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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.
A pilot study by 6 Clinical and Translational Science Awards (CTSAs) explored how bibliometrics can be used to assess research influence.
Evaluators from 6 institutions shared data on publications (4202 total) they supported, and conducted a combined analysis with state-of-the-art tools. This paper presents selected results based on the tools from 2 widely used vendors for bibliometrics: Thomson Reuters and Elsevier.
Both vendors located a high percentage of publications within their proprietary databases (>90%) and provided similar but not equivalent bibliometrics for estimating productivity (number of publications) and influence (citation rates, percentage of papers in the top 10% of citations, observed citations relative to expected citations). A recently available bibliometric from the National Institutes of Health Office of Portfolio Analysis, examined after the initial analysis, showed tremendous potential for use in the CTSA context.
Despite challenges in making cross-CTSA comparisons, bibliometrics can enhance our understanding of the value of CTSA-supported clinical and translational research.
Two large earthquakes in 2015 caused widespread destruction in Nepal. This study aimed to examine frequency of common mental health and psychosocial problems and their correlates following the earthquakes.
A stratified multi-stage cluster sampling design was employed to randomly select 513 participants (aged 16 and above) from three earthquake-affected districts in Nepal: Kathmandu, Gorkha and Sindhupalchowk, 4 months after the second earthquake. Outcomes were selected based on qualitative preparatory research and included symptoms of depression and anxiety (Hopkins Symptom Checklist-25); post-traumatic stress disorder (PTSD Checklist-Civilian); hazardous alcohol use (AUDIT-C); symptoms indicating severe psychological distress (WHO-UNHCR Assessment Schedule of Serious Symptoms in Humanitarian Settings (WASSS)); suicidal ideation (Composite International Diagnostic Interview); perceived needs (Humanitarian Emergency Settings Perceived Needs Scale (HESPER)); and functional impairment (locally developed scale).
A substantial percentage of participants scored above validated cut-off scores for depression (34.3%, 95% CI 28.4–40.4) and anxiety (33.8%, 95% CI 27.6–40.6). Hazardous alcohol use was reported by 20.4% (95% CI 17.1–24.3) and 10.9% (95% CI 8.8–13.5) reported suicidal ideation. Forty-two percent reported that ‘distress’ was a serious problem in their community. Anger that was out of control (symptom from the WASSS) was reported by 33.7% (95% CI 29.5–38.2). Fewer people had elevated rates of PTSD symptoms above a validated cut-off score (5.2%, 95% CI 3.9–6.8), and levels of functional impairment were also relatively low. Correlates of elevated symptom scores were female gender, lower caste and greater number of perceived needs. Residing in Gorkha and Sindhupalchowk districts and lower caste were also associated with greater perceived needs. Higher levels of impaired functioning were associated with greater odds of depression and anxiety symptoms; impaired functioning was less strongly associated with PTSD symptoms.
Four months after the earthquakes in Nepal, one out of three adults experienced symptoms of depression and distressing levels of anger, one out of five engaged in hazardous drinking, and one out of ten had suicidal thoughts. However, posttraumatic stress symptoms and functional impairment were comparatively less frequent. Taken together, the findings suggest that there were significant levels of psychological distress but likely low levels of disorder. The findings highlight the importance of indicated prevention strategies to reduce the risk of distress progressing to disorder within post-disaster mental health systems of care.
Alcohol use is a well-documented risk factor for intimate partner violence (IPV); however, the majority of research comes from high-income countries.
Using nationally representative data from 86 024 women that participated in the Demographic and Health Surveys, we evaluated the relationship between male partner alcohol use and experiencing IPV in 14 countries in sub-Saharan Africa (SSA). Using multilevel mixed-effects models, we calculated the within-country, between-country, and contextual effects of alcohol use on IPV.
Prevalence of partner alcohol use and IPV ranged substantially across countries (3–62 and 11–60%, respectively). Partner alcohol use was associated with a significant increase in the odds of reporting IPV for all 14 countries included in this analysis. Furthermore, the relationship between alcohol use and IPV, although largely explained by partner alcohol use, was also attributable to overall prevalence of alcohol use in a given country. The partner alcohol use–IPV relationship was moderated by socioeconomic status (SES): among women with a partner who used alcohol those with lower SES had higher odds of experiencing IPV than women with higher SES.
Results of this study suggest that partner alcohol use is a robust correlate of IPV in SSA; however, drinking norms may independently relate to IPV and confound the relationship between partner alcohol use and IPV. These findings motivate future research employing experimental and longitudinal designs to examine alcohol use as a modifiable risk factor of IPV and as a novel target for treatment and prevention research to reduce IPV in SSA.
