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The effect of older age on outcomes of rTMS treatment for treatment-resistant depression
- Michael K. Leuchter, Cole Citrenbaum, Andrew C. Wilson, Tristan D. Tibbe, Nicholas J. Jackson, David E. Krantz, Scott A. Wilke, Juliana Corlier, Thomas B. Strouse, Gil D. Hoftman, Reza Tadayonnejad, Ralph J. Koek, Aaron R. Slan, Nathaniel D. Ginder, Margaret G. Distler, Hewa Artin, John H. Lee, Adesewa E. Adelekun, Evan H. Einstein, Hanadi A. Oughli, Andrew F. Leuchter
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- Journal:
- International Psychogeriatrics , First View
- Published online by Cambridge University Press:
- 25 March 2024, pp. 1-6
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Clinical outcomes of repetitive transcranial magnetic stimulation (rTMS) for treatment of treatment-resistant depression (TRD) vary widely and there is no mood rating scale that is standard for assessing rTMS outcome. It remains unclear whether TMS is as efficacious in older adults with late-life depression (LLD) compared to younger adults with major depressive disorder (MDD). This study examined the effect of age on outcomes of rTMS treatment of adults with TRD. Self-report and observer mood ratings were measured weekly in 687 subjects ages 16–100 years undergoing rTMS treatment using the Inventory of Depressive Symptomatology 30-item Self-Report (IDS-SR), Patient Health Questionnaire 9-item (PHQ), Profile of Mood States 30-item, and Hamilton Depression Rating Scale 17-item (HDRS). All rating scales detected significant improvement with treatment; response and remission rates varied by scale but not by age (response/remission ≥ 60: 38%–57%/25%–33%; <60: 32%–49%/18%–25%). Proportional hazards models showed early improvement predicted later improvement across ages, though early improvements in PHQ and HDRS were more predictive of remission in those < 60 years (relative to those ≥ 60) and greater baseline IDS burden was more predictive of non-remission in those ≥ 60 years (relative to those < 60). These results indicate there is no significant effect of age on treatment outcomes in rTMS for TRD, though rating instruments may differ in assessment of symptom burden between younger and older adults during treatment.
Repetitive transcranial magnetic stimulation treatment of major depressive disorder and comorbid chronic pain: response rates and neurophysiologic biomarkers
- Juliana Corlier, Reza Tadayonnejad, Andrew C Wilson, Jonathan C Lee, Katharine G Marder, Nathaniel D Ginder, Scott A Wilke, Jennifer Levitt, David Krantz, Andrew F Leuchter
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- Journal:
- Psychological Medicine / Volume 53 / Issue 3 / February 2023
- Published online by Cambridge University Press:
- 22 June 2021, pp. 823-832
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Background
Major depressive disorder (MDD) and chronic pain are highly comorbid, and pain symptoms are associated with a poorer response to antidepressant medication treatment. It is unclear whether comorbid pain also is associated with a poorer response to treatment with repetitive transcranial magnetic stimulation (rTMS).
Methods162 MDD subjects received 30 sessions of 10 Hz rTMS treatment administered to the left dorsolateral prefrontal cortex (DLPFC) with depression and pain symptoms measured before and after treatment. For a subset of 96 patients, a resting-state electroencephalogram (EEG) was recorded at baseline. Clinical outcome was compared between subjects with and without comorbid pain, and the relationships among outcome, pain severity, individual peak alpha frequency (PAF), and PAF phase-coherence in the EEG were examined.
Results64.8% of all subjects reported pain, and both depressive and pain symptoms were significantly reduced after rTMS treatment, irrespective of age or gender. Patients with severe pain were 27% less likely to respond to MDD treatment than pain-free individuals. PAF was positively associated with pain severity. PAF phase-coherence in the somatosensory and default mode networks was significantly lower for MDD subjects with pain who failed to respond to MDD treatment.
ConclusionsPain symptoms improved after rTMS to left DLPFC in MDD irrespective of age or gender, although the presence of chronic pain symptoms reduced the likelihood of treatment response. Individual PAF and baseline phase-coherence in the sensorimotor and midline regions may represent predictors of rTMS treatment outcome in comorbid pain and MDD.
Avoid the Goose! Paramedic Identification of Esophageal Intubation by Ultrasound
- Penelope C. Lema, Michael O’Brien, Juliana Wilson, Erika St. James, Heather Lindstrom, John DeAngelis, Jennifer Caldwell, Paul May, Brian Clemency
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- Journal:
- Prehospital and Disaster Medicine / Volume 33 / Issue 4 / August 2018
- Published online by Cambridge University Press:
- 21 August 2018, pp. 406-410
- Print publication:
- August 2018
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Objectives
Rapid identification of esophageal intubations is critical to avoid patient morbidity and mortality. Continuous waveform capnography remains the gold standard for endotracheal tube (ETT) confirmation, but it has limitations. Point-of-care ultrasound (POCUS) may be a useful alternative for confirming ETT placement. The objective of this study was to determine the accuracy of paramedic-performed POCUS identification of esophageal intubations with and without ETT manipulation.
