Heterogeneity In Major Depression: Influence On Treatment Outcomes And Processes-Outcome Relations

Some have proposed that all psychotherapies for depression, as well as for other common mental disorders, are equally efficacious and that they all work through common processes, especially a relationship with a therapist. One reason it may be difficult to discern differential efficacy among treatments, as well as how they exert their effects, is that depression and other disorders are heterogeneous in both presentation and prognosis. The studies presented in the dissertation aimed to explore how heterogeneity in depression may moderate treatment effects and process-outcome relations. In study 1, a prognostic index (PI) was developed and treatment differences along the PI were explored in a sample of patients (N = 622) randomized to treatment as usual (TAU) or stepped care starting with brief therapy (BT) or with cognitive-behavioral therapy (CBT). The PI comprised five variables: unemployment status, depression severity, hostility, sleep problems, and lower positive emotionality, all of which predicted a lower likelihood of recovery. For patients whose PI indicated a high likelihood of recovery (73% of the sample), recovery rates were similarly high across the treatments. Among patients whose PI indicated a lower likelihood of recovery, patients in the CBT condition experienced a substantially higher recovery rate (65%) than patients in TAU (40%) or BT (44%). In study 2, variability in the predictive relationship between the therapeutic alliance and depressive symptom change was explored in a sample of patients receiving cognitive therapy (CT) for depression (N = 60). The alliance predicted outcome in the subgroup of clients with 0–2 prior episodes (r = .52), but not in those with 3 or more prior episodes (r = -.02). In study 3, these findings were replicated in an independent sample of patients receiving CBT for depression, but they did not extend to patients in a psychodynamic therapy condition. Taken together, these findings suggest that there may be identifiable subgroups of patients for whom factors common to all treatments will promote symptom change. By contrast, complementary subgroups, such as those with poorer prognoses or more recurrent histories of depression, may reveal differences in the efficacies of treatments and their active mechanisms

Paper Session II-C - Laser Ordnance Ignition Capability at KSC

A laser ordnance demonstration system has been developed at the Kennedy Space Center (KSC) within the Launch Equipment Test Facility (LETF) to perform testing and evaluation of ground support equipment (GSE) and other items featuring laser-actuated initiators and other secondary ordnance for future vehicle programs. Its current form enables verification of firing dual redundant laser-actuated initiators by measuring their output pressure pulses, providing adjustable and measurable timing delays, and incorporating system checkout capability without requiring ordnance. The system comprises an electronics rack with required fiber-optic and other cabling to a secured test area within the LETF, where the initiators can be safely fired using appropriate test bombs, safety equipment, and instrumentation. It is designed to be easily merged with the LETF instrumentation and infrastructure normally used for testing and certification of GSE systems and articles. This capability enables the LETF, a unique facility extensively used in supporting Space Shuttle as well as other programs such as X-33, to evaluate the potential advantages of using laser ordnance technology for safety, cost savings, and increased reliability towards streamlining future processing and launch operations. Configuration design, as well as data and results from demonstration test firings of initiators, is presented in this paper

A Study of the Two Major Causes of Neonatal Deaths: Perinatal Conditions and Congenital Anomalies

Infant mortality is a public health concern in the United states. We concentrate on neonatal mortality for its high accountability of infant mortality. In this paper we study the neonatal mortality of Florida\u27s 1989 live birth cohort. The data has been analyzed for two major causes of deaths: perinatal conditions and congenital anomalies. We use the KAPLAN-MEIER method to estimate the survival probabilities. For each cause, data were fit to the Weibull models and Extreme Value models to estimate the parameters of the survival curves. The results indicate that primary factors for each cause of neonatal deaths are very low birth weight, prior pregnancies of the mother, and late initiation of prenatal care when the variables are considered separately. The conclusion still remains the same for perinatal conditions when the interaction effects of the factors are considered, but we do not conclude similarly for the congenital anomalies at the same interaction level

The 341 737 ways of qualifying for the melancholic specifier

Stress and Psychopatholog

Heterogeneity in major depression and its melancholic and atypical specifiers: a secondary analysis of STAR*D

Objectives: The melancholic and atypical specifiers for a major depressive episode (MDE) are supposed to reduce heterogeneity in symptom presentation by requiring additional, specific features. Fried et al. (2020) recently showed that the melancholic specifier may increase the potential heterogeneity in presenting symptoms. In a large sample of outpatients with depression, our objective was to explore whether the melancholic and atypical specifiers reduced observed heterogeneity in symptoms. Methods: We used baseline data from the Inventory of Depression Symptoms (IDS), which was available for 3,717 patients, from the Sequenced Alternatives to Relieve Depression (STAR*D) trial. A subsample met criteria for MDE on the IDS ("IDS-MDE"; N =2,496). For patients with IDS-MDE, we differentiated between those with melancholic, non-melancholic, non-melancholic, atypical, and non-atypical depression. We quantified the observed heterogeneity between groups by counting the number of unique symptom combinations pertaining to their given diagnostic group (e.g., counting the melancholic symptoms for melancholic and non-melancholic groups), as well as the profiles of DSM-MDE symptoms (i.e., ignoring the specifier symptoms). Results: When considering the specifier and depressive symptoms, there was more observed heterogeneity within the melancholic and atypical subgroups than in the IDS-MDE sample (i.e., ignoring the specifier subgroups). The differences in number of profiles between the melancholic and non-melancholic groups were not statistically significant, irrespective of whether focusing on the specifier symptoms or only the DSM-MDE symptoms. The differences between the atypical and non-atypical subgroups were smaller than what would be expected by chance. We found no evidence that the specifier groups reduce heterogeneity, as can be quantified by unique symptom profiles. Most symptom profiles, even in the specifier subgroups, had five or fewer individuals. Conclusion: We found no evidence that the atypical and melancholic specifiers create more symptomatically homogeneous groups. Indeed, the melancholic and atypical specifiers introduce heterogeneity by adding symptoms to the DSM diagnosis of MDE.Stress and Psychopatholog

