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It remains unclear which individuals with subthreshold depression benefit most from psychological intervention, and what long-term effects this has on symptom deterioration, response and remission.
Aims
To synthesise psychological intervention benefits in adults with subthreshold depression up to 2 years, and explore participant-level effect-modifiers.
Method
Randomised trials comparing psychological intervention with inactive control were identified via systematic search. Authors were contacted to obtain individual participant data (IPD), analysed using Bayesian one-stage meta-analysis. Treatment–covariate interactions were added to examine moderators. Hierarchical-additive models were used to explore treatment benefits conditional on baseline Patient Health Questionnaire 9 (PHQ-9) values.
Results
IPD of 10 671 individuals (50 studies) could be included. We found significant effects on depressive symptom severity up to 12 months (standardised mean-difference [s.m.d.] = −0.48 to −0.27). Effects could not be ascertained up to 24 months (s.m.d. = −0.18). Similar findings emerged for 50% symptom reduction (relative risk = 1.27–2.79), reliable improvement (relative risk = 1.38–3.17), deterioration (relative risk = 0.67–0.54) and close-to-symptom-free status (relative risk = 1.41–2.80). Among participant-level moderators, only initial depression and anxiety severity were highly credible (P > 0.99). Predicted treatment benefits decreased with lower symptom severity but remained minimally important even for very mild symptoms (s.m.d. = −0.33 for PHQ-9 = 5).
Conclusions
Psychological intervention reduces the symptom burden in individuals with subthreshold depression up to 1 year, and protects against symptom deterioration. Benefits up to 2 years are less certain. We find strong support for intervention in subthreshold depression, particularly with PHQ-9 scores ≥ 10. For very mild symptoms, scalable treatments could be an attractive option.
An assessment of systemic inflammation and nutritional status may form the basis of a framework to examine the prognostic value of cachexia in patients with advanced cancer. The objective of the study was to examine the prognostic value of the Global Leadership Initiative on Malnutrition criteria, including BMI, weight loss (WL) and systemic inflammation (as measured by the modified Glasgow Prognostic Score (mGPS)), in advanced cancer patients. Three criteria were examined in a combined cohort of patients with advanced cancer, and their relationship with survival was examined using Cox regression methods. Data were available on 1303 patients. Considering BMI and the mGPS, the 3-month survival rate varied from 74 % (BMI > 28 kg/m2) to 61 % (BMI < 20 kg/m2) and from 84 % (mGPS 0) to 60 % (mGPS 2). Considering WL and the mGPS, the 3-month survival rate varied from 81 % (WL ± 2·4 %) to 47 % (WL ≥ 15 %) and from 93 % (mGPS 0) to 60 % (mGPS 2). Considering BMI/WL grade and mGPS, the 3-month survival rate varied from 86 % (BMI/WL grade 0) to 59 % (BMI/WL grade 4) and from 93 % (mGPS 0) to 63 % (mGPS 2). When these criteria were combined, they better predicted survival. On multivariate survival analysis, the most highly predictive factors were BMI/WL grade 3 (HR 1·454, P = 0·004), BMI/WL grade 4 (HR 2·285, P < 0·001) and mGPS 1 and 2 (HR 1·889, HR 2·545, all P < 0·001). In summary, a high BMI/WL grade and a high mGPS as outlined in the BMI/WL grade/mGPS framework were consistently associated with poorer survival of patients with advanced cancer. It can be readily incorporated into the routine assessment of patients.
In addition to the type species, Binkhorstia ubaghsii, which is fairly common in the upper part of the Nekum Member (Maastricht Formation) in the wider vicinity of Maastricht (the Netherlands) and Binkhorstia euglypha, which appears to be restricted to the overlying Meerssen Member of the same formation (uppermost Maastrichtian), a third member, B. desaegheri nov. sp., is recorded from the upper middle Santonian of the Campine area in north-east Belgium. The history of Binkhorstia is convoluted, serving as a prime example of how attempts to unravel the higher-level taxonomic position of late Mesozoic crabs may prove difficult. Over time, the genus has been referred to various families or subfamilies, either podotreme or putative eubrachyuran; here the new family Binkhorstiidae is placed in the superfamily Retroplumoidea. Binkhorstiids appear to have been a relatively short-lived endemic group that fell victim to Cretaceous‒Paleogene (K/Pg) boundary perturbations.