MethodsA prospective, observational study using a cadaver model was conducted. Local paramedics were recruited as subjects and each completed a survey of their demographics, employment history, intubation experience, and prior POCUS training. Subjects participated in a didactic session in which they learned POCUS identification of ETT location. During each study session, investigators randomly placed an ETT in either the trachea or esophagus of four cadavers, confirmed with direct laryngoscopy. Subjects then attempted to determine position using POCUS both without and with manipulation of the ETT. Manipulation of the tube was performed by twisting the tube. Descriptive statistics and logistic regression were used to assess the results and the effects of previous paramedic experience.
ResultsDuring 12 study sessions, from March 2014 through December 2015, 57 subjects participated, evaluating a total of 228 intubations: 113 tracheal and 115 esophageal. Subjects were 84.0% male, mean age of 39 years (range: 22 - 62 years), with median experience of seven years (range: 0.6 - 39 years). Paramedics correctly identified ETT location in 158 (69.3%) cases without and 194 (85.1%) with ETT manipulation. The sensitivity and specificity of identifying esophageal location without ETT manipulation increased from 52.2% (95% confidence interval [CI], 43.0-61.0) and 86.7% (95% CI, 81.0-93.0) to 87.0% (95% CI, 81.0-93.0) and 83.2% (95% CI, 0.76-0.90) after manipulation (P<.0001), without affecting specificity (P=.45). Subjects correctly identified 41 previously incorrectly identified esophageal intubations. Paramedic experience, previous intubations, and POCUS experience did not correlate with ability to identify tube location.
Conclusion:Paramedics can accurately identify esophageal intubations with POCUS, and manipulation improves identification. Further studies of paramedic use of dynamic POCUS to identify inadvertent esophageal intubations are needed.
,Lema PC ,O’Brien M ,Wilson J ,St. James E ,Lindstrom H ,DeAngelis J ,Caldwell J ,May P Clemency B. Avoid the Goose! Paramedic Identification of Esophageal Intubation by Ultrasound . Prehosp Disaster Med.2018 ;33 (4 ):406 –410
Contributors
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- By Krista Adamek, Ana Luisa K. Albernaz, J. Marcio Ayres†, Andrew J. Baker, Karen L. Bales, Adrian A. Barnett, Christopher Barton, John M. Bates, Jennie Becker, Bruna M. Bezerra, Júlio César Bicca-Marques, Richard Bodmer, Jean P. Boubli, Mark Bowler, Sarah A. Boyle, Christini Barbosa Caselli, Janice Chism, Elena P. Cunningham, José Maria C. da Silva, Lesa C. Davies, Nayara de Alcântara Cardoso, Manuella A. de Souza, Stella de la Torre, Ana Gabriela de Luna, Thomas R. Defler, Anthony Di Fiore, Eduardo Fernandez-Duque, Stephen F. Ferrari, Wilsea M.B. Figueiredo-Ready, Tracy Frampton, Paul A. Garber, Brian W. Grafton, L. Tremaine Gregory, Maria L. Harada, Amy Harrison-Levine, Walter C. Hartwig, Stefanie Heiduck, Eckhard W. Heymann, André Hirsch, Leandro Jerusalinsky, Gareth Jones, Richard F. Kay, Martin M. Kowalewski, Shawn M. Lehman, Laura Marsh, Jesús Martinez, William A. Mason, Hope Matthews, Wynlyn McBride, Shona McCann-Wood, W. Scott McGraw, D. Jeffrey Meldrum, Sally P. Mendoza, Nohelia Mercado, Russell A. Mittermeier, Mirjam N. Nadjafzadeh, Marilyn A. Norconk, Robert Gary Norman, Marcela Oliveira, Marcelo M. Oliveira, Maria Juliana Ospina Rodríguez, Erwin Palacios, Suzanne Palminteri, Liliam P. Pinto, Marcio Port-Carvalho, Leila Porter, Carlos Portillo-Quintero, George Powell, Ghillean T. Prance, Rodrigo C. Printes, Pablo Puertas, P. Kirsten Pullen, Helder L. Queiroz, Luis Reginaldo R. Rodrigues, Adriana Rodríguez, Alfred L. Rosenberger, Anthony B. Rylands, Ricardo R. Santos, Horacio Schneider, Eleonore Z.F. Setz, Suleima S.B. Silva, José S. Silva Júnior, Andrew T. Smith, Marcelo C. Sousa, Antonio S. Souto, Wilson R. Spironello, Masanaru Takai, Marcelo F. Tejedor, Cynthia L. Thompson, Diego G. Tirira, Raul Tupayachi, Bernardo Urbani, Liza M. Veiga, Marianela Velilla, João Valsecchi, Jean-Christophe Vié, Tatiana M. Vieira, Suzanne E. Walker-Pacheco, Rob Wallace, Patricia C. Wright, Charles E. Zartman
- Edited by Liza M. Veiga, Universidade Federal do Pará, Brazil, Adrian A. Barnett, Roehampton University, London, Stephen F. Ferrari, Universidade Federal de Sergipe, Brazil, Marilyn A. Norconk, Kent State University, Ohio
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- Book:
- Evolutionary Biology and Conservation of Titis, Sakis and Uacaris
- Published online:
- 05 April 2013
- Print publication:
- 11 April 2013, pp xii-xv
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Characterizing spontaneously reported cognitive complaints: the development and reliability of a classification instrument
- Daniel Apolinario, Rafaela Branco Miranda, Claudia Kimie Suemoto, Regina Miksian Magaldi, Alexandre Leopold Busse, Aline Thomaz Soares, Leonardo da Costa Lopes, Juliana Yumi Tizon Kasai, Erika Satomi, Elina Lika Kikuchi, Wilson Jacob-Filho
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- Journal:
- International Psychogeriatrics / Volume 25 / Issue 1 / January 2013
- Published online by Cambridge University Press:
- 04 September 2012, pp. 157-166
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Background: The characteristics and associated risks of spontaneously reported cognitive complaints have not been investigated due to the lack of a classification instrument.
