregnancy. Insomnia is a frequent sleep disturbance experienced by pregnant women which can be primary or due to co-morbid conditions. The differential diagnosis of insomnia in pregnancy includes anxiety disorders, mood disorders, breathing related sleep disorders and restless legs syndrome. Early interventions to treat the sleep disturbance are recommended to avoid adverse pregnancy outcomes. Management strategies include improving sleep hygiene, behavioral therapies, and pharmacotherapy. The risks of pharmacotherapy must be weighed against their benefits due to the possible risk of teratogenicity associated with some medications. METHODS: We searched PubMed and Google Scholar employing a combination of key words: pregnancy, sleep disturbances, Obstructive Sleep Apnea, Sleep disorders and insomnia. We included original studies, review articles, meta-analysis and systematic reviews in our search prioritizing articles from the last 10-15 years. Articles older than 15 years were only included if their findings had not been superseded by more recent data. Further selection of articles was done from bibliographies and references of selected articles. CONCLUSION: Sleep disturbances in pregnancy are common and cause considerable morbidity. Management includes a combination of non-pharmacological and pharmacological treatments carefully weighing the risks and benefits of each for the expectant mother and fetus.

Failed efficacy of ziprasidone in the treatment of post-traumatic stress disorder.

BACKGROUND: Post-traumatic stress disorder (PTSD) is a chronic anxiety disorder that is often difficult to treat. Patients suffering from PTSD often fail to respond to antidepressants and may have a high incidence of positive symptoms of psychosis, though antipsychotic medications have been minimally studied in this population. The aim of this study was to assess the impact of the atypical antipsychotic ziprasidone (Geodon) on PTSD symptom clusters, as well as comorbid major depressive disorder. To our knowledge, this is the first completed randomized controlled trial investigating the potential efficacy and tolerability of ziprasidone in patients with chronic PTSD. METHODS: We conducted a 9-week prospective, randomized, double-blind, placebo-controlled trial of ziprasidone in 30 patients diagnosed with PTSD and comorbid depression. After screening and randomization, patients completed nine weekly study visits at which treatment safety and efficacy were evaluated. Primary measures of efficacy included total and subscale scores from the Clinician-Administered PTSD Scale (CAPS), while the Hamilton Rating Scale for Depression (HAM-D), Hamilton Anxiety Scale (HAM-A), Clinical Global Impression (CGI), and Treatment Outcome PTSD Scale (TOP-8) were implemented as secondary efficacy measures. RESULTS: We observed no significant effect of treatment on reduction of PTSD or depression symptoms from pre- to post-treatment. CONCLUSIONS: Our findings suggest that ziprasidone treatment may not significantly improve symptoms of PTSD or comorbid depression, though further study is needed.

A Comparison of Homeless Male Veterans in Metropolitan and Micropolitan Areas in Nebraska: A Methodological Caveat.

This study explored differences between homeless male veterans in metropolitan and micropolitan cities in Nebraska on sociodemographic, housing, clinical, and psychosocial characteristics as well as health service use. A convenience sample of 151 homeless male veterans (112 metropolitan, 39 micropolitan) were recruited from Veterans Affairs facilities and area shelters in Omaha, Lincoln, Grand Island, and Hastings in Nebraska. Research staff conducted structured interviews with homeless veterans. Results showed that compared to homeless veterans in metropolitans, those in micropolitans were more likely to be White, unmarried, living in transitional settings, and were far more transient but reported greater social support and housing satisfaction. Veterans in micropolitans also reported more medical problems, diagnoses of anxiety and personality disorders, and unexpectedly, were more likely to report using various health services and less travel time for services. Together, these findings suggest access to homeless and health services for veterans in micropolitan areas may be facilitated through Veterans Affairs facilities and community providers that work in close proximity to one another. Many homeless veterans in these areas are transient, making them a difficult population to study and serve. Innovative ways to provide outreach to homeless veterans in micropolitan and more rural areas are needed.

