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NeuroStar transcranial magnetic stimulation (TMS) is an effective acute treatment for patients with major depressive disorder (MDD). In order to further understand use of the NeuroStar in a clinical setting, Neuronetics has established a patient treatment and outcomes registry to collect and analyze utilization information on patients receiving treatment with the NeuroStar.
Individual NeuroStar providers are invited to participate in the registry and agree to provide their de-identified patient treatment data. The NeuroStar has an integrated electronic data management system (TrakStar) which allows for the data collection to be automated. The data collected for the registry include Demographic Elements (age, gender), Treatment Parameters, and Clinical Ratings. Clinical assessments are: Clinician Global Impression - Severity of Illness (CGI-S) and thePatient Health Questionnaire 9-item (PHQ-9). De-identified patient data is uploaded to Registry server; an independent statistical service then creates final data reports.
Over 500 patients have entered the NeuroStar Outcomes Registry since Sept 2016. Mean patient age: 48.0 (SD±16.0); 64% Female. Baseline PHQ-9, mean 18.8 (SD±5.0.) Response/Remission Rate, PHQ-9: 61%/33% CGI-S: 78%/59%.
For the initial 500 patients in the Outcomes Registry, approximately 2/3 patients achieve respond and 1/3 patients achieve remission with an acute course of NeuroStar. These treatment outcomes consistent with NeuroStar open-label study data (Carpenter, 2012). The TrakStar data management system makes large scale data collection feasible. The NeuroStarOutcomes Registry is ongoing, and expected to reach 6000 outpatients from more than 47 clinical sites in 36 months.
California and Washington recently replaced traditional partisan elections with nonpartisan “top-two” election procedures. Some reform advocates hoped that voters would behave in a way to support moderate candidates in the primary stage; the limited evidence for this behaviour has led some scholars to conclude that the reform has little chance to change meaningful policy outcomes. Yet we find that the nonpartisan procedure has predictable and disparate political consequences: the general elections between two candidates of the same party, called copartisan general elections, tend to occur in districts without any meaningful crossparty competition. Furthermore, copartisan elections are more likely to occur with open seats, when a new legislator will begin building a network of relationships. The results, viewed through the lens of the Advocacy Coalition Framework, suggest that opportunities exist for coalitional rearrangement over time.
The impact of spatial and temporal variations in the surface albedo and aerodynamic roughness length on the surface energy balance of Haut Glacier d’Arolla, Switzerland, was examined using a semi-distributed surface energy-balance model (Arnold and others, 1996). The model was updated to incorporate the glacier-wide effects of albedo and aerodynamic roughness-length variations using parameterizations following Brock (1997). After the model’s performance was validated, the glacier-wide patterns of the net shortwave, turbulent and melt energy fluxes were examined on four days, representative of surface conditions in late May, June July and August. In the model, meteorological conditions were held constant on each day in order that the impact of albedo and aerodynamic roughness-length variations could be assessed independently. A late-summer snowfall event was also simulated. Albedo and aerodynamic roughness-length variations, particularly those associated with the migration of the transient snowline and the decay of the winter snowpack, were found to exert a strong influence on the magnitude of the surface energy fluxes The importance of meteorological conditions in suppressing the surface energy fluxes and melt rate following a fresh snowfall was highlighted
Spatial and temporal variations in aerodynamic roughness length (z0) on Haut Glacier d’Arolla, Switzerland, during the 1993 and 1994 ablation seasons are described, based on measurements of surface microtopography. The validity of the microtopographic z0 measurements is established through comparison with independent vertical wind profile z0 measurements over melting snow, slush and ice. The z0 variations are explained through correlation and regression analyses, using independent measurements of meteorological and surface variables, and parameterizations are developed to calculate z0 variations for use in surface energy-balance melt models. Several independent variables successfully explain snow z0 variation through their correlation with increasing surface roughness, caused by ablation hollow formation, during snowmelt. Non-linear parameterizations based on either accumulated melt or accumulated daily maximum temperatures since the most recent snowfall explain over 80% of snow z0 variation. The z0 following a fresh snowfall on an ice surface is parameterized based on relationships with the underlying ice z0, snow depth and accumulated daily maximum temperatures. None of the independent variables were able to successfully explain ice z0 variation. Although further comparative studies are needed, the results lend strong support to the microtopographic technique of measuring z0 over melting glacier surfaces.
