Reemergence of Plasmodium vivax malaria in the republic of Korea.

Plasmodium vivax malaria reemerged in the Republic of Korea in 1993. The number of cases has tripled each year since, with more than 1,600 cases reported in 1997. All 27 cases in U.S. troops resolved uneventfully with chloroquine/primaquine therapy. Disease is localized along the western Demilitarized Zone and presents minimal risk to tourists

SAGES: A Suite of Freely-Available Software Tools for Electronic Disease Surveillance in Resource-Limited Settings

Public health surveillance is undergoing a revolution driven by advances in the field of information technology. Many countries have experienced vast improvements in the collection, ingestion, analysis, visualization, and dissemination of public health data. Resource-limited countries have lagged behind due to challenges in information technology infrastructure, public health resources, and the costs of proprietary software. The Suite for Automated Global Electronic bioSurveillance (SAGES) is a collection of modular, flexible, freely-available software tools for electronic disease surveillance in resource-limited settings. One or more SAGES tools may be used in concert with existing surveillance applications or the SAGES tools may be used en masse for an end-to-end biosurveillance capability. This flexibility allows for the development of an inexpensive, customized, and sustainable disease surveillance system. The ability to rapidly assess anomalous disease activity may lead to more efficient use of limited resources and better compliance with World Health Organization International Health Regulations

Selective serotonin reuptake inhibitors in the treatment of generalized anxiety disorder

Selective serotonin reuptake inhibitors have proven efficacy in the treatment of panic disorder, obsessive–compulsive disorder, post-traumatic stress disorder and social anxiety disorder. Accumulating data shows that selective serotonin reuptake inhibitor treatment can also be efficacious in patients with generalized anxiety disorder. This review summarizes the findings of randomized controlled trials of selective serotonin reuptake inhibitor treatment for generalized anxiety disorder, examines the strengths and weaknesses of other therapeutic approaches and considers potential new treatments for patients with this chronic and disabling anxiety disorder

NIMH Research Domain Criteria (RDoC)

of Mental Health (NIMH) formed a working group to implement Strategy 1.4 of its Strategic Plan that called for the “development, for research purposes, of new ways of classify-ing psychopathology based on dimensions of observable behaviors and neurobiological measures. ” This project became known as the Research Domain Criteria (RDoC; Insel et al., 2010). RDoC marks a shift in psychi-atric research. For the past 30-plus years, most research on mental disorders has been based on clinical syndromes as defined in the DSM. The structure of RDoC departs from clinically described syndromes and attempts to “carve nature at its joints ” by studying psychopathology based on objective behav-ioral, neurobiological, and genetic measures while remaining agnostic concerning tradi-tional diagnoses based on clinical description (Sanislow et al., 2010). History and Rationale Efforts to codify psychiatric diagnosis for research purposes began in the 1970s with the advent of the Feighner criteria, later the Research Diagnostic Criteria, which served as the foundation for the 1980 DSM-III (Feighner et al., 1972). These developments marked a Authors ’ note: The authors thank Lisa Alberts and Bruce Cuthbert for helpful comments on an earlier draft of this entry

Uncontrolled Self-Medication with Venlafaxine in a Patient with Major Depressive Disorder

Antidepressants are known to have no significant ability to cause addiction. However, a recent study showed many individuals with mood disorders self-medicated with antidepressants to relieve symptoms. We report here a male physician, diagnosed five years ago with major depressive disorder, with insomnia, anxiousness, and chest heaviness. He began self-medicating with 150 mg of venlafaxine daily, without any monitoring. During his most recent severe depressive episode, he was taking up to 1,500 mg of venlafaxine daily. Without this medication, he experienced discontinuation syndrome, which included severe anxiety, chest heaviness, and breathing difficulty, and which he judged as indicating a more severely depressed state. He also experienced overdose symptoms, such as hypertension and tachycardia. He attempted suicide with drugs that he possessed. In conclusion, careful monitoring is needed when treating patients with venlafaxine, because its discontinuation syndrome is similar to symptoms of major depressive disorder, and suicidality may result from an overdose

Mantle plume capture, anchoring, and outflow during Galápagos plume-ridge interaction

Compositions of basalts erupted between the main zone of Galápagos plume upwelling and adjacent Galápagos Spreading Center (GSC) provide important constraints on dynamic processes involved in transfer of deep-mantle-sourced material to mid-ocean ridges. We examine recent basalts from central and northeast Galápagos including some that have less radiogenic Sr, Nd, and Pb isotopic compositions than plume-influenced basalts (E-MORB) from the nearby ridge. We show that the location of E-MORB, greatest crustal thickness, and