Effects of Escitalopram on Autonomic Function in Posttraumatic Stress Disorder Among Veterans of Operations Enduring Freedom and Iraqi Freedom (OEF/OIF).

OBJECTIVE: Posttraumatic stress disorder is a chronic, debilitating condition that has become a growing concern among combat veterans. Previous research suggests that posttraumatic stress disorder disrupts normal autonomic responding and may increase the risk of cardiovascular disease and mortality. Measures of heart rate variability and QT interval variability have been used extensively to characterize sympathetic and parasympathetic influences on heart rate in a variety of psychiatric populations. The objective of this study was to better understand the effects of pharmacological treatment on autonomic reactivity in posttraumatic stress disorder. DESIGN: A 12-week, Phase IV, prospective, open-label trial of escitalopram in veterans with combat-related posttraumatic stress disorder and comorbid depression. SETTING: An outpatient mental health clinic at a Veterans Affairs Medical Center. PARTICIPANTS: Eleven male veterans of Operations Enduring Freedom and Iraqi Freedom diagnosed with posttraumatic stress disorder and comorbid depression. MEASUREMENTS: Autonomic reactivity was measured by examining heart rate variability and QT interval variability. Treatment safety and efficacy were also evaluated pre- and post-treatment. RESULTS: We observed a reduction in posttraumatic stress disorder and depression symptoms from pre- to post-treatment, and escitalopram was generally well tolerated in our sample. In addition, we observed a decrease in high frequency heart rate variability and an increase in QT variability, indicating a reduction in cardiac vagal function and heightened sympathetic activation. CONCLUSION: These findings suggest that escitalopram treatment in patients with posttraumatic stress disorder and depression can trigger changes in autonomic reactivity that may adversely impact cardiovascular health.

An Open-Label Trial of Memantine for Cognitive Impairment in Patients with Posttraumatic Stress Disorder.

Background. Studies using standard neuropsychological instruments have demonstrated memory deficits in patients with PTSD. We evaluated the efficacy and safety of the N-methyl-D-aspartate antagonist memantine in veterans with PTSD and cognitive impairment. Methods. Twenty-six veterans with PTSD and cognitive impairment received 16 weeks of memantine in an open-label fashion. Cognition was assessed using the Spatial Span, Logical Memory I, and Letter-Number Sequencing subtests of the Wechsler Memory Scale III and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). RBANS measures attention, language, visuospatial skills, and immediate and delayed memories. The Clinician Administered PTSD Scale (CAPS), Hamilton Depression Scale (HAM-D), Hamilton Anxiety Scale (HAM-A), Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q), and Sheehan Disability Scale (SDS) were secondary outcome measures. Results. There was a significant improvement in RBANS, both total and subscale scores (P < 0.05), over time. There was a reduction in total CAPS scores, avoidance/numbing symptoms (CAPS-C) and hyperarousal symptoms (CAPS-D), HAM-D, Q-LES-Q, and SDS scores. However, there was no reduction in reexperiencing (CAPS-B) and HAM-A scores. Memantine was well tolerated. Conclusions. Memantine improved cognitive symptoms, PTSD symptoms, and mood in veterans with PTSD. Randomized double-blind studies are needed to validate these preliminary observations.

The Bhagavad Gita and contemporary psychotherapies.

The Bhagavad Gita is based on a discourse between Lord Krishna and Arjuna at the inception of the Kurukshetra war and elucidates many psychotherapeutic principles. In this article, we discuss some of the parallels between the Gita and contemporary psychotherapies. We initially discuss similarities between psychodynamic theories of drives and psychic structures, and the concept of three gunas. Arjuna under duress exhibits elements of distorted thinking. Lord Krishna helps remedy this through a process akin to Cognitive Behavioral Therapy (CBT). We ascertain the analogies between the principles of Gita and CBT, grief emancipation, role transition, self-esteem, and motivation enhancement, as well as interpersonal and supportive psychotherapies. We advocate the pragmatic application of age old wisdom of the Gita to enhance the efficacy of psychotherapeutic interventions for patients from Indian subcontinent and to add value to the art of western psychotherapies.

