Track E Implementation Science, Health Systems and Economics

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/138412/1/jia218443.pd

Pharmacological treatment and staging in bipolar disorder: evidence from clinical practice

Objectives:Staging models for medical diseases are widely used to guide treatment and prognosis. Bipolar disorder (BD) is a chronic condition and it is among the most disabling disorders in medicine. The staging model proposed by Kapczinski in 2009 presents four progressive clinical stages of BD. Our aim was to evaluate pharmacological maintenance treatment across these stages in patients with BD.Methods:One hundred and twenty-nine subjects who met DSM-IV criteria for BD were recruited from the Bipolar Disorders Program at Hospital de Clínicas de Porto Alegre, Brazil. All patients were in remission. The subjects were classified according to the staging model: 31 subjects were classified as stage I, 44 as stage II, 31 as stage III, and 23 as stage IV.Results:Patterns of pharmacological treatment differed among the four stages (p = 0.001). Monotherapy was more frequent in stage I, and two-drug combinations in stage II. Patients at stages III and IV needed three or more medications or clozapine. Impairment in functional status (Functioning Assessment Short Test [FAST] scale scores) correlated positively with the number of medications prescribed.Conclusions:This study demonstrated differences in pharmacological treatment in patients with stable BD depending on disease stage. Treatment response can change with progression of BD. Clinical guidelines could consider the staging model to guide treatment effectiveness

High-Resolution Numerical Modeling of Barotropic Global Ocean Tides for Satellite Gravimetry

The recently upgraded barotropic tidal model TiME is employed to study the influence of fundamental tidal processes, the chosen model resolution, and the bathymetric map on the achievable model accuracy, exemplary for the M2 tide. Additionally, the newly introduced pole-rotation scheme allows to estimate the model’s inherent precision (open ocean rms: 0.90 cm) and enables studies of the Arctic domain without numerical deviations originating from pole cap handling. We find that the smallest open ocean rms with respect to the FES14-atlas (3.39 cm) is obtained when tidal dissipation is carried out to similar parts by quadratic bottom friction, wave drag, and parametrized eddy-viscosity. This setting proves versatile to obtaining high accuracy values for a diverse ensemble of additional partial tides. Using the preferred model settings, we show that for certain minor tides it is possible to obtain solutions that are more accurate than results derived with admittance assumptions from data-constrained tidal atlases. As linear admittance derived minor tides are routinely used for de-aliasing of satellite gravimetric data, this opens the potential for improving gravity field products by employing the solutions from TiME