In response to the COVID-19 pandemic, we rapidly implemented a plasma coordination center, within two months, to support transfusion for two outpatient randomized controlled trials. The center design was based on an investigational drug services model and a Food and Drug Administration-compliant database to manage blood product inventory and trial safety.
Methods:
A core investigational team adapted a cloud-based platform to randomize patient assignments and track inventory distribution of control plasma and high-titer COVID-19 convalescent plasma of different blood groups from 29 donor collection centers directly to blood banks serving 26 transfusion sites.
Results:
We performed 1,351 transfusions in 16 months. The transparency of the digital inventory at each site was critical to facilitate qualification, randomization, and overnight shipments of blood group-compatible plasma for transfusions into trial participants. While inventory challenges were heightened with COVID-19 convalescent plasma, the cloud-based system, and the flexible approach of the plasma coordination center staff across the blood bank network enabled decentralized procurement and distribution of investigational products to maintain inventory thresholds and overcome local supply chain restraints at the sites.
Conclusion:
The rapid creation of a plasma coordination center for outpatient transfusions is infrequent in the academic setting. Distributing more than 3,100 plasma units to blood banks charged with managing investigational inventory across the U.S. in a decentralized manner posed operational and regulatory challenges while providing opportunities for the plasma coordination center to contribute to research of global importance. This program can serve as a template in subsequent public health emergencies.
The New Jersey Kids Study (NJKS) is a transdisciplinary statewide initiative to understand influences on child health, development, and disease. We conducted a mixed-methods study of project planning teams to investigate team effectiveness and relationships between team dynamics and quality of deliverables.
Methods:
Ten theme-based working groups (WGs) (e.g., Neurodevelopment, Nutrition) informed protocol development and submitted final reports. WG members (n = 79, 75%) completed questionnaires including de-identified demographic and professional information and a modified TeamSTEPPS Team Assessment Questionnaire (TAQ). Reviewers independently evaluated final reports using a standardized tool. We analyzed questionnaire results and final report assessments using linear regression and performed constant comparative qualitative analysis to identify central themes.
Results:
WG-level factors associated with greater team effectiveness included proportion of full professors (β = 31.24, 95% CI 27.65–34.82), team size (β = 0.81, 95% CI 0.70–0.92), and percent dedicated research effort (β = 0.11, 95% CI 0.09–0.13); age distribution (β = −2.67, 95% CI –3.00 to –2.38) and diversity of school affiliations (β = –33.32, 95% CI –36.84 to –29.80) were inversely associated with team effectiveness. No factors were associated with final report assessments. Perceptions of overall initiative leadership were associated with expressed enthusiasm for future NJKS participation. Qualitative analyses of final reports yielded four themes related to team science practices: organization and process, collaboration, task delegation, and decision-making patterns.
Conclusions:
We identified several correlates of team effectiveness in a team science initiative's early planning phase. Extra effort may be needed to bridge differences in team members' backgrounds to enhance the effectiveness of diverse teams. This work also highlights leadership as an important component in future investigator engagement.
The use of older data and references is becoming increasingly disfavored for publication. A myopic focus on newer research risks losing sight of important research questions already addressed by now-invisible older studies. This creates a ‘Groundhog Day’ effect as illustrated by the 1993 movie of this name in which the protagonist has to relive the same day (Groundhog Day) over and over and over within a world with no memory of it. This article examines the consequences of the recent preference for newer data and references in current publication practices and is intended to stimulate new consideration of the utility of selected older data and references for the advancement of scientific knowledge.
Methods
Examples from the literature are used to exemplify the value of older data and older references. To illustrate the recency of references published in original medical research articles in a selected sample of recent academic medical journals, original research articles were examined in recent issues in selected psychiatry, medicine, and surgery journals.
