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Olanzapine is more effective than placebo, and combined olanzapine-fluoxetine is more effective than olanzapine and placebo in the treatment of bipolar I depression without increased risk of developing manic symptoms.

Research on a scale measuring adjustment to college is described. A 52-item self-report Likert-type scale, yielding indices of four aspects of adjustment as well as a full-scale score, was administered once each semester in each of 3 successive academic years to samples of freshman students. Reliability data for the scale as a whole and for the several subscales individually are presented, and validity is assessed through examination of the relationship between the subscales and several independent variables expected to be differentially relevant to the subscales. Criterion variables employed were attrition, appeals for services from a psychological services center, freshman year grade point average, election to an academic honorary society, a social activities checklist, and decisions regarding applications for dormitory assistant positions. Implications for use of the scale in counseling and other remedial interventions are discussed.

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SummaryBackgroundStudies evaluating titration of antihypertensive medication using self-monitoring give contradictory findings and the precise place of telemonitoring over self-monitoring alone is unclear. The TASMINH4 trial aimed to assess the efficacy of self-monitored blood pressure, with or without telemonitoring, for antihypertensive titration in primary care, compared with usual care.MethodsThis study was a parallel randomised controlled trial done in 142 general practices in the UK, and included hypertensive patients older than 35 years, with blood pressure higher than 140/90 mm Hg, who were willing to self-monitor their blood pressure. Patients were randomly assigned (1:1:1) to self-monitoring blood pressure (self-montoring group), to self-monitoring blood pressure with telemonitoring (telemonitoring group), or to usual care (clinic blood pressure; usual care group). Randomisation was by a secure web-based system. Neither participants nor investigators were masked to group assignment. The primary outcome was clinic measured systolic blood pressure at 12 months from randomisation. Primary analysis was of available cases. The trial is registered with ISRCTN, number ISRCTN 83571366.Findings1182 participants were randomly assigned to the self-monitoring group (n=395), the telemonitoring group (n=393), or the usual care group (n=394), of whom 1003 (85%) were included in the primary analysis. After 12 months, systolic blood pressure was lower in both intervention groups compared with usual care (self-monitoring, 137·0 [SD 16·7] mm Hg and telemonitoring, 136·0 [16·1] mm Hg vs usual care, 140·4 [16·5]; adjusted mean differences vs usual care: self-monitoring alone, −3·5 mm Hg [95% CI −5·8 to −1·2]; telemonitoring, −4·7 mm Hg [–7·0 to −2·4]). No difference between the self-monitoring and telemonitoring groups was recorded (adjusted mean difference −1·2 mm Hg [95% CI −3·5 to 1·2]). Results were similar in sensitivity analyses including multiple imputation. Adverse events were similar between all three groups.InterpretationSelf-monitoring, with or without telemonitoring, when used by general practitioners to titrate antihypertensive medication in individuals with poorly controlled blood pressure, leads to significantly lower blood pressure than titration guided by clinic readings. With most general practitioners and many patients using self-monitoring, it could become the cornerstone of hypertension management in primary care.FundingNational Institute for Health Research via Programme Grant for Applied Health Research (RP-PG-1209-10051), Professorship to RJM (NIHR-RP-R2-12-015), Oxford Collaboration for Leadership in Applied Health Research and Care, and Omron Healthcare UK.

ABSTRACT. A ring-shea r device was used to study the factors that co ntrol the ultimate (steady) streng th of till at high shea r strains. Tests a t a steady strain ra te and at different stresses norm al to th e shearing direction yielded ultim ate friction angles of26.3° and 18.6° for tills conta ining 4% and 30% clay-sized particles, respectivcly. Other tests at steady normal stresses a nd va ri abl e shear-strain rates indi cated a tendency for both tills lO weaken slightly w ith increasing stra in rate. This weakening may be due to sma ll increases in till porosity.Th ese res ults provide no evidence o f v iscous behavior and suggest that a Coulombplas ti c idealization is reasonable [or till deformation. Howeve r, vi scous behavior has often been sugges ted on th e basis of di stributed shear stra in observed in subglaci a l till. We hyp ot hes ize that deform ation may becom e distributed in till th at is deformed cyc licall y in response to flu ctu ations in basal wa ter pressure. During a deform ation event, transient dil ation of discre te shea r zones should cause a reduction in intern al pore-water pressu re that should streng then th ese zo nes rela tive to the surro unding till, a process call ed dilarant harde ning. Consequent changes in hea r-zo ne positi on, when integrated over time, may yield the obse rved di tributed stra in.

Background: A 6-week double-blind, randomized, placebo-controlled trial was conducted to determine the efficacy of combined therapy with olanzapine and either valproate or lithium compared with valproate or lithium alone in treating acute manic or mixed bipolar episodes.Methods: The primary objective was to evaluate the efficacy of olanzapine (5-20 mg/d) vs placebo when added to ongoing mood-stabilizer therapy as measured by reductions in Young Mania Rating Scale (YMRS) scores. Patients with bipolar disorder (n = 344), manic or mixed episode, who were inadequately responsive to more than 2 weeks of lithium or valproate therapy, were randomized to receive cotherapy (olanzapine + moodstabilizer) or monotherapy (placebo + mood-stabilizer).Results: Olanzapine cotherapy improved patients' YMRS total scores significantly more than monotherapy (−13.11 vs −9.10; P=.003). Clinical response rates (Ն50% improvement on YMRS) were significantly higher with cotherapy (67.7% vs 44.7%; PϽ.001). Olanzapine cotherapy im-proved 21-item Hamilton Depression Rating Scale (HAMD-21) total scores significantly more than monotherapy (4.98 vs 0.89 points; PϽ.001). In patients with mixed-episodes with moderate to severe depressive symptoms (DSM-IV mixed episode; HAMD-21 score of Ն20 at baseline), olanzapine cotherapy improved HAMD-21 scores by 10.31 points compared with 1.57 for monotherapy (PϽ.001). Extrapyramidal symptoms (Simpson-Angus Scale, Barnes Akathisia Scale, Abnormal Involuntary Movement Scale) were not significantly changed from baseline to end point in either treatment group. Treatment-emergent symptoms that were significantly higher for the olanzapine cotherapy group included somnolence, dry mouth, weight gain, increased appetite, tremor, and slurred speech. Conclusion:Compared with the use of valproate or lithium alone, the addition of olanzapine provided superior efficacy in the treatment of manic and mixed bipolar episodes.

These results suggest that olanzapine was significantly more effective than lithium in preventing manic and mixed episode relapse/recurrence in patients acutely stabilized with olanzapine and lithium co-treatment. Both agents were comparable in preventing depression relapse/recurrence.