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Major depressive disorder (MDD) is a highly heterogeneous condition in terms of symptom presentation and, likely, underlying pathophysiology. Accordingly, it is possible that only certain individuals with MDD are well-suited to antidepressants. A potentially fruitful approach to parsing this heterogeneity is to focus on promising endophenotypes of depression, such as neuroticism, anhedonia, and cognitive control deficits.
Within an 8-week multisite trial of sertraline v. placebo for depressed adults (n = 216), we examined whether the combination of machine learning with a Personalized Advantage Index (PAI) can generate individualized treatment recommendations on the basis of endophenotype profiles coupled with clinical and demographic characteristics.
Five pre-treatment variables moderated treatment response. Higher depression severity and neuroticism, older age, less impairment in cognitive control, and being employed were each associated with better outcomes to sertraline than placebo. Across 1000 iterations of a 10-fold cross-validation, the PAI model predicted that 31% of the sample would exhibit a clinically meaningful advantage [post-treatment Hamilton Rating Scale for Depression (HRSD) difference ⩾3] with sertraline relative to placebo. Although there were no overall outcome differences between treatment groups (d = 0.15), those identified as optimally suited to sertraline at pre-treatment had better week 8 HRSD scores if randomized to sertraline (10.7) than placebo (14.7) (d = 0.58).
A subset of MDD patients optimally suited to sertraline can be identified on the basis of pre-treatment characteristics. This model must be tested prospectively before it can be used to inform treatment selection. However, findings demonstrate the potential to improve individual outcomes through algorithm-guided treatment recommendations.
The acronym for “certified electron microscopy technologist” is CEMT, and these letters designate the bearer as having passed the written and practical exams necessary to become “certified”! The acronym was approved by the MSA Council to more firmly provide a professional identification of certification in the area of transmission electron microscopy (TEM) of biological tissue. A CEMT may use these initials after his or her name for as long as the certification remains valid (for example, Jane Doe, AA, BS, CEMT).
This work presents a study on the activation behavior of high-dose (φ > 1015 cm-2) boron and phosphorus implants for low resistance source and drain regions for thin-film transistors (TFTs) fabricated using solid-phase crystallization (SPC) of amorphous silicon. Process variables include factors associated with ion implant and annealing conditions, as well as the SPC and implant process arrangement. Four-point probe sheet resistance (Rs) measurements were used as a comprehensive assessment of the electrical properties. Results have identified similarities and differences in activation behavior that can influence process integration strategies considering both the SPC approach and TFT fabrication.
To determine healthcare-associated infection (HAI) prevalence in 9 hospitals in Jacksonville, Florida; to evaluate the performance of proxy indicators for HAIs; and to refine methodology in preparation for a multistate survey.
Point prevalence survey.
Acute care inpatients of any age.
HAIs were defined using National Healthcare Safety Network criteria. In each facility a trained primary team (PT) of infection prevention (IP) staff performed the survey on 1 day, reviewing records and collecting data on a random sample of inpatients. PTs assessed patients with one or more proxy indicators (abnormal white blood cell count, abnormal temperature, or antimicrobial therapy) for the presence of HAIs. An external IP expert team collected data from a subset of patient records reviewed by PTs to assess proxy indicator performance and PT data collection.
Of 851 patients surveyed by PTs, 51 had one or more HAIs (6.0%; 95% confidence interval, 4.5%–7.7%). Surgical site infections (n = 18), urinary tract infections (n = 9), pneumonia (n = 9), and bloodstream infections (n = 8) accounted for 75.8% of 58 HAIs detected by PTs. Staphylococcus aureus was the most common pathogen, causing 9 HAIs (15.5%). Antimicrobial therapy was the most sensitive proxy indicator, identifying 95.5% of patients with HAIs.
HAI prevalence in this pilot was similar to that reported in the 1970s by the Centers for Disease Control and Prevention's Study on the Efficacy of Nosocomial Infection Control. Antimicrobial therapy was a sensitive screening variable with which to identify those patients at higher risk for infection and reduce data collection burden. Additional work is needed on validation and feasibility to extend this methodology to a national scale.
Data from a community-based prospective longitudinal study were used to
investigate the association of minor depressive disorder during adolescence
with adverse mental health outcomes during adulthood. Structured diagnostic
interviews were administered to a community-based sample of 755 individuals
during adolescence and adulthood. Results indicated that minor depressive
disorder during adolescence was associated with elevated risk for subsequent
psychiatric disorders during adulthood, including major depressive disorder,
⩾1 disruptive disorders and clinically relevant impairment after
corresponding and co-occurring disorders were controlled statistically.
Extended maternal separations before age 5 were evaluated as a predictor of long-term risk for offspring borderline personality disorder (BPD) symptoms in longitudinal data from a large random community sample. Early separations from mother predicted elevations in BPD symptoms assessed repeatedly from early adolescence to middle adulthood. Early separations also predicted a slower than normal rate of decline in symptoms with age. Other theoretically grounded risks were examined and shown to predict elevated BPD symptoms over the developmental trajectory. Long-term effects of early separations were largely independent of childhood temperament, child abuse, maternal problems, and parenting risks. These data provide the first prospectively collected data on the developmental course of BPD symptoms and suggest a series of environmental and other influences on these very disabling problems.