Results
The literature examined reflected this article's initial assertion that journals are emphasizing the publication of research with newer data and more recent references.
Conclusions
The current valuation of newer data above older data fails to appreciate the fact that new data eventually become old, and that old data were once new. The bias demonstrated in arbitrary policies pertaining to older data and older references can be addressed by instituting comparable treatment of older and newer data and references.
Inflammation may contribute to the high prevalence of depressive symptoms seen in lung cancer. “Sickness behavior” is a cluster of symptoms induced by inflammation that are similar but distinct from depressive symptoms. The Sickness Behavior Inventory-Revised (SBI-R) was developed to measure sickness behavior. We hypothesized that the SBI-R would demonstrate adequate psychometric properties in association with inflammation.
Method
Participants with stage IV lung cancer (n = 92) were evaluated for sickness behavior using the SBI-R. Concomitant assessments were made of depression (Patient Hospital Questionniare-9, Hospital Anxiety and Depression Scale) and inflammation [C-reactive protein (CRP)]. Classical test theory (CTT) was applied and multivariate models were created to explain SBI-R associations with depression and inflammation. Factor Analysis was also used to identify the underlying factor structure of the hypothesized construct of sickness behavior. A longitudinal analysis was conducted for a subset of participants.
Results
The sample mean for the 12-item SBI-R was 8.3 (6.7) with a range from 0 to 33. The SBI-R demonstrated adequate internal consistency with a Cronbach's coefficient of 0.85, which did not increase by more than 0.01 with any single-item removal. This analysis examined factor loadings onto a single factor extracted using the principle components method. Eleven items had factor loadings that exceeded 0.40. SBI-R total scores were significantly correlated with depressive symptoms (r = 0.78, p < 0.001) and CRP (r = 0.47, p < 0.001). Multivariate analyses revealed that inflammation and depressive symptoms explained 67% of SBI-R variance.
Significance of results
The SBI-R demonstrated adequate reliability and construct validity in this patient population with metastatic lung cancer. The observed findings suggest that the SBI-R can meaningfully capture the presence of sickness behavior and may facilitate a greater understanding of inflammatory depression.
Precise instrumental calibration is of crucial importance to 21-cm cosmology experiments. The Murchison Widefield Array’s (MWA) Phase II compact configuration offers us opportunities for both redundant calibration and sky-based calibration algorithms; using the two in tandem is a potential approach to mitigate calibration errors caused by inaccurate sky models. The MWA Epoch of Reionization (EoR) experiment targets three patches of the sky (dubbed EoR0, EoR1, and EoR2) with deep observations. Previous work in Li et al. (2018) and (2019) studied the effect of tandem calibration on the EoR0 field and found that it yielded no significant improvement in the power spectrum (PS) over sky-based calibration alone. In this work, we apply similar techniques to the EoR1 field and find a distinct result: the improvements in the PS from tandem calibration are significant. To understand this result, we analyse both the calibration solutions themselves and the effects on the PS over three nights of EoR1 observations. We conclude that the presence of the bright radio galaxy Fornax A in EoR1 degrades the performance of sky-based calibration, which in turn enables redundant calibration to have a larger impact. These results suggest that redundant calibration can indeed mitigate some level of model incompleteness error.
In 2017, transgender woman Danica Roem stunned political observers in Virginia by unseating a long-time anti-LGBTQ legislator from a conservative district in the Virginia House of Delegates.1 She was the first openly transgender person elected and seated to a state legislature. Delegate Roem’s election was historic in LGBTQ political representation, but it also occurred in a period when backlash against the LGBTQ community seemed to be growing (Taylor, Lewis, and Haider-Markel 2018). These two threads led us to ask: How are LGBTQ candidates achieving historic successes even as forces seem mobilized against them?