Utilization of greenhouse gases through dry reforming: screening of nickel-based bimetallic catalysts and kinetic studies.

A series of bimetallic catalysts containing nickel supported over MgO-ZrO2 were tested for activity in the dry reforming of carbon dioxide. A nickel-cobalt bimetallic catalyst gave the best performance in terms of conversion and coke resistance from a range of Ni-X bimetallic catalysts, X=Ca, K, Ba, La, and Ce. The nitrogen-adsorption and hydrogen-chemisorption studies showed the Ni-Co bimetallic supported catalyst to have good surface area with high metal dispersion. This contributed to the high catalytic activity, in terms of conversion activity and stability of the catalyst, at an equimolar methane/carbon dioxide feed ratio. The kinetics of methane dry reforming are studied in a fixed-bed reactor over an Ni-Co bimetallic catalyst in the temperature range 700-800 °C by varying the partial pressures of CH4 and CO2. The experimental data were analyzed based on the proposed reaction mechanism using the Langmuir-Hinshelwood kinetic model. The activation energies for methane and carbon dioxide consumption were estimated at 52.9 and 48.1 kJ mol(-1), respectively. The lower value of CO2 activation energy compared to the activation energy of CH4 indicated a higher reaction rate of CO2, which owes to the strong basicity of nanocrystalline support, MgO-ZrO2.

Obstructive sleep apnea and depression: a review.

Obstructive sleep apnea is a common sleep disorder associated with several medical conditions, increased risk of motor vehicle accidents, and overall healthcare expenditure. There is higher prevalence of depression in people with obstructive sleep apnea in both clinical and community samples. Many symptoms of depression and obstructive sleep apnea overlap causing under-diagnosis of obstructive sleep apnea in depressed patients. Sleep problems, including obstructive sleep apnea, are rarely assessed on a regular basis in patients with depressive disorders, but they may be responsible for antidepressant treatment failure. The mechanism of the relationship between obstructive sleep apnea and depression is complex and remains unclear. Though some studies suggest a mutual relationship, the relationship remains unclear. Several possible pathophysiological mechanisms could explain how obstructive sleep apnea can cause or worsen depression. Increased knowledge of the relationship between obstructive sleep apnea and depression might significantly improve diagnostic accuracy as well as treatment outcomes for both obstructive sleep apnea and depression.

Production of biofuel from waste cooking palm oil using nanocrystalline zeolite as catalyst: process optimization studies.

The catalytic cracking of waste cooking palm oil to biofuel was studied over different types of nano-crystalline zeolite catalysts in a fixed bed reactor. The effect of reaction temperature (400-500 °C), catalyst-to-oil ratio (6-14) and catalyst pore size of different nanocrystalline zeolites (0.54-0.80 nm) were studied over the conversion of waste cooking palm oil, yields of Organic Liquid Product (OLP) and gasoline fraction in the OLP following central composite design (CCD). The response surface methodology was used to determine the optimum value of the operating variables for maximum conversion as well as maximum yield of OLP and gasoline fraction, respectively. The optimum reaction temperature of 458 °C with oil/catalyst ratio=6 over the nanocrystalline zeolite Y with pore size of 0.67 nm gave 86.4 wt% oil conversion, 46.5 wt% OLP yield and 33.5 wt% gasoline fraction yield, respectively. The experimental results were in agreement with the simulated values within an experimental error of less than 5%.

Current status of ceramic-based membranes for oxygen separation from air.

