A Control Approach for Nonlinear Stochastic State Uncertain Systems with Probabilistic Safety Guarantees

This paper presents an algorithm to apply nonlinear control design approaches in the case of stochastic systems with partial state observation. Deterministic nonlinear control approaches are formulated under the assumption of full state access and, often, relative degree one. We propose a control design approach that first generates a control policy for nonlinear deterministic models with full state observation. The resulting control policy is then used to build an importance-like probability distribution over the space of control sequences which are to be evaluated for the true stochastic and state-uncertain dynamics. This distribution serves in the sampling step within a random search control optimization procedure, to focus the exploration effort on certain regions of the control space. The sampled control sequences are assigned costs determined by a prescribed finite-horizon performance and safety measure, which is based on the stochastic dynamics. This sampling algorithm is parallelizable and shown to have computational complexity indifferent to the state dimension, and to be able to guarantee safety over the prescribed prediction horizon. A numerical simulation is provided to test the applicability and effectiveness of the presented approach and compare it to a certainty equivalence controller

Arabic Translation, Validation and Cultural Adaptation of the 7-Item Hamilton Depression Rating Scale in Two Community Samples

Objectives: Depression is a common mental disorder, the severity of which is frequently assessed via interview-based clinical scales such as the 7-item Hamilton Depression Rating Scale (HAMD-7). The current study aimed to translate and examine the validity of an Arabic version of the HAMD-7 scale. Methods: This study took place between February and March 2016 in the Psychiatry Department of King Saud University, Riyadh, Saudi Arabia. The HAMD-7 scale was translated into Arabic using forward and backward translation methods. A total of 153 Arabic speakers were recruited to test the translated scale, including 57 medical students and 96 members of the general public. The Arabic version of the HAMD-7 scale was completed by trained investigators during face-toface interviews with the participants. In order to assess convergent validity, participants also completed an Arabic version of the self-assessed Patient Health Questionnaire-9 (PHQ-9) scale. Subsequently, the test-retest reliability of the translated HAMD-7 scale was evaluated two weeks later during a second interview. Results: Overall, HAMD-7 scores were positively correlated with PHQ-9 scores (r = 0.633–0.749). Moreover, the translated HAMD-7 scale proved to be reliable in terms of test-retest reliability (intra-class correlation coefficient: 0.807; P <0.001). With regards to internal consistency, the Cronbach’s α values ranged between 0.607–0.756. Conclusion: The Arabic HAMD-7 scale was found to be reliable and valid among two samples of Arabic speakers in Saudi Arabia. However, further research among Arab-speaking patients diagnosed with depression is needed in order to establish its usefulness in assessing the severity of depressive symptoms. Keywords: Psychiatry; Depression; Psychometrics; Validity and Reliability; Translation; Questionnaire Design; Saudi Arabia

Development and implementation of guidelines for the management of depression: a systematic review

Objective: To evaluate the development and implementation of clinical practice guidelines for the management of depression globally. Methods: We conducted a systematic review of existing guidelines for the management of depression in adults with major depressive or bipolar disorder. For each identified guideline, we assessed compliance with measures of guideline development quality (such as transparency in guideline development processes and funding, multidisciplinary author group composition, systematic review of comparative efficacy research) and implementation (such as quality indicators). We compared guidelines from low- and middle-income countries with those from high-income countries. Findings: We identified 82 national and 13 international clinical practice guidelines from 83 countries in 27 languages. Guideline development processes and funding sources were explicitly specified in a smaller proportion of guidelines from low- and middle-income countries (8/29; 28%) relative to high-income countries (35/58; 60%). Fewer guidelines (2/29; 7%) from low- and middle-income countries, relative to high-income countries (22/58; 38%), were authored by a multidisciplinary development group. A systematic review of comparative effectiveness was conducted in 31% (9/29) of low- and middle-income country guidelines versus 71% (41/58) of high-income country guidelines. Only 10% (3/29) of low- and middle-income country and 19% (11/58) of high-income country guidelines described plans to assess quality indicators or recommendation adherence. Conclusion: Globally, guideline implementation is inadequately planned, reported and measured. Narrowing disparities in the development and implementation of guidelines in low- and middle-income countries is a priority. Future guidelines should present strategies to implement recommendations and measure feasibility, cost-effectiveness and impact on health outcomes

Foreign–trained medical professionals: Wanted or not? A case study of Canada

Definitions of the term “International Medical Graduate” vary but the Medical Council of Canada defines an IMG to be a graduate of a medical school outside of Canada or the United States, with the exception of US schools of osteopathic medicine

The prevalence and clinical characteristics associated with Diagnostic and Statistical Manual Version-5-defined anxious distress specifier in adults with major depressive disorder:results from the International Mood Disorders Collaborative Project

