Mannose and galactose as substrates for production of itaconic acid by Aspergillus terreus.

Itaconic acid (IA), an unsaturated 5-carbon dicarboxylic acid, is a building block platform chemical that is currently produced industrially from glucose by fermentation with Aspergillus terreus. Softwood has the potential to serve as low cost source of sugars for its production. Effective utilization of all softwood derived sugars such as glucose, mannose and galactose by the fungus for production of IA will lower the cost of its production. In this work, 20 A. terreus strains were evaluated for the first time for IA production from mannose and galactose in shake-flasks at initial pH of 3·1, 33°C and 200 rev min-1 for 7 days. Strain NRRL 1971 possesses the unique ability to produce high concentrations of IA from mannose. It produced 36·4 ± 0·2 g IA from 80 g mannose per litre with a yield of 0·46 g g-1 mannose (highest titre reported so far). This strain has the potential to be used for IA production from softwood. The maximum (1·1 ± 0·2 g) IA was produced by strain DSM 23081 from 80 g galactose per litre utilizing only 9·1 ± 0·3 g. Galactose was not suitable for IA production by these strains. This is the first detailed report on the production of IA from mannose and galactose. SIGNIFICANCE AND IMPACT OF THE STUDY: Itaconic acid (IA) is a building block platform chemical which is currently produced industrially from glucose by fermentation with Aspergillus terreus. In order to expand the use of IA, its production cost must be lowered. Softwood has the potential to serve as low cost source of sugars for its production. In this work, 20 A. terreus strains were evaluated for the first time for production of IA from mannose and galactose, sugars derived from softwood. A novel strain was found that gave the highest IA titre reported so far. Galactose was a poor substrate for IA production by A. terreus.

Persistence and remission of depressive symptoms in late life.

OBJECTIVE: The relation of poor health to the onset of depression symptoms in late life is well recognized, but little attention has been given to characteristics that might predict persistence or remission of depressive symptoms. In previous analyses the authors found that increasing disability and declining health preceded the emergence of depressive symptoms in older community residents and accounted for 70% of the variance explained by discriminant analyses. The aim of the present analysis was to examine the relevance of changes in health and disability to the persistence of depressive symptoms. METHOD: A representative sample of 1,855 adults aged 65 or older were assessed with the Center for Epidemiologic Studies Depression Scale at baseline. Twenty-four months later, 1,577 individuals were available for a second assessment of depressive symptoms. The characteristics of the 97 community residents whose depressive symptoms persisted over 24 months were compared to those of the 114 whose symptoms remitted. RESULTS: Changes in health, differences in age, sleep disturbance, and added formal support services accounted for more than 30% of the variance between the persistently depressed and remission groups. Advanced age and worsening health were associated with persistent symptoms, improved health with remission. CONCLUSIONS: Previous studies have indicated that untoward changes in health and disability play a major role in the onset of depressive symptoms. These findings show a substantial contribution to chronicity as well.

A longitudinal study of psychotropic prescriptions in a teaching nursing home.

This study clarifies the methodological pitfalls of using cross-sectional data to characterize episodic and continuous patterns of prescribing psychotropic medications in nursing homes. Although more than half of the residents in a teaching nursing home received a psychotropic drug during their 5 years of residence, less than one-quarter were continuously medicated. The authors conclude that although the rates of psychotropic prescriptions are an important entry point for concerns about quality and appropriateness of psychotropic administration to older nursing home residents, longitudinal studies including the prescribing pattern, indications, and efficacy are needed to determine more clinically meaningful indicators of quality care.

Hierarchy of characteristics associated with depressive symptoms in an urban elderly sample.

In contrast to the uncertainty about the prevalence and importance of late-life depressive disorders, a consistent pattern of risk factors for depressive symptoms has been shown by studies using the Center for Epidemiologic Studies Depression Scale (CES-D). The authors surveyed a representative sample of 2,137 elderly community residents with the CES-D and found a hierarchy of characteristics associated with substantial levels of depressive symptoms: illness, disability, isolation, bereavement, and poverty. If these findings are confirmed by prospective studies, addressing modifiable factors in the emergence, persistence, and remission of depressive symptoms might extend the independent survival of older adults.

The relation of religious preference and practice to depressive symptoms among 1,855 older adults.