Is there a subgroup of long-term evolution among patients with advanced lung cancer?: Hints from the analysis of survival curves from cancer registry data

Background: Recently, with the access of low toxicity biological and targeted therapies, evidence of the existence of a long-term survival subpopulation of cancer patients is appearing. We have studied an unselected population with advanced lung cancer to look for evidence of multimodality in survival distribution, and estimate the proportion of long-term survivors. Methods: We used survival data of 4944 patients with non-small-cell lung cancer (NSCLC) stages IIIb-IV at diagnostic, registered in the National Cancer Registry of Cuba (NCRC) between January 1998 and December 2006. We fitted one-component survival model and two-component mixture models to identify short-and long-term survivors. Bayesian information criterion was used for model selection. Results: For all of the selected parametric distributions the two components model presented the best fit. The population with short-term survival (almost 4 months median survival) represented 64% of patients. The population of long-term survival included 35% of patients, and showed a median survival around 12 months. None of the patients of short-term survival was still alive at month 24, while 10% of the patients of long-term survival died afterwards. Conclusions: There is a subgroup showing long-term evolution among patients with advanced lung cancer. As survival rates continue to improve with the new generation of therapies, prognostic models considering short-and long-term survival subpopulations should be considered in clinical research.LS, PL, CV, TC, AL were funded by their employer the Center of Molecular Immunology. YG is funded by the Ministry of Health. JB received no funding. We thank Dr. Camilo Rodriguez for their contribution to this work and for facilitate literature needed for manuscript writing

Oral leiomyoma in retromolar trigone : a case report

Leiomyomas are bening tumours originated on smooth muscle. The most frequent site of appearance are uterine myometrium, gastrointestinal tract and skin. The highest incidence ocurs between 40 and 49 years of age. Its presentation is unusual in children or in older patients. Leiomyomas are unfrequent in the oral cavity, but in this location are usually localized on tongue, lips and palate. Leiomyomas use to appear as well-defined masses, with slow growth and totally asymptomatic. Pain is present just in rare cases. The treatment is surgical escision. Recurrences are extremely unfrequent. The diagnosis is mainly determined by histological studies due to its unspecific clinical appearance. Histopathologicaly proliferation of smooth muscle cells is observad without necrotic areas. A low number of mitotic figures can be seen. We present the case report of a 25-year old male patient, with a leiomioma on his right retromolar trigone.The low incidence of this pathology, the age of the patient and the inusual location, make the report of the case worthy

Accessible routes integrating data from multiple sources

Providing citizens with the ability to move around in an accessible way is a requirement for all cities today. However, modeling city infrastructures so that accessible routes can be computed is a challenge because it involves collecting information from multiple, large-scale and heterogeneous data sources. In this paper, we propose and validate the architecture of an information system that creates an accessibility data model for cities by ingesting data from different types of sources and provides an application that can be used by people with different abilities to compute accessible routes. The article describes the processes that allow building a network of pedestrian infrastructures from the OpenStreetMap information (i.e., sidewalks and pedestrian crossings), improving the network with information extracted obtained from mobile-sensed LiDAR data (i.e., ramps, steps, and pedestrian crossings), detecting obstacles using volunteered information collected from the hardware sensors of the mobile devices of the citizens (i.e., ramps and steps), and detecting accessibility problems with software sensors in social networks (i.e., Twitter). The information system is validated through its application in a case study in the city of Vigo (Spain).This work was supported in part by the project Friendly barrierLess AdapTable City (FLATCity) (Ministerio de Ciencia, innovación y Universidades/ERDF, EU) funded by the Spanish Agencia Estatal de Investigación (AEI, doi 10.13039/501100011033), and in part by the European Regional Development Fund (ERDF), under Grants TIN2016-77158-C4-1-R, TIN2016-77158-C4-2-R and TIN2016-77158-C4-3-R. This work was also supported in part by the project Massive Geospatial Data Storage and Processing for Intelligent and Sustainable Urban Transportation (MaGIST), funded by the Spanish Agencia Estatal de Investigación (AEI, doi 10.13039/501100011033) under grants PID2019-105221RBC41, PID2019-105221RB-C43 and PID2019-105221RB-C44. The research of Miguel R. Luaces was also partially founded by: Xunta de Galicia/FEDER-UE GRC: ED431C 2017/58 and Xunta de Galicia/FEDER-UE, ConectaPeme, GEMA: IN852A 2018/14. Miguel R. Luaces also wishes to acknowledge the support received from the Centro de Investigación de Galicia "CITIC", funded by Xunta de Galicia and the European Union (European Regional Development Fund- Galicia 2014-2020 Program), by grant ED431G 2019/01. Jesús Balado and Lucía Díaz-Vilariño would like to thank to the Xunta de Galicia given through human resources grants ED481B-2019-061 and ED481D 2019/020, respectively