There has been tremendous progress in membrane technology for gas separation, in particular oxygen separation from air in the last 20 years. It provides an alternative route to the existing conventional separation processes such as cryogenic distillation and pressure swing adsorption as well as cheaper production of oxygen with high purity. This review presents the recent advances of ceramic membranes for the separation of oxygen from air at high temperature. It covers the issues and problems with respect to the selectivity and separation performance. The paper also presents different approaches applied to overcome these challenges. The future directions of ceramic-based membranes for oxygen separation from air are also presented.

The feasibility study of crude palm oil transesterification at 30 °C operation.

The objective of this research is to investigate the potential of transesterification of crude palm oil (CPO) to biodiesel at 30 degrees C. The mass transfer limitations problem crucial at 30 degrees C due to the viscosity of CPO has been addressed. The process parameters that are closely related to mass transfer effects like enzyme loading, agitation speed and reaction time were optimized. An optimum methanol to oil substrate molar ratio at 6.5:1 was observed and maintained throughout the experiments. The optimum operating condition for the transesterification process was found at 6.67 wt% of enzyme loading and at 150 rpm of agitation speed. The corresponding initial reaction and FAME yield obtained at 6 h were 89.29% FAME yield/hr and 85.01%, respectively. The 85% FAME yield obtained at 30 degrees C operation of CPO transesterification shows that the process is potentially feasible for the biodiesel synthesis.

Subcritical water liquefaction of oil palm fruit press fiber in the presence of sodium hydroxide: an optimisation study using response surface methodology.

Thermal decomposition of oil palm fruit press fiber (FPF) into a liquid product (LP) was achieved using subcritical water treatment in the presence of sodium hydroxide in a high pressure batch reactor. This study uses experimental design and process optimisation tools to maximise the LP yield using response surface methodology (RSM) with central composite rotatable design (CCRD). The independent variables were temperature, residence time, particle size, specimen loading, and additive loading. The mathematical model that was developed fit the experimental results well for all of the response variables that were studied. The optimal conditions were found to be a temperature of 551 K, a residence time of 40 min, a particle size of 710-1000 microm, a specimen loading of 5 g, and a additive loading of 9 wt.% to achieve a LP yield of 76.16%.

Sub/supercritical liquefaction of oil palm fruit press fiber for the production of bio-oil: effect of solvents.

Thermal decomposition of oil palm fruit press fiber (FPF) with sub/supercritical methanol, ethanol, acetone, and 1,4-dioxane treatments were investigated using a high-pressure autoclave reactor. When FPF was decomposed with methanol, ethanol, and acetone from 483 to 603 K, the highest degree of conversion obtained were 81.5%, 77.8%, and 67.9% while the highest liquid product yield (LP) obtained were 38.0%, 36.9%, and 38.5%, respectively. For the case of 1,4-dioxane, the conversion of FPF increased from 18.30% to 80.00%, while LP yield increased dramatically from 13.30% to 50.90% (consisting of 42.3% bio-oil compounds) when the reaction temperature was increased from 483 to 563 K. However, the conversion of FPF and LP yield decreased to 69.60% and 24.10%, respectively, when the temperature was further increased to 603 K. Comparison between all the solvents, subcritical 1,4-dioxane treatment was found very effective in the degradation of FPF to produce bio-oil component.

Hot compressed water pretreatment of oil palm fronds to enhance glucose recovery for production of second generation bio-ethanol.

This work presents the pretreatment of oil palm fronds (OPF) using hot compressed water (HCW) to enhance sugar recovery in enzymatic hydrolysis. A central, composite rotatable design was used to optimize the effect of reaction temperature, reaction time and liquid-solid ratio on the pretreatment process. All variables were found to significantly affect the glucose yield. A quadratic polynomial equation was used to model glucose yield by multiple regression analysis, using response surface methodology (RSM). Using a 10 bar pressurized reactor, the optimum conditions for pretreatment of OPF were found at 178 degrees C, 11.1 min and a liquid-solid ratio of 9.6. The predicted glucose yield was 92.78 wt.% at the optimum conditions. Experimental verification of the optimum conditions gave a glucose yield in good agreement with the estimated value of the model.