Spatial and temporal variations of surface albedo on Haut Glacier d’Arolla, Switzerland, during the 1993 and 1994 ablation seasons are described. Correlation and regression analyses are used to explain the albedo variations in terms of independent meteorological and surface property variables. Parameterizations are developed which allow estimation of albedo variation in surface energy-balance models. Snow albedo is best estimated from accumulated daily maximum temperatures since snowfall. On “deep” snow (≥0.5 cm w.e. depth) a logarithmic function is used, while on “shallow” snow (<0.5 cm w.e. depth) an exponential function is used to enable the albedo to decay to the underlying ice or debris albedo. The transition from “deep” to “shallow” snow is calculated as a function of decreasing snow depth (combined r2 = 0.65). This new parameterization performs better than earlier schemes because accumulated daily maximum temperatures since snowfall correlate strongly with snow grain-size and impurity concentration, the main physical controls on snow albedo. Ice albedo may be parameterized by its relationship to elevation (r2 = 0.28), but this approach results in only a small improvement over the assumption of a constant mean ice albedo.
Universal screening for postpartum depression is recommended in many countries. Knowledge of whether the disclosure of depressive symptoms in the postpartum period differs across cultures could improve detection and provide new insights into the pathogenesis. Moreover, it is a necessary step to evaluate the universal use of screening instruments in research and clinical practice. In the current study we sought to assess whether the Edinburgh Postnatal Depression Scale (EPDS), the most widely used screening tool for postpartum depression, measures the same underlying construct across cultural groups in a large international dataset.
Ordinal regression and measurement invariance were used to explore the association between culture, operationalized as education, ethnicity/race and continent, and endorsement of depressive symptoms using the EPDS on 8209 new mothers from Europe and the USA.
Education, but not ethnicity/race, influenced the reporting of postpartum depression [difference between robust comparative fit indexes (∆*CFI) < 0.01]. The structure of EPDS responses significantly differed between Europe and the USA (∆*CFI > 0.01), but not between European countries (∆*CFI < 0.01).
Investigators and clinicians should be aware of the potential differences in expression of phenotype of postpartum depression that women of different educational backgrounds may manifest. The increasing cultural heterogeneity of societies together with the tendency towards globalization requires a culturally sensitive approach to patients, research and policies, that takes into account, beyond rhetoric, the context of a person's experiences and the context in which the research is conducted.
Correlation of lower Cambrian strata is often confounded by provincialism of key fauna. The widespread occurrence of the micromollusc Watsonella crosbyi Grabau, 1900 is therefore an important biostratigraphic signpost with potential for international correlation of lower Cambrian successions. Previous correlations of W. crosbyi from Australia (Normanville Group) suggested an Atdabanian- to Botoman-equivalent age. However, in the upper part of the Mount Terrible Formation, stratigraphic ranges of W. crosbyi and Aldanella sp. cf. golubevi overlap prior to the incoming of vertically burrowed ‘piperock’, which is indicative of an age no earlier than Cambrian Stage 2. The stratigraphic range of W. crosbyi in the Normanville Group, South Australia correlates with the ranges of the taxon in China, France, Mongolia and Siberia (though not Newfoundland). The new Australian data add further support for considering the first occurrence of W. crosbyi a good potential candidate for defining the base of Cambrian Stage 2. The stratigraphic range of W. crosbyi through the lower Cambrian Normanville Group has been determined based on collections from measured sections. Although rare, W. crosbyi is part of an assemblage of micromolluscs including Bemella sp., Parailsanella sp. cf. murenica and a sinistral form of Aldanella (A. sp. cf. A. golubevi). Other fauna present include Australohalkieria sp., Eremactis mawsoni, chancelloriids and Cupitheca sp.