With improvements in early survival following congenital heart surgery, it has become increasingly important to understand longer-term outcomes; however, routine collection of these data is challenging and remains very limited. We describe the development and initial results of a collaborative programme incorporating standardised longitudinal follow-up into usual care at the Children’s Hospital of Philadelphia (CHOP) and University of Michigan (UM).
We included children undergoing benchmark operations of the Society of Thoracic Surgeons. Considerations regarding personnel, patient/parent engagement, funding, regulatory issues, and annual data collection are described, and initial follow-up rates are reported.
The present analysis included 1737 eligible patients undergoing surgery at CHOP from January 2007 to December 2014 and 887 UM patients from January 2010 to December 2014. Overall, follow-up data, of any type, were obtained from 90.8% of patients at CHOP (median follow-up 4.3 years, 92.2% survival) and 98.3% at UM (median follow-up 2.8 years, 92.7% survival), with similar rates across operations and institutions. Most patients lost to follow-up at CHOP had undergone surgery before 2010. Standardised questionnaires assessing burden of disease/quality of life were completed by 80.2% (CHOP) and 78.4% (UM) via phone follow-up. In subsequent pilot testing of an automated e-mail system, 53.4% of eligible patients completed the follow-up questionnaire through this system.
Standardised follow-up data can be obtained on the majority of children undergoing benchmark operations. Ongoing efforts to support automated electronic systems and integration with registry data may reduce resource needs, facilitate expansion across centres, and support multi-centre efforts to understand and improve long-term outcomes in this population.
Long-acting injectable formulations of antipsychotics are treatment alternatives to oral agents.
To assess the efficacy of aripiprazole once-monthly compared with oral aripiprazole for maintenance treatment of schizophrenia.
A 38-week, double-blind, active-controlled, non-inferiority study; randomisation (2:2:1) to aripiprazole once-monthly 400 mg, oral aripiprazole (10–30 mg/day) or aripiprazole once-monthly 50mg (a dose below the therapeutic threshold for assay sensitivity). (Trial registration: clinicaltrials.gov, NCT00706654.)
A total of 1118 patients were screened, and 662 responders to oral aripiprazole were randomised. Kaplan–Meier estimated impending relapse rates at week 26 were 7.12% for aripiprazole once-monthly 400mg and 7.76% for oral aripiprazole. This difference (−0.64%, 95% CI −5.26 to 3.99) excluded the predefined non-inferiority margin of 11.5%. Treatments were superior to aripiprazole once-monthly 50mg (21.80%, P⩽0.001).
Aripiprazole once-monthly 400mg was non-inferior to oral aripiprazole, and the reduction in Kaplan–Meier estimated impending relapse rate at week 26 was statistically significant v. aripiprazole once-monthly 50 mg.
Diagnostic errors can have tremendous consequences because they can result in a fatal chain of wrong decisions. Experts assume that physicians' desire to confirm a preliminary diagnosis while failing to seek contradictory evidence is an important reason for wrong diagnoses. This tendency is called ‘confirmation bias’.
To study whether psychiatrists and medical students are prone to confirmation bias and whether confirmation bias leads to poor diagnostic accuracy in psychiatry, we presented an experimental decision task to 75 psychiatrists and 75 medical students.
A total of 13% of psychiatrists and 25% of students showed confirmation bias when searching for new information after having made a preliminary diagnosis. Participants conducting a confirmatory information search were significantly less likely to make the correct diagnosis compared to participants searching in a disconfirmatory or balanced way [multiple logistic regression: odds ratio (OR) 7.3, 95% confidence interval (CI) 2.53–21.22, p<0.001; OR 3.2, 95% CI 1.23–8.56, p=0.02]. Psychiatrists conducting a confirmatory search made a wrong diagnosis in 70% of the cases compared to 27% or 47% for a disconfirmatory or balanced information search (students: 63, 26 and 27%). Participants choosing the wrong diagnosis also prescribed different treatment options compared with participants choosing the correct diagnosis.
Confirmatory information search harbors the risk of wrong diagnostic decisions. Psychiatrists should be aware of confirmation bias and instructed in techniques to reduce bias.
Sarcina flava ATCC 540 (ade) and Micrococcus flavocyaneus ATCC 8673 (ade), two related micrococci, were transformed to prototrophy at frequencies as high as 0·02% and 0·005% of colony-forming units, respectively. Both of these organisms were transformed by selected prototrophic strains of Micrococcus lysodeikticus, M. flavocyaneus, S. flava and Sarcina lutea.
The feasibility of direct thin strip casting of various steel grades for
further metallic coating has been investigated. The surface evolution
is described for each processing step. Special attention to steel
cleanliness and scale formation was given, since local surface
heterogeneities of grain structure and chemical composition may
disturb the coating process. Low alloyed cast strip can be coated
with little to none difference to classical coating routes, however,
some highly alloyed steel grades require further optimization.