Religious devotion is a complex phenomenon but a potentially important source of support and meaning in the lives of older adults. Nonetheless, attendance at religious services and religious preference (affiliation) have received relatively little prominence in epidemiological studies of late life mental illness despite their relative case of measurement. We examined differences in the prevalence and course of depressive symptoms and associated characteristics among 1,855 older community residents who expressed a Jewish, Catholic, or other religious preference. At baseline, Jewish religious preference was associated with a twofold elevation in the prevalence of depressive symptoms compared to Catholics. Lack of attendance at religious services was associated with greater prevalence of depression among all groups, significantly so among Catholics. The relationship of depression with Jewish religious preference and with failure to attend services could not be accounted for by measures of age, gender, health, disability, or social support. Twenty-four months following baseline, Jewish religious preference was associated with the emergence of depressive symptoms and remained significant when the effects of age, gender, health, disability, and social support were controlled. Failure to attend services was associated with both the emergence and persistence of depression but did not remain significant once the effects of other characteristics were controlled. For both religious and health care institutions, these findings have implications for the prevention, recognition, and treatment of late life mental illness.

The geriatric syndrome of late-life depression.

Existing data on the treatment, course, and outcome of depression are not representative of the older depressed person who is most frequently encountered in clinical practice. If mental health services are to become more effectively applied, late-life depression should be conceptualized not as a categorical disorder but as a geriatric syndrome with multiple etiologies requiring a combination of treatments. To support this argument, the author reviews the prevalence of late-life depression across clinical and community settings and in association with somatic and central nervous system conditions. He recommends a comprehensive geriatric assessment and a tripartite treatment approach incorporating definitive, rehabilitative, and supportive interventions.

Psychogeriatric emergencies.

Through training and orientation, clinicians specializing in geriatric medicine are well-equipped to identify the various contributors to life-threatening mental states and associated conditions of older adults. The clinical drill to sort out factors contributing to a change in mental status is well-known and only the less frequently encountered causes and complications of treatment are considered in the previous paragraphs. In situations where a major mental disorder or suicidal or assaultive ideas are suspected, psychiatric consultation will be helpful. When treatment decisions (e.g., acceptance of hospital admission or diagnostic procedures) are difficult to resolve because of distress or conflict in the patient or family, a psychiatric consultation should also be considered. The more challenging task lies in the area of preventable emergencies, those that arise as a result of unsuspected suicidality, elder abuse or an unrecognized anxiety disorder. The pressures of ED practice and the complexity of pathology seen in the clinic work against keeping the physician alert to these possibilities. However, the present economic distress and demographic shifts in American society are unlikely to slow the increase in late life suicide and abuse. The extent to which more aggressive efforts at community outreach might offset the costs of emergency care as well as our seniors' quality of life remain to be demonstrated.

Psychiatric emergencies: rapid response and life-saving therapies.

Mental status in older patients can be acutely affected by a range of factors, particularly polypharmacy, disorders of cognition, psychosis, and elder abuse. Patients so affected may be agitated, uncooperative, combative, suicidal, or incapable of participating in treatment decisions. In a life-threatening emergency, a patient may need to be restrained or a treatment administered against a patient's wishes. Key to successful management of psychiatric emergencies is an awareness of the potential scenarios, familiarity with appropriate interventions, and an understanding of patient rights. An increased alertness for life-threatening behaviors can help prevent an event from worsening and minimize the likelihood of a patient acting out on a threat of violence or suicide.

Acute fatal pneumonia in calves due to respiratory syncytial virus.

An acute pneumonia developed in 28 calves which had been housed together from one to two weeks of age. The clinical signs included pyrexia, tachypnoea, respiratory distress and coughing. Some of the calves died. The pneumonia was characterised by an alveolitis with multinucleated syncytia, alveolar epithelial hyperplasia and bronchiolitis. Interstitial emphysema was also present. Fifteen of 19 calves examined serologically had rising neutralising antibody titres to respiratory syncytial virus; in nine calves the rise was fourfold or greater. Respiratory syncytial virus was not isolated from the calves. There was no evidence of parainfluenza type 3 virus involvement. The adult cows being sucked by the calves remained clinically normal throughout the incident. Six calves examined six weeks after the outbreak started had a chronic cuffing pneumonia characterised by lymphocytic bronchiolitis; some of the calves also had bronchiolitis obliterans. Mycoplasma dispar was found in two of them.

Psychotherapy with older adults.

The scope of need and possible benefit of psychosocial interventions in late life far exceeds the scientific evidence of efficacy. Most studies have been conducted in academic settings with self-selected, relatively independent older adults for whom measures of benefit were narrowly defined. In reviewing the existing literature concerning individual, group, and couples therapies in the geriatric population, we find that with appropriate adaptations for medical comorbidity, cognitive and sensory impairment, caregiver inclusion, and realistic modification of treatment goals, psychotherapeutic endeavors with the senior patient can prove to be highly successful.