Tourette syndrome (TS) is a neurodevelopmental disorder characterized by the hyperkinetic movements of motor and phonic tics manifested in young age. Currently approved treatments in the United States are antipsychotics: haloperidol, pimozide, and aripiprazole, which are associated with serious side effects, including tardive dyskinesia (TD). Deutetrabenazine, a vesicular monoamine transporter type 2 (VMAT2) inhibitor, was approved in 2017 by the US FDA for the treatment of chorea associated with Huntington’s disease and TD. Three ongoing studies (Alternatives for Reducing Tics in TS [ARTISTS]) are evaluating the efficacy, safety, and tolerability of deutetrabenazine in reducing tics in TS in children and adolescents (age 6-16 years).
Methods:
ARTISTS 1, a phase 2/3, response-driven, dose-titration, placebo-controlled study, randomizes patients (N=116) 1:1 to deutetrabenazine or placebo for 12 weeks. ARTISTS 2, a phase 3, fixed-dose study, randomizes patients (N=150) 1:1:1 to deutetrabenazine high or low dose, or placebo for 8 weeks. The primary efficacy outcome in these pivotal studies is change from baseline to end of treatment in the Total Tic Score (TTS) of the Yale Global Tic Severity Scale (YGTSS). Additional efficacy endpoints and safety/tolerability are also evaluated. ARTISTS is a 56-week, open-label, single-arm, long-term safety/tolerability study in patients who have successfully completed either ARTISTS 1 or ARTISTS 2.
Results:
Not available yet.
Conclusion:
TS can have potentially long-term life impact, and there remains unmet medical need for effective and well-tolerated treatments. Three ARTISTS studies will evaluate the efficacy, safety, and tolerability of deutetrabenazine in patients with tics in TS.
Funding Acknowledgements:
The studies are sponsored by Teva Pharmaceuticals and operationalized by Teva’s development partner, Nuvelution TS Pharma INC.
This study investigated the characteristics of subjective memory complaints (SMCs) and their association with current and future cognitive functions.
Methods:
A cohort of 209 community-dwelling individuals without dementia aged 47–90 years old was recruited for this 3-year study. Participants underwent neuropsychological and clinical assessments annually. Participants were divided into SMCs and non-memory complainers (NMCs) using a single question at baseline and a memory complaints questionnaire following baseline, to evaluate differential patterns of complaints. In addition, comprehensive assessment of memory complaints was undertaken to evaluate whether severity and consistency of complaints differentially predicted cognitive function.
Results:
SMC and NMC individuals were significantly different on various features of SMCs. Greater overall severity (but not consistency) of complaints was significantly associated with current and future cognitive functioning.
Conclusions:
SMC individuals present distinctive features of memory complaints as compared to NMCs. Further, the severity of complaints was a significant predictor of future cognition. However, SMC did not significantly predict change over time in this sample. These findings warrant further research into the specific features of SMCs that may portend subsequent neuropathological and cognitive changes when screening individuals at increased future risk of dementia.
Three corn root bioassays were evaluated for detecting imazaquin in soil. Two techniques, one which utilized a cone-shaped tube as the growth container and another, a petri dish, were compared to a method that utilized a thin layer of soil between two 20 by 20 cm glass plates. Corn root growth responded logarithmically to imazaquin regardless of bioassay method. Corn was most sensitive to low imazaquin concentrations when grown using the glass plate apparatus. At a low concentration (0.5 ng/g) of imazaquin, corn root length was reduced 6% using the cone-tube, 2% using the petri dish, and 24% using the glass plate method. In contrast, the cone-tube method provided a better measure of high imazaquin concentration (200 ng/g) than the other methods.
Studies were conducted in Florida to evaluate interference of common cocklebur with peanut. Peanut yield reduction ranged from 0 to 88% for common cocklebur densities of 0–32 plants 8 m−1 of peanut row, and predicted loss was similar under normal moisture conditions. When moisture levels were above normal, the impact on yield was 9–24% less than when soil moisture was normal. Common cocklebur caused peanut yield loss if allowed to interfere for more than the first 2 wk after crop emergence, and peanut had to be common cocklebur free for at least 12 wk to prevent a yield reduction. These results show common cocklebur to be more competitive with peanut than other weeds evaluated previously.
