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Remitted psychotic depression (MDDPsy) has heterogeneity of outcome. The study's aims were to identify subgroups of persons with remitted MDDPsy with distinct trajectories of depression severity during continuation treatment and to detect predictors of membership to the worsening trajectory.
One hundred and twenty-six persons aged 18–85 years participated in a 36-week randomized placebo-controlled trial (RCT) that examined the clinical effects of continuing olanzapine once an episode of MDDPsy had remitted with sertraline plus olanzapine. Latent class mixed modeling was used to identify subgroups of participants with distinct trajectories of depression severity during the RCT. Machine learning was used to predict membership to the trajectories based on participant pre-trajectory characteristics.
Seventy-one (56.3%) participants belonged to a subgroup with a stable trajectory of depression scores and 55 (43.7%) belonged to a subgroup with a worsening trajectory. A random forest model with high prediction accuracy (AUC of 0.812) found that the strongest predictors of membership to the worsening subgroup were residual depression symptoms at onset of remission, followed by anxiety score at RCT baseline and age of onset of the first lifetime depressive episode. In a logistic regression model that examined depression score at onset of remission as the only predictor variable, the AUC (0.778) was close to that of the machine learning model.
Residual depression at onset of remission has high accuracy in predicting membership to worsening outcome of remitted MDDPsy. Research is needed to determine how best to optimize the outcome of psychotic MDDPsy with residual symptoms.
Metabolites produced by microbial fermentation in the human intestine, especially short-chain fatty acids (SCFAs), are known to play important roles in colonic and systemic health. Our aim here was to advance our understanding of how and why their concentrations and proportions vary between individuals. We have analysed faecal concentrations of microbial fermentation acids from 10 human volunteer studies, involving 163 subjects, conducted at the Rowett Institute, Aberdeen, UK over a 7-year period. In baseline samples, the % butyrate was significantly higher, whilst % iso-butyrate and % iso-valerate were significantly lower, with increasing total SCFA concentration. The decreasing proportions of iso-butyrate and iso-valerate, derived from amino acid fermentation, suggest that fibre intake was mainly responsible for increased SCFA concentrations. We propose that the increase in % butyrate among faecal SCFA is largely driven by a decrease in colonic pH resulting from higher SCFA concentrations. Consistent with this, both total SCFA and % butyrate increased significantly with decreasing pH across five studies for which faecal pH measurements were available. Colonic pH influences butyrate production through altering the stoichiometry of butyrate formation by butyrate-producing species, resulting in increased acetate uptake and butyrate formation, and facilitating increased relative abundance of butyrate-producing species (notably Roseburia and Eubacterium rectale).
Little is known about the relationship between psychomotor disturbance (PMD) and treatment outcome of psychotic depression. This study examined the association between PMD and subsequent remission and relapse of treated psychotic depression.
Two hundred and sixty-nine men and women aged 18–85 years with an episode of psychotic depression were treated with open-label sertraline plus olanzapine for up to 12 weeks. Participants who remained in remission or near-remission following an 8-week stabilization phase were eligible to participate in a 36-week randomized controlled trial (RCT) that compared the efficacy and tolerability of sertraline plus olanzapine (n = 64) with sertraline plus placebo (n = 62). PMD was measured with the psychiatrist-rated sign-based CORE at acute phase baseline and at RCT baseline. Spearman's correlations and logistic regression analyses were used to analyze the association between CORE total score at acute phase baseline and remission/near-remission and CORE total score at RCT baseline and relapse.
Higher CORE total score at acute phase baseline was associated with lower frequency of remission/near-remission. Higher CORE total score at RCT baseline was associated with higher frequency of relapse, in the RCT sample as a whole, as well as in each of the two randomized groups.
PMD is associated with poorer outcome of psychotic depression treated with sertraline plus olanzapine. Future research needs to examine the neurobiology of PMD in psychotic depression in relation to treatment outcome.