Worldwide, dating rock art is difficult to achieve because of the frequent lack of datable material and the difficulty of removing contamination from samples. Our research aimed to select the paints that would be the most likely to be successfully radiocarbon dated and to estimate the quantity of paint needed depending on the nature of the paint and the weathering and alteration products associated with it. To achieve this aim, a two-step sampling strategy, coupled with a multi-instrument characterization (including SEM-EDS, Raman spectroscopy, and FTIR spectroscopy analysis) and a modified acid-base-acid (ABA) pretreatment, was created. In total, 41 samples were dated from 14 sites in three separate regions of southern Africa. These novel protocols ensure that the 14C chronology produced was robust and could also be subsequently applied to different regions with possible variations in paint preparation, geology, weathering conditions, and contaminants.
Charcoal is the result of natural and anthropogenic burning events, when biomass is exposed to elevated temperatures under conditions of restricted oxygen. This process produces a range of materials, collectively known as pyrogenic carbon, the most inert fraction of which is known as black carbon (BC). BC degrades extremely slowly and is resistant to diagenetic alteration involving the addition of exogenous carbon, making it a useful target substance for radiocarbon dating particularly of more ancient samples, where contamination issues are critical. We present results of tests using a new method for the quantification and isolation of BC, known as hydropyrolysis (hypy). Results show controlled reductive removal of non-BC organic components in charcoal samples, including lignocellulosic and humic material. The process is reproducible and rapid, making hypy a promising new approach not only for isolation of purified BC for 14C measurement but also in quantification of different labile and resistant sample C fractions.
Young children's disregard for conduct rules (failing to experience discomfort following transgressions and violating adults' prohibitions) often foreshadows future antisocial trajectories, perhaps in part because it elicits more power-assertive parental discipline, which in turn promotes children's antisocial behavior. This process may be particularly likely for children with low skin conductance level (SCL). In 102 two-parent community families, we tested a model in which children's SCL, assessed at 8 years, was posed as a moderator of the cascade from children's disregard for conduct rules at 4.5 years to parents' power assertion at 5.5 and 6.5 years to antisocial behavior at 10 and 12 years. Children's disregard for conduct rules was observed in scripted laboratory paradigms, parents' power assertion was observed in discipline contexts, and children's antisocial behavior was rated by parents. Conditional process analyses revealed that the developmental cascade from early disregard for rules to future parental power assertion to antisocial outcomes occurred only for the children with low SCL (below median), but not their high-SCL (above median) peers. By elucidating the specific interplay among children's disregard for rules, the parenting they receive, and their psychophysiology, this study represents a developmentally informed, multilevel approach to early etiology of antisocial behavior.
The Chauvet-Pont d'Arc Cave is one of the most important sites for the study of the earliest manifestations and development of prehistoric art at the beginning of the Upper Paleolithic. Different dating techniques have been performed thus far (AMS 14C, U/Th TIMS, 36Cl dating) to model the chronological framework of this decorated cave. The cave yielded several large charcoal fragments, which enabled the opportunity for obtaining multiple dates; thus, a First Radiocarbon Intercomparison Program (FIP) was initiated in 2004 using three charcoal pieces. The FIP demonstrated that those cross-dated samples belonged to a time period associated with the first human occupation. One of the statistical interests of an intercomparison program is to reduce the uncertainty on the sample age; thus, to further assess the accuracy of the chronological framework, the Second Intercomparison Program (SIP) involving 10 international 14C laboratories was carried out on two pieces of charcoal found inside two hearth structures of the Galerie des Mégacéros. Each laboratory used its own pretreatment and AMS facilities. In total, 21 and 22 measurements were performed, respectively, which yielded consistent results averaging ∼32 ka BP. Two strategies have currently been developed to identify statistical outliers and to deal with them; both lead to quasi-identical calibrated combined densities. Finally, the new results were compared with those of the FIP, leading to the important conclusion that five different samples from at least three different hearth structures give really tightened temporal densities, associated with one short human occupation in the Galerie des Mégacéros.