In field experiments conducted near Marianna, Trenton, and Archer, FL in 1990 and 1991, nicosulfuron applied 55 weeks after planting (WAP) at 18, 27, 36, or 54 g ai/ha injured peanut initially. When applied 7 WAP, only the two higher nicosulfuron rates injured peanut more than 10%. By 6 wk after application, crop injury was less than 8% for all treatments, except the highest (54 g/ha) rate. Nicosulfuron applied 5 or 7 WAP at 54 g/ha reduced peanut yield and sound mature kernels.
Field experiments conducted in Marianna, Trenton, and Archer, FL in 1990 and 1991 investigated the effect of time of application of nicosulfuron and nicosulfuron mixtures on ‘Sunrunner’ peanut. Nicosulfuron was applied alone at 36 g ai/ha and in mixture with acifluorfen, bentazon, chlorimuron, chlorothalonil, fluazifop-P, imazethapyr, lactofen, or pyridate at 5, 7, or 9 weeks after planting (WAP). Applying nicosulfuron with chlorimuron, pyridate, or imazethapyr increased visible peanut injury and reduced yields more than nicosulfuron alone. Conversely, nicosulfuron applied with acifluorfen or lactofen was less injurious than nicosulfuron applied alone. Bentazon, chlorothalonil, and fluazifop-P generally did not influence phytotoxicity from nicosulfuron. Peanut tolerance to nicosulfuron increased with age.
Field experiments were conducted near Marianna, Trenton, and Archer, FL in 1990 and 1991 to investigate the effect of nicosulfuron mixtures and time of application on five peanut cultivars. Nicosulfuron at 54 g ai/ha was applied alone or in mixture with 2,4-DB at 280 g ai/ha 5 weeks after planting (WAP), 9 WAP, or 5 plus 9 WAP. Injury was greater from early and sequential nicosulfuron applications while a single application 9 WAP typically did not cause significant injury or reduce peanut yield. The 5 WAP and 5 plus 9 WAP applications often caused early visible injury and sometimes reduced peanut yield. When peanut yields were compared, ‘Florigiant’ was the most sensitive cultivar while ‘Southern Runner’ and ‘Valencia’ were more tolerant to nicosulfuron. ‘Sunrunner’ and ‘NC-7’ were intermediate in tolerance to nicosulfuron. In several instances, the addition of 2,4-DB to nicosulfuron reduced initial crop injury and ameliorated yield losses resulting from nicosulfuron applied alone.
In field studies effective dogfennel control was obtained with glyphosate, dicamba + 2,4-D, triclopyr + 2,4-D, and fluroxypyr at rates of 1.68, 0.44 + 1.25, 0.56 + 1.12, and 0.28 kg ai/ha, respectively, applied after dogfennel was 75 cm tall. Mowing alone reduced dogfennel regrowth by 81% and when combined with dicamba + 2,4-D or triclopyr + 2,4-D regrowth was reduced over 94%. Triclopyr, dichlorprop, and sulfometuron also controlled dogfennel greater than 90% but metsulfuron did not.
Field experiments were conducted at Jay and Marianna, FL in 1988 and 1989 to determine the effects of sicklepod, Florida beggarweed, and common cocklebur density on chlorothalonil deposition to peanut foliage, peanut foliar disease incidence, and peanut yield. At a density of four weed plants per 8 m of row, Florida beggarweed and sicklepod reduced chlorothalonil deposition on peanut foliage by 20%, while common cocklebur reduced fungicide deposition by 34%. At the same density, incidence of the foliar diseases early leaf spot and late leaf spot increased 10% with Florida beggarweed, 14% with sicklepod, and 20% with common cocklebur compared with weed-free peanut. The predicted peanut yield loss from a weed density of four plants per 8 m was 16 to 19% for Florida beggarweed, 23 to 25% for sicklepod, and 31 to 39% for common cocklebur. Weed biomass increased with increasing weed density.