Previous studies have revealed a “theory of mind” impairment in children with autism. The aim of this study was to assess whether it is possible to intervene by teaching children with autism to understand the mental states of emotion, belief, or pretence. Results showed that it is possible to teach children with autism to pass tasks that assess emotion and belief understanding. Introducing unfamiliar materials in structurally similar tasks did not adversely influence teaching effects, either immediately after teaching, or 2 months later. However, teaching effects did not generalize to tasks in domains where children received no teaching. In addition, no significant progress in spontaneous pretend play resulted from teaching. These results indicate that children may be passing tasks using rules rather than any genuine understanding of the concepts involved.
Low socioeconomic status (SES) background has been identified as a risk for several mental disorders. However evidence regarding SES and the developmental course of personality disorder (PD) has not been addressed. Nor is it clear whether an SES relationship to PD symptom course may be attributable to known associated risks. Further, specificity of such relationships to a particular PD diagnostic pattern independent of comorbidity with other PD or with depression has not been investigated. Data are from a general population studied longitudinally between ages 10 and 36 in four assessment waves. Effects of SES-associated risks on the level of symptoms of schizotypal and borderline disorders are estimated and compared to effects on depressive symptoms. Low family SES had robust modest independent effects on both PDs over the entire age span despite substantial cumulative effects of trauma history, stressful recent life events, IQ, poor parenting, and comorbid symptoms. SES effects on depressive symptoms were generally absent, but a small “protective” effect of low SES appeared when comorbidity with PD symptoms was taken into account. Cumulatively, these risks account for developmental failures of substantial magnitude and consequence, marking the importance of understanding the remaining mechanisms of SES effects and programmatic implications for minimizing associated risk.
Dr. D is a primary healthcare worker in a large city in an East European country. He struggles to make ends meet for his family given his paltry income. Recently, Dr. D was approached by a multinational pharmaceutical company at his practice. He was told that for every prescription of the company's product for high blood pressure, he will receive an additional 5 dollars. Dr. D believes it is a pretty good medication but knows there are other equally effective, though much less expensive medications. He does not want to engage in unethical prescribing, but the monetary incentives offered to him make this a difficult choice.
Company E has a new drug that could considerably help to cure inflicted populations in Africa and elsewhere. However, this new product is priced well beyond the purchasing power of most persons in developing countries and would significantly drain already limited health budgets of developing country governments. The company argues that it needs to price the drug at a rate that will enable it to recoup its significant research and development costs. But people will die without access to it.
What is access to medicines and corporate social responsibility?
The phrase “access to medicines” as used in this context refers to the social problem of providing medicines to those who need them both domestically and globally. The problem exists primarily because of the high cost of these medicines.
This study examined the effects of being born very preterm on children's early language development using prospective longitudinal data from a representative regional cohort of 90 children born very preterm (gestational age <33 weeks and/or birth weight <1,500 grams) and a comparison sample of 102 children born full term (gestational age 38–41 weeks). The MacArthur-Bates Communicative Development Inventory: Words and Sentences (CDI-WS) was used to assess children's language development at age 2 ; 0 (corrected for gestational age at birth). Clear linear relationships were found between gestational age at birth and later language outcomes, with decreasing gestational age being associated with poorer parent-reported language skills. Specifically, children born extremely preterm (<28 weeks' gestation) tended to perform less well than those born very preterm (28–32 weeks' gestation), who in turn performed worse than children born full term (38–41 weeks' gestation). This pattern of findings was evident across a range of outcomes spanning vocabulary size and quality of word use, as well as morphological and syntactic complexity. Importantly, associations between gestational age at birth and language outcomes persisted after statistical control for child and family factors correlated with both preterm birth and language development. These findings demonstrate the presence of pervasive delays in the early language development of children born very preterm. They also highlight the importance of gestational age in predicting later language risk in this population of infants.
Little is currently known about functioning and impairment during adulthood associated with the course of personality disorders.
To investigate the association of personality disorder stability from adolescence through middle adulthood with measures of global functioning and impairment, using prospective epidemiological data.
A community-based sample of 658 individuals was interviewed at mean ages 14, 16, 22 and 33 years.
Individuals with persistent personality disorder had markedly poorer functioning and greater impairment at mean age 33 years than did those who had never been identified as having such disorder or who had a personality disorder that was in remission, after co-occurring Axis I disorders at age 33 years were taken into account. Remitted disorder was associated with mild long-term impairment. Adult-onset personality disorders, however, were also associated with significant impairment.
Persistent and adult-onset personality disorders are associated with functional impairment among adults in the community. These effects are independent of co-occurring Axis 1 disorders.