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Reflections on the Lack of Consideration of Ethnic Ancestry to Stratify Clozapine Dosing
Jose de Leon(Jose de Leon ) 대한신경정신의학회 2023 PSYCHIATRY INVESTIGATION Vol.20 No.3
This review article argues against trusting standard clozapine references, including the US package insert, because they do not include advances in the sciences of pharmacokinetics and pharmacovigilance and ignore the effects of ethnic ancestry on therapeutic dosing. The minimum therapeutic dose leading to the minimum therapeutic concentration of 350 ng/mL in serum/plasma can be used to compare individuals/groups with treatment-resistant schizophrenia. The US clozapine package insert recommends targeting doses of 300-450 mg/day and, subsequently, increments of up to 100 mg with a maximum dose of 900 mg/day. Ethnic ancestry is defined by DNA ancestry group. Asians (people with ancestry ranging from Pakistan to Japan) and Indigenous Americans are similar in clozapine dosing; their average clozapine minimum therapeutic dose ranged from 166 mg/day (female non-smokers) to 270 mg/day (male smokers). For those with European ancestry, average clozapine minimum therapeutic doses ranged from 236 mg/day (female non-smokers) to 368 mg/day (male smokers). Based on limited studies, Black (African sub-Saharan ancestry) patients may be treated with typical US doses (300-600 mg/day), assuming no poor metabolism (PM) status. Ancestry’s impact on clozapine lethality in four countries is discussed (two countries with highly homogenous populations, Denmark and Japan, and two countries with increasingly heterogenous populations due to immigration, Australia and the UK). An international guideline with 104 authors from 50 countries/regions was recently published, providing 6 personalized clozapine titration schedules for adult inpatients (3 ancestry groups and PM/non-PM schedules) and recommending c-reactive protein monitoring at baseline and weekly for 4 weeks.
Encounters and Dialogues: Styles and Levels of Communication in Philosophical Practice
Leon de Haas 강원대학교 인문과학연구소 2011 Journal of Humanities Therapy Vol.2 No.-
The world of philosophical practice is a patchwork of partly vague, partly not reducible styles and methods. We badly lack a common language regarding the quality of philosophical practice. The author contributes to the professional discussion of philosophical practice by being explicit about his approach. He characterizes his phenomenologically inspired way of philosophical practice as ‘dialogical encounter’. He describes some examples from his coaching practice. In the last part of the essay, he makes a distinction between encountering and procedural practices by describing two events.
Mechanical properties of whey protein/Na alginate gel microparticles
Leon, A.M.,Medina, W.T.,Park, D.J.,Aguilera, J.M. Applied Science Publishers 2016 Journal of food engineering Vol.188 No.-
<P>A proportion of the fast-growing elderly population needs special foods which are soft to chew and easily swallowed. Gel microparticles, GMP, (e.g., less than 100 mu m in size) are an alternative as texture modifiers in liquid and pureed foods, and may be used as carriers of needed flavors and nutrients. GMP (sizes < 40 mu m) were fabricated from whey protein isolate (WPI)/sodium alginate (NaAlg) mixtures by size reduction of bulk gels made by the cold-gelation method. A cell test based on back extrusion was designed to evaluate the mechanical properties of a GMP paste and image analysis techniques implemented to resolve the size of GMP. A good correlation (R-2 = 0.89) was obtained between the stress (at 60% strain) of bulk gels and that of GMP. Compression stress at 30% strain depended on the concentrations of WPI and NaAlg and a maximum was observed at intermediate values. Through Principal Component Analysis gels with low and high sodium alginate contents were clearly explaining 93% of the variability. The ample range of mechanical properties of GMP suggest that they may be used to design or modify the texture of soft foods. (C) 2016 Elsevier Ltd. All rights reserved.</P>
Education for sustainable development in Africa: a critique of regional agendas
Leon Tikly 서울대학교 교육연구소 2019 Asia Pacific Education Review Vol.20 No.2
Education is often perceived in policy agendas as playing a transformative role in realising sustainable development and the SDGs on the continent. The assumption is based, however, on an insufciently critical understanding of the historical role of education in supporting unsustainable development. The article provides a critical account of the relationship between education policy and sustainable development in Africa as an aspect of the postcolonial condition, i.e. as an aspect of the colonial legacy and of Africa’s position in relation to contemporary processes of globalisation. It is argued that if education is to play a transformative role in relation to sustainable development then education policy needs to be fundamentally reoriented and harnessed to wider processes of economic, cultural and political transformation in the interests of social and environmental justice.