Methods: In phase 1, a classification system with descriptive categories and cognitive domains was developed by experts through a modified Delphi technique. In phase 2, 180 elderly patients seeking medical attention for cognitive complaints provided free reports of their cognitive difficulties and each complaint was recorded verbatim. Three observers were asked to classify each complaint into a descriptive category. Perceived cognitive function was further characterized using the Memory Complaint Questionnaire (MAC-Q).
Results: The patients reported 493 spontaneous complaints, with a range of 1–6 complaints per patient and a mean of 2.7 (±1.3). The proportion of complaints that could be classified into a category by each of the three observers varied from 91.9% to 95.7%. Inter-observer agreement assessed using the κ statistic varied from 0.79 to 1 for descriptive categories and 0.83 to 0.97 for domains. Compared with the MAC-Q, spontaneously reported complaints provided complementary information by avoiding the cueing effect provoked by the questionnaire. The total number of complaints and their occurrences in specific domains were associated with important sociodemographic and clinical factors, indicating that their meaning and associated risks need to be further investigated.
Conclusion: The instrument developed in this study proved to be a practical tool for classifying the majority of spontaneously reported cognitive complaints with high reliability. Further studies are needed to investigate clinical usefulness of this approach.
Geochemical and scintillometric characterization and correlation of amethyst geode-bearing Paraná lavas from the Quaraí and Los Catalanes districts, Brazil and Uruguay
- LÉO A. HARTMANN, WILSON WILDNER, LAUREN C. DUARTE, SANDRO K. DUARTE, JULIANA PERTILLE, KARINE R. ARENA, LAURA C. MARTINS, NORBERTO LESSA DIAS
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- Journal:
- Geological Magazine / Volume 147 / Issue 6 / November 2010
- Published online by Cambridge University Press:
- 19 July 2010, pp. 954-970
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Geochemical studies of the six lowermost lava flows of the Cretaceous Serra Geral Formation (Paraná volcanic province) in Quaraí (Brazil) and Artigas (Uruguay) were combined with flow-by-flow field studies of structures and scintillometric profiles to establish a consistent regional stratigraphic framework over at least 100 km. This greatly improves exploration capability for amethyst and agate geodes. A basalt, colada Mata Olho (Alegrete facies, Serra Geral Formation), was the first lava to flow over the ancient Botucatu desert in the region, but an andesite, colada Catalán, overstepped this basalt in many places, perhaps palaeohighs. Four basaltic andesites complete the lava stratigraphy in this formation, adding up to 300 m of lavas. The stratigraphic sequence of contrasting lava compositions is 51.0 wt% SiO2 in the first lava, followed by 57.5, 52.5, 56.0, 53.0 and finally 54.5 wt% SiO2. Overall MgO variation is between 2 and 7 wt%. All lavas in the two districts are low-Ti (<2.0 wt% TiO2) of the Gramado type. The characteristic contents of most major and trace elements (124 rock samples analysed) allow the ready identification of each lava. Contrasting rock chemistry also results in strong variation in scintillometric values (270 points measured in the field and nineteen continuous borehole profiles); from bottom to top of the stratigraphy, the cps values are 49±3.2, 123±10.3, 62±4.7, 94±4.6, ~45 and ~85. Colada Catalán has the structure of aa lava, particularly the contorted igneous banding and autobreccias in the upper and lower crusts. In some places, a 2 m thick, silicified sandstone layer lies on top of some coladas, and silicified sandstone forms breccias with volcanic rocks. Geochemistry of the six lavas indicates complex evolution, involving melting of lithospheric mantle, injection into the crust and assimilation of crust followed by fractional crystallization. This study indicates the possibility of world-class deposits of amethyst geodes on the Brazilian side of the border with Uruguay.