Suicide and aging: international perspectives.

From Durkheim to Kraepelin, suicide has been recognized as a social and psychiatric ill. Among clinical scientists in the United States, interest in suicide grew substantially in the 1980's as rates among older adults increased. However, major advances in the science of mental health seem unlikely to reduce the prevalence of suicide as long as case recognition at the community level continues to be problematic. Public policy promoted to reduce social risk factors coupled with greater attention to psychopathology is the logical outgrowth from the most recent data. Differences in suicide rates by nation add weight to the argument.

The emergence of depressive symptoms in late life: the importance of declining health and increasing disability.

Despite considerable progress in the epidemiology of late life depressive disorders, the determinants and course of late life depressive symptoms remain unclear. The apparent reciprocal relationship between depression and disability, a consistent finding in cross-sectional studies further confounds efforts to estimate the importance of depressive symptoms in the elderly. In a longitudinal study of 1457 aged community residents who completed the Center for Epidemiologic Studies Depression scale at baseline and 24 months later, a significant level of depressive symptoms emerged in 163 respondents (11%), while 1080 (74%) remained symptom free. Unlike other studies, we found that the number of medical conditions, social support, life events, and demographic characteristics contributed little to distinguish those with emerging symptoms from those who remained symptom free. However, increasing disability and declining health preceded the emergence of depressive symptoms and accounted for seventy percent of the variance explained by discriminant analysis. These findings have etiologic implications for both the course and determinants of depression in late life.

Significance of depression and cognitive impairment in patients undergoing programed stimulation of cardiac arrhythmias.

Although depression and cognitive impairment have been associated with excess mortality following heart surgery, the relationship of these factors to death following treatment for cardiac arrhythmias is unknown. We prospectively examined the associations between biobehavioral factors, mortality, and arrhythmia manageability in 88 patients undergoing programed electrical stimulation for the diagnosis and treatment of supraventricular and ventricular tachyarrhythmias or syncope of unknown origin. Statistically significant relationships were identified between depression and mortality, and between cognitive impairment and mortality. No relationships were observed between cognitive impairment or psychologic profile and arrhythmia severity or treatment efficacy. Our data suggest that arrhythmia morbidity and mortality may in part be a function of cognitive and emotional impairments that lessen the individual's capacity to comply with lifesaving therapy, maintain a stable physiologic milieu, and continue an adaptive emotional life. Failure to recognize the clinical significance of these impairments in patients at risk for sudden cardiac death will contribute to the current difficulty reducing the death and disability associated with cardiac arrhythmias.

Depressive symptoms and mortality in elderly persons.

Studies on the relationship between depression and mortality in elderly community populations have yielded contradictory findings, although an association frequently is found in studies of elderly psychiatric patients. These different results may be due to differences in the measures of depression, the populations under study, the covariates in the analysis, or to sample attrition. In this study of elderly residents of an urban neighborhood, depressive symptoms are measured at two time points. People are classified as consistently nonsymptomatic (N-N), with emergent symptoms (N-D), in remission (D-N), or persistently symptomatic (D-D). Symptoms of depression, sociodemographic characteristics, and measures of changes in health, functional status, number of chronic medical conditions, and social support are examined in relation to mortality in multivariate Cox regression models. Although symptoms of depression are not found to be related to time-to-death, older people, those with declines in health and functional status, and men have greater relative risks of mortality over a three-year follow-up.

Cognitive impairment and mortality in older community residents.

OBJECTIVE: Cognitive impairment among the elderly has been linked to mortality in studies of clinical populations. The purpose of this study was to examine the mortality risk associated with cognitive impairment among elderly populations in the community. METHODS: Cognitive impairment and other social and health factors were assessed in 1855 elderly community residents. This sample was reinterviewed periodically to assess changes in health and survival. RESULTS: At baseline 33% of the sample were mildly impaired and 8% were severely impaired. Across a 48-month observation period the survival probability was .85 for the cognitively unimpaired, .69 for the mildly impaired, and .51 for severely impaired respondents. When adjustments were made for the effects of other health and social covariates, severely impaired persons were twice as likely to die as unimpaired persons. Those who were mildly impaired were also at an increased risk. CONCLUSIONS: Other investigators have found that cognitive impairment is a significant predictor of dementia. We found that it is a significant predictor of mortality as well. Early detection of impaired cognition and attention to associated health problems could improve the quality of life of these older adults and perhaps extend their survival.