rTMS is an emerging treatment for major depressive disorder (MDD) refractory to medications and psychotherapy. The conventional target for rTMS in MDD is the dorsolateral prefrontal cortex (DLPFC). However, convergent evidence from lesion, stimulation, and neuroimaging studies suggests that the dorsomedial prefrontal cortex (DMPFC) may play a more central role in emotion regulation. We have recently demonstrated robust and potentially superior antidepressant properties for excitatory rTMS of the DMPFC. However, one of the enduring limitations of rTMS is the long duration of each treatment session under conventional protocols, which require ~40 minutes per day over 20-30 sessions for maximum efficacy using conventional 10 Hz stimulation. More recent studies have suggested that theta-burst stimulation (TBS) protocols can achieve stronger and more durable effects in markedly less time. Intermittent theta-burst stimulation (iTBS) generates robust and long-lasting excitatory effects with 600 pulses over ~3 min. Pilot studies have previously reported antidepressant effects with TBS over the DLPFC. However, TBS over the DMPFC has not previously been studied. Here we report robust antidepressant effects for a 7 min course of iTBS, administered bilaterally over the DMPFC with MRI-guidance at 120% resting motor threshold, over 20-30 sessions, in an open-label series of 40 patients with refractory MDD. Safety, efficacy, and tolerability are comparable to a 10 Hz rTMS protocol requiring 30-40 min of treatment. iTBS of the DMPFC may effectively reduce the duration (and cost) of rTMS >4-fold, thus increasing patient capacity per clinic and improving the overall accessibility of rTMS in refractory MDD.
Salmonella enterica serovar Wangata (S. Wangata) is an important cause of endemic salmonellosis in Australia, with human infections occurring from undefined sources. This investigation sought to examine possible environmental and zoonotic sources for human infections with S. Wangata in north-eastern New South Wales (NSW), Australia. The investigation adopted a One Health approach and was comprised of three complimentary components: a case–control study examining human risk factors; environmental and animal sampling; and genomic analysis of human, animal and environmental isolates. Forty-eight human S. Wangata cases were interviewed during a 6-month period from November 2016 to April 2017, together with 55 Salmonella Typhimurium (S. Typhimurium) controls and 130 neighbourhood controls. Indirect contact with bats/flying foxes (S. Typhimurium controls (adjusted odds ratio (aOR) 2.63, 95% confidence interval (CI) 1.06–6.48)) (neighbourhood controls (aOR 8.33, 95% CI 2.58–26.83)), wild frogs (aOR 3.65, 95% CI 1.32–10.07) and wild birds (aOR 6.93, 95% CI 2.29–21.00) were statistically associated with illness in multivariable analyses. S. Wangata was detected in dog faeces, wildlife scats and a compost specimen collected from the outdoor environments of cases’ residences. In addition, S. Wangata was detected in the faeces of wild birds and sea turtles in the investigation area. Genomic analysis revealed that S. Wangata isolates were relatively clonal. Our findings suggest that S. Wangata is present in the environment and may have a reservoir in wildlife populations in north-eastern NSW. Further investigation is required to better understand the occurrence of Salmonella in wildlife groups and to identify possible transmission pathways for human infections.
Unhealthy food and drink consumption is associated with a range of physical and mental health concerns. In response, public health policies have been developed targeting a reduction in obesity in particular. In the present commentary we argue that government–industry partnerships have reduced the effectiveness of resultant policies and explore why.
Perspectives of authors.
Populations in the UK; UK Government.
Industry involvement has presented three interrelated challenges for the UK Government: (i) balancing collaboration while maintaining appropriate distance from industry stakeholders; (ii) resultant production of ‘watertight’ and effective legislation or intervention; and (iii) actual or perceived limited sanctioning or bargaining power.
Industry involvement in public health policy making has led to weak action. Support with policy implementation (rather than development) and genuine ‘buy-in’ from industry could accelerate the pace of public health improvement.
An emerging recombinant norovirus GII.P16/GII.4 Sydney 2012 strain caused a gastroenteritis outbreak amongst attendees at a large health function in regional New South Wales, Australia. This was the third outbreak caused by the recombinant GII.P16/GII.4 Sydney 2012 strain in this region in 2017, which appears to be emerging as a common strain in the Hunter New England region.
Previous studies have demonstrated that several major psychiatric disorders are influenced by shared genetic factors. This shared liability may influence clinical features of a given disorder (e.g. severity, age at onset). However, findings have largely been limited to European samples; little is known about the consistency of shared genetic liability across ethnicities.
The relationship between polygenic risk for several major psychiatric diagnoses and major depressive disorder (MDD) was examined in a sample of unrelated Han Chinese women. Polygenic risk scores (PRSs) were generated using European discovery samples and tested in the China, Oxford, and VCU Experimental Research on Genetic Epidemiology [CONVERGE (maximum N = 10 502)], a sample ascertained for recurrent MDD. Genetic correlations between discovery phenotypes and MDD were also assessed. In addition, within-case characteristics were examined.