An important advance in the radiocarbon dating of archaeological material occurred in the late 1990s, with direct dating of cremated human remains. A crucial part of the argument was the demonstration that comparable results could be obtained from paired dates of charcoal and calcined bone from the same contexts. Recent studies, however, have noted the influence of carbon from the fuel sources, raising a question over the interpretation of the paired charcoal/bone dates. Here, fleshed modern animal joints were burned with “old” fuel of known age, providing experimental evidence under natural conditions, demonstrating a clear effect of the fuel source on the carbon isotopic composition of calcined bone. In most situations in which branchwood was used as fuel, dates on calcined bone should not show any significant offset, as the wood will be of a similar age to the cadaver. For cases in which old wood, coal, or peat are used as fuel, we expect an offset of some decades/centuries, potentially up to millennia. We observed, however, that the amount of 14C intake from the fuel is extremely variable (from 39 to 95%). A strong correlation between age offset and δ13C values suggests that the latter might be useful in identifying large inputs from 14C-depleted fuels. A level of caution is recommended when 14C dating calcined bone in cases where fuels with an inbuilt age may have been used in the cremation process.
The public health threat posed by zoonotic Plasmodium knowlesi appears to be growing: it is increasingly reported across South East Asia, and is the leading cause of malaria in Malaysian Borneo. Plasmodium knowlesi threatens progress towards malaria elimination as aspects of its transmission, such as spillover from wildlife reservoirs and reliance on outdoor-biting vectors, may limit the effectiveness of conventional methods of malaria control. The development of new quantitative approaches that address the ecological complexity of P. knowlesi, particularly through a focus on its primary reservoir hosts, will be required to control it. Here, we review what is known about P. knowlesi transmission, identify key knowledge gaps in the context of current approaches to transmission modelling, and discuss the integration of these approaches with clinical parasitology and geostatistical analysis. We highlight the need to incorporate the influences of fine-scale spatial variation, rapid changes to the landscape, and reservoir population and transmission dynamics. The proposed integrated approach would address the unique challenges posed by malaria as a zoonosis, aid the identification of transmission hotspots, provide insight into the mechanistic links between incidence and land use change and support the design of appropriate interventions.
The behavioral sciences have flourished by studying how traditional and/or rational behavior has been governed throughout most of human history by relatively well-informed individual and social learning. In the online age, however, social phenomena can occur with unprecedented scale and unpredictability, and individuals have access to social connections never before possible. Similarly, behavioral scientists now have access to “big data” sets – those from Twitter and Facebook, for example – that did not exist a few years ago. Studies of human dynamics based on these data sets are novel and exciting but, if not placed in context, can foster the misconception that mass-scale online behavior is all we need to understand, for example, how humans make decisions. To overcome that misconception, we draw on the field of discrete-choice theory to create a multiscale comparative “map” that, like a principal-components representation, captures the essence of decision making along two axes: (1) an east–west dimension that represents the degree to which an agent makes a decision independently versus one that is socially influenced, and (2) a north–south dimension that represents the degree to which there is transparency in the payoffs and risks associated with the decisions agents make. We divide the map into quadrants, each of which features a signature behavioral pattern. When taken together, the map and its signatures provide an easily understood empirical framework for evaluating how modern collective behavior may be changing in the digital age, including whether behavior is becoming more individualistic, as people seek out exactly what they want, or more social, as people become more inextricably linked, even “herdlike,” in their decision making. We believe the map will lead to many new testable hypotheses concerning human behavior as well as to similar applications throughout the social sciences.
In a recent New York Times column (April 15, 2013), David Brooks discussed how the big-data agenda lacks a coherent framework of social theory – a deficiency that the Bentley, O'Brien, and Brock (henceforth BOB) model was meant to overcome. Or, stated less pretentiously, the model was meant as a first step in that direction – a map that hopefully would serve as a minimal, practical, and accessible framework that behavioral scientists could use to analyze big data. Rather than treating big data as a record of, and also a predictor of, where and when certain behaviors might take place, the BOB model is interested in what big data reveal about how decisions are being made, how collective behavior evolves from daily to decadal time scales, and how this varies across communities.