OBJECTIVES: The aim of the study was to evaluate the prevalence of and illness characteristics in adults with major depressive disorder (MDD) with anxious distress specifier (ADS) enrolled in the International Mood Disorders Collaborative Project, which is a collaborative research platform at the Mood Disorders Psychopharmacology Unit, University of Toronto, Canada and the Cleveland Clinic, Cleveland, Ohio, USA. METHODS: Data from participants who met criteria for a current major depressive episode as part of MDD (n = 830) were included in this post hoc analysis. Diagnostic and Statistical Manual Version-5-defined ADS was operationalized as the presence of at least two out of three proxy items instead of two out of five specifiers. RESULTS: A total of 464 individuals (i.e. 56%) met criteria for ADS. There were no between-group differences in sociodemographic variables (e.g. gender, employment, marital status). Greater severity of illness was observed in adults with ADS as evidenced by a higher number of hospitalizations, higher rates of suicidal ideation, greater depressive symptom severity, greater workplace impairment, decreased quality of life, and greater self-reported cognitive impairment. CONCLUSIONS: Our findings underscore the importance of evaluating ADS in adults with MDD as its presence identifies a subpopulation with greater illness-associated burden and hazards

Advancing biomarker research: utilizing 'Big Data' approaches for the characterization and prevention of bipolar disorder

Objective: To provide a strategic framework for the prevention of bipolar disorder (BD) that incorporates a 'Big Data' approach to risk assessment for BD.Methods: Computerized databases (e. g., Pubmed, PsychInfo, and MedlinePlus) were used to access English-language articles published between 1966 and 2012 with the search terms bipolar disorder, prodrome, 'Big Data', and biomarkers cross-referenced with genomics/genetics, transcriptomics, proteomics, metabolomics, inflammation, oxidative stress, neurotrophic factors, cytokines, cognition, neurocognition, and neuroimaging. Papers were selected from the initial search if the primary outcome(s) of interest was (were) categorized in any of the following domains: (i) 'omics' (e. g., genomics), (ii) molecular, (iii) neuroimaging, and (iv) neurocognitive.Results: the current strategic approach to identifying individuals at risk for BD, with an emphasis on phenotypic information and family history, has insufficient predictive validity and is clinically inadequate. the heterogeneous clinical presentation of BD, as well as its pathoetiological complexity, suggests that it is unlikely that a single biomarker (or an exclusive biomarker approach) will sufficiently augment currently inadequate phenotypic-centric prediction models. We propose a 'Big Data'-bioinformatics approach that integrates vast and complex phenotypic, anamnestic, behavioral, family, and personal 'omics' profiling. Bioinformatic processing approaches, utilizing cloud-and grid-enabled computing, are now capable of analyzing data on the order of tera-, peta-, and exabytes, providing hitherto unheard of opportunities to fundamentally revolutionize how psychiatric disorders are predicted, prevented, and treated. High-throughput networks dedicated to research on, and the treatment of, BD, integrating both adult and younger populations, will be essential to sufficiently enroll adequate samples of individuals across the neurodevelopmental trajectory in studies to enable the characterization and prevention of this heterogeneous disorder.Conclusions: Advances in bioinformatics using a 'Big Data' approach provide an opportunity for novel insights regarding the pathoetiology of BD. the coordinated integration of research centers, inclusive of mixed-age populations, is a promising strategic direction for advancing this line of neuropsychiatric research.Stanley Medical Research InstituteNational Alliance for Research on Schizophrenia and DepressionNational Institute of Mental HealthAstraZenecaBristol-Myers SquibbEli Lilly Co.ForestJanssen-OrthoLundbeckPfizerSepracorShireNational Institute of HealthNeuropsychopharmacology Research GroupSunnybrook Research InstituteToronto Rehabilitation InstituteHeart and Stroke Foundation Centre for Stroke RecoveryEli Lilly Fellowship AwardConselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Univ Toronto, Dept Psychiat, Toronto, ON M5T 2S8, CanadaUniv Toronto, Dept Pharmacol, Toronto, ON M5T 2S8, CanadaUniv Hlth Network, Mood Disorders Psychopharmacol Unit, Toronto, ON, CanadaUniv Toronto, Inst Med Sci, Toronto, ON M5T 2S8, CanadaUniv S Carolina, Sch Med, Dept Neuropsychiat, Columbia, SC USASunnybrook Res Inst, Toronto, ON, CanadaUniv Fed Rio Grande do Sul, Psychiat Residents Hosp Clin Porto Alegre, Porto Alegre, RS, BrazilQueens Univ, Ctr Neurosci Studies, Kingston, ON, CanadaUniversidade Federal de São Paulo, Dept Psychiat, Program Recognit & Intervent Individuals At Risk, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Psychiat, Interdisciplinary Lab Clin Neurosci, São Paulo, BrazilMt Sinai Hosp, Samuel Lunenfeld Res Inst, Toronto, ON M5G 1X5, CanadaUniversidade Federal de São Paulo, Dept Psychiat, Program Recognit & Intervent Individuals At Risk, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Psychiat, Interdisciplinary Lab Clin Neurosci, São Paulo, BrazilWeb of Scienc