European-based polygenic risk for several major psychiatric disorder phenotypes was significantly associated with the MDD case status in CONVERGE. Risk for clinically significant indicators (neuroticism and subjective well-being) was also associated with case–control status. The variance accounted for by PRS for both psychopathology and for well-being was similar to estimates reported for within-ethnicity comparisons in European samples. However, European-based PRS were largely unassociated with CONVERGE family history, clinical characteristics, or comorbidity.
The shared genetic liability across severe forms of psychopathology is largely consistent across European and Han Chinese ethnicities, with little attenuation of genetic signal relative to within-ethnicity analyses. The overall absence of associations between PRS for other disorders and within-MDD variation suggests that clinical characteristics of MDD may arise due to contributions from ethnicity-specific factors and/or pathoplasticity.
The vapor pressures of the four most common commercial low-volatile esters and a reference high-volatile ester of 2,4-dichlorophenoxyacetic acid (2,4-D) were determined by gas-liquid chromatography. The order of increasing volatility and the vapor pressure of these esters in mm of Hg at 187 C are as follows: isooctyl—2.7; 2-ethylhexyl—3.0; butoxy ethanol—3.9; propylene glycol butyl ether—3.9; and the reference, isopropyl—16.7. Extrapolations to 25 C support this ranking at working temperatures. Commercial esters of 2,4-D derived from long-chain hydrocarbon alcohols are in the same volatility range as the commercial esters containing an ether linkage.
Prior research consistently demonstrates that neuroticism increases risk for suicidal ideation, but the association between neuroticism and suicidal behavior has been inconsistent. Whereas neuroticism is recommended as an endophenotype for suicidality, the association of neuroticism with attempted suicide warrants clarification. In particular, prior research has not distinguished between correlates of attempted suicide, correlates of suicidal ideation, and correlates of comorbid psychopathology.
The present study used the CONVERGE study, a sample of 5864 women with major depressive disorder (MD) and 5783 women without MD throughout China. Diagnoses, suicidal ideation, and attempted suicide were assessed with the Composite International Diagnostic Interview (CIDI). Neuroticism was assessed with the neuroticism portion of the Eysenck Personality Questionnaire.
Results replicate prior findings on the correlates of suicidal ideation, particularly elevated neuroticism among individuals who report prior suicidal ideation. Moreover, as compared with individuals who reported having experienced only suicidal ideation, neuroticism was associated with decreased likelihood of having attempted suicide.
The association of neuroticism with suicidality is more complicated than has been previously described. Whereas neuroticism increases risk for suicidal ideation, neuroticism may decrease risk for a suicide attempt among individuals with suicidal ideation. These results have implications for the assessment of risk for a suicide attempt among individuals who report suicidal ideation and addresses prior discordant findings by clarifying the association between neuroticism and attempted suicide.
Organic agricultural systems increase the complexity of weed management, leading organic farmers to cite weeds as one of the greatest barriers to organic production. Integrated Weed Management (IWM) systems have been developed to address the ecological implications of weeds and weed management in cropping systems, but adoption is minimal. Organic agriculture offers a favorable context for application of IWM, as both approaches are motivated by concern for environmental quality and agricultural sustainability. However, adoption of IWM on organic farms is poorly understood due to limited data on weed management practices used, absence of an IWM adoption metric, and insufficient consideration given to the unique farming contexts within which weed management decisions are made. Therefore, this study aimed to (1) characterize organic weed management systems; (2) identify motivations for, and barriers to, selection of weed management practices; and (3) generate guiding principles for effective targeting of weed management outreach. We surveyed Midwestern organic growers to determine how specified psychosocial, demographic, and farm structure factors influence selection of weed management practices. Cluster analysis of the data detected three disparate, yet scaled, approaches to organic weed management. Clusters were distinguished by perspective regarding weeds and the number of weed management practices used. Categorization of individual farms within the identified approaches was influenced by primary farm products as well as farmer education, years farming, and information-seeking behavior. The proposed conceptual model allows weed management educators to target outreach for enhanced compatibility of farming contexts and weed management technologies.