Blair equates the constructs of working memory (WM), executive function, and general fluid intelligence (gF). We argue that there is good reason not to equate these constructs. We view WM and gF as separable but highly related, and suggest that the mechanism behind the relationship is controlled attention – an ability that is dependent on normal functioning of the prefrontal cortex.
The idea that short-term memory is an important component of intelligence is not new. For example, over a century ago, James (1890) wrote, “All the intellectual value for us of a state of mind depends on our after memory of it. Only then is it combined in a system and knowingly made to contribute to a result. Only then does it count for us.” Around the same time, Binet (1905) included a test of short-term memory in a test battery designed to identify learning disabled children in the Paris school system. And more recently, short-term memory has been conceptualized as a fundamental component of human cognition. For example, Miller (1956) famously proposed that the capacity of short-term memory is limited to 7 ± 2 bits of information. Later, Atkinson and Shiffrin (1968) incorporated this idea of a central bottleneck in information processing into their “modal” model of memory.
Nevertheless, the extent to which short-term memory plays an important role in higher-level cognition — intelligence manifested in complex cognitive activities like reasoning and learning — has been a topic of considerable debate in cognitive psychology. Consider, for example, the results of a series of experiments by Baddeley and Hitch (1974). The surprising finding in these experiments was that a secondary task designed to tax short-term memory had little or no effect on a variety of reasoning, comprehension, and memory primary tasks.
Due to their extremely small luminosity compared to the stars they orbit, planets outside our own Solar System are extraordinarily difficult to detect directly in optical light. Careful photometric monitoring of distant stars, however, can reveal the presence of exoplanets via the microlensing or eclipsing effects they induce. The international PLANET collaboration is performing such monitoring using a cadre of semi-dedicated telescopes around the world. Their results constrain the number of gas giants orbiting 1–7 AU from the most typical stars in the Galaxy. Upgrades in the program are opening regions of “exoplanet discovery space” – toward smaller masses and larger orbital radii – that are inaccessible to the Doppler velocity technique.
The phenomenon of dynamic embrittlement involves the stress-induced diffusion of a surface- adsorbed embrittling element into grain boundaries, leading to time-dependent decohesion along these boundaries. Here, the state of our understanding of this generic type of brittle fracture is reviewed, with the focus on cracking of nickel-base superalloys caused by oxygen, including recent and new results on cracking in bicrystals, thermo-mechanical processing to reduce the susceptibility to dynamic embrittlement, and quench cracking.
The Sangro Valley Project was established in 1994 by John Lloyd, Neil Christie and Amalia Faustoferri. Its aim was to study anthropogenic change in society, economy and settlement between the Bronze Age and the Middle Ages, within the context of a Mediterranean river valley system (see Lloyd et al. 1997; Lloyd & Faustoferri 1998). Part of this research has integrated field survey between the Sangro river and Monte Pallano with excavations conducted by the Soprintendenza on the mountain itself. Monte Pallano is best known for its fine megalithic walls (Oakely 1995: 84-7), marking a putative oppidum site. Recent Italian excavations [with Anglo-American support] have aimed at clarifying the situation at a substantial public buildinghilla complex on the mountain. This work has been fruitful in its initial phases; much, however, remains to be done.
We review the current status and future prospects of the PLANET collaboration, an international team of astronomers performing high-precision photometric monitoring of microlensing events. Our photometric precision and sampling is characterised and the suitability of the database for variable star studies is discussed. Preliminary results on K-giant stability are presented.
Working memory is a system consisting of those long-term memory traces active above threshold, the procedures and skills necessary to achieve and maintain that activation, and limited-capacity, controlled attention. The specific features of our model include:
(2) Domain-specific codes and maintenance (phonological loop and visuospatial sketchpad are two examples but the potential number of such codes is large).
(3) Individual differences in both 1 and 2, but individual differences in capacity for controlled processing are general and possibly the mechanism for general fluid intelligence. Although people can, with practice and expertise, circumvent the abiding limitations of controlled attention in quite specific situations, the limitations reemerge in novel situations and even in the domain of expertise if the situation calls for controlled processing.
(4) Limited-capacity, controlled processing is required for maintaining temporary goals in the face of distraction and interference and for blocking, gating, and/or suppressing distracting events.
(5) The dorsolateral prefrontal cortex (PFC) and associated structures mediate the controlled processing functions of working memory. We also argue that individual differences in controlled processing represent differences in functioning of the PFC.
A number of intellectual influences have served to shape our thinking about working memory (WM) and its evolution as a construct separate from that of short-term memory (STM).
Individuals may differ in the general-attention executive
component or in the subordinate domain-specific “slave”
components of working memory. Tasks requiring sustained memory
representations across attention shifts are reliable, valid indices of
executive abilities. Measures emphasizing specific processing skills
may increase reliability within restricted samples but will not
reflect the attention component responsible for the broad
predictive validity of span tasks.