Supercritical fluid reactive extraction of Jatropha curcas L. seeds with methanol: A novel biodiesel production method.

The novel biodiesel production technology using supercritical reactive extraction from Jatropha curcas L. oil seeds in this study has a promising role to fill as a more cost-effective processing technology. Compared to traditional biodiesel production method, supercritical reactive extraction can successfully carry out the extraction of oil and subsequent esterification/transesterification process to fatty acid methyl esters (FAME) simultaneously in a relatively short total operating time (45-80 min). Particle size of the seeds (0.5-2.0 mm) and reaction temperature/pressure (200-300 degrees C) are two primary factors being investigated. With 300 degrees C reaction temperature, 240 MPa operating pressure, 10.0 ml/g methanol to solid ratio and 2.5 ml/g of n-hexane to seed ratio, optimum oil extraction efficiency and FAME yield can reach up to 105.3% v/v and 103.5% w/w, respectively which exceeded theoretical yield calculated based on n-hexane Soxhlet extraction of Jatropha oil seeds.

Methylphenidate for apathy and functional status in dementia of the Alzheimer type.

OBJECTIVE: Apathy is the most common behavioral problem in persons with dementia of the Alzheimer type (DAT). Treatment of apathy in DAT is not systematically studied. The purpose of this study was to evaluate the response of apathy to methylphenidate treatment and to examine whether functional status improved. METHODS: The authors conducted a 12-week open-labeled study with immediate release formulation of methylphenidate. Twenty-three patients with DAT scoring >40 on the Apathy Evaluation Scale (AES) were recruited. Repeated measures analysis of variance and correlation analysis were performed. RESULTS: None of the patients dropped out of the study because of adverse events. Significant improvement in apathy was noted during 12 weeks. Significant improvement was also noted in depression, Mini-Mental State Examination score, and functional status. There was no correlation between changes in the AES and depression scores. CONCLUSIONS: Methylphenidate was well tolerated in these patients with DAT. Apathy improved with the use of methylphenidate.

Ordered mesoporous silica (OMS) as an adsorbent and membrane for separation of carbon dioxide (CO2).

Separation of carbon dioxide (CO(2)) from gaseous mixture is an important issue for the removal of CO(2) in natural gas processing and power plants. The ordered mesoporous silicas (OMS) with uniform pore structure and high density of silanol groups, have attracted the interest of researchers for separation of carbon dioxide (CO(2)) using adsorption process. These mesoporous silicas after functionalization with amino groups have been studied for the removal of CO(2). The potential of functionalized ordered mesoporous silica membrane for separation of CO(2) is also recognized. The present paper reviews the synthesis of mesoporous silicas and important issues related to the development of mesoporous silicas. Recent studies on the CO(2) separation using ordered mesoporous silicas (OMS) as adsorbent and membrane are highlighted. The future prospectives of mesoporous silica membrane for CO(2) adsorption and separation are also presented and discussed.

Subcritical water liquefaction of oil palm fruit press fiber for the production of bio-oil: effect of catalysts.

Decomposition of oil palm fruit press fiber (FPF) to various liquid products in subcritical water was investigated using a high-pressure autoclave reactor with and without the presence of catalyst. When the reaction was carried in the absence of catalyst, the conversion of solid to liquid products increased from 54.9% at 483 K to 75.8% at 603 K. Simultaneously, the liquid yield increased from 28.8% to 39.1%. The liquid products were sub-categorized to bio-oil (benzene soluble, diethylether soluble, acetone soluble) and water soluble. When 10% ZnCl(2) was added, the conversion increased slightly but gaseous products increased significantly. However, when 10% Na(2)CO(3) and 10% NaOH were added independently, the solid conversion increased to almost 90%. In the presence of catalyst, the liquid products were mainly bio-oil compounds. Although solid conversion increased at higher reaction temperature, but the liquid yield did not increase at higher temperature.