The focus of the present paper is to examine the strategy use in Australian small and medium enterprises exporting to Asia. A selection of strategic issues is examined in order to identify their relative importance to a firm's exporting activities. No attempt is made to establish a causal linkage between strategy and export performance. Rather, the paper attempts to appraise the level of importance of various strategic factors that are often dealt with by an exporting firm. The study was conducted with an expectation of assisting future research endeavours into the relevance of strategies to export-performance. A set of impediments and the extent of their negativity on the exporting activities have also been considered, the understanding of which may help a firm in achieving appropriate strategic direction. Both quantitative and qualitative research methods were used in an attempt to capture the intricacies and challenges of using strategies in a cross-cultural environment.
The walnut twig beetle (WTB), Pityophthorus juglandis Blackman (Coleoptera: Curculionidae), vectors a fungus, Geosmithia morbida Kolařík, Freeland, Utley, and Tisserat (Ascomycota: Hypocreales), which colonises and kills the phloem of walnut and butternut trees, Juglans Linnaeus (Juglandaceae). Over the past two decades, this condition, known as thousand cankers disease (TCD), has led to the widespread mortality of Juglans species in the United States of America. Recently the beetle and pathogen were discovered on several Juglans species in northern Italy. Little is known about the extra-generic extent of host acceptability and suitability for the WTB. We report the occurrence of both the WTB and G. morbida in three species of wingnut, Pterocarya fraxinifolia Spach, Pterocarya rhoifolia Siebold and Zuccarini, and Pterocarya stenoptera de Candolle (Juglandaceae) growing in the United States Department of Agriculture-Agricultural Research Service, National Clonal Germplasm Repository collection in northern California (NCGR) and in the Los Angeles County Arboretum and Botanic Garden in southern California, United States of America. In two instances (once in P. stenoptera and once in P. fraxinifolia) teneral (i.e., brood) adult WTB emerged and were collected more than four months after infested branch sections had been collected in the field. Koch’s postulates were satisfied with an isolate of G. morbida from P. stenoptera, confirming this fungus as the causal agent of TCD in this host. A survey of the 37 Pterocarya Kunth accessions at the NCGR revealed that 46% of the trees had WTB attacks and/or symptoms of G. morbida infection. The occurrence of other subcortical Coleoptera associated with Pterocarya and the first occurrence of the polyphagous shot hole borer, a species near Euwallacea fornicatus Eichhoff (Coleoptera: Curculionidae), in Juglans are also documented.
Do DSM-IV diagnostic criteria for major depression (MD) in Chinese and Western women perform in a similar manner?
The CONVERGE study included interview-based assessments of women of Han Chinese descent with treated recurrent MD. Using Mplus software, we investigated the overall degree of between-sample measurement invariance (MI) for DSM-IV diagnostic criteria for MD in the CONVERGE sample and samples selected from four major Western studies from the USA and Europe matched to the inclusion criteria of CONVERGE. These analyses were performed one pair at a time. We then compared the results from CONVERGE paired with Western samples to those obtained when examining levels of MI between pairs of the Western samples.
Assuming a single factor model for the nine diagnostic criteria for MD, the level of MI based on global fit indexes observed between the CONVERGE and the four Western samples was very similar to that seen between the Western samples. Comparable results were obtained when using a two-factor structure for MI testing when applied to the 14 diagnostic criteria for MD disaggregated for weight, appetite, sleep, and psychomotor changes.
Despite differences in language, ethnicity and culture, DSM criteria for MD perform similarly in Chinese women with recurrent MD and comparable subjects from the USA and Europe. The DSM criteria for MD may assess depressive symptoms that are relatively insensitive to cultural and ethnic differences. These results support efforts to compare findings from depressed patients in China and Western countries.
Treatment resistance is reported in up to 40% of older patients with major depression. Before labeling an episode of depression as treatment resistant, it is important to ensure that the diagnosis is correct and that the patient has received and adhered to an adequate dose of treatment for an appropriate length of time. It is also important to assess the patient for comorbid physical and psychiatric conditions that can contribute to treatment resistance. In patients who do not experience remission of symptoms with an adequate trial of medication, the following options can be considered: augmenting the antidepressant with a drug that is not primarily an antidepressant, adding a second antidepressant to the first, switching to a different antidepressant medication, or switching to electroconvulsive therapy. This paper reviews the concept of treatment-resistant depression and discusses its assessment and management in the elderly. The author concludes that when a systematic stepped-care approach to treatment is followed, most older patients with major depression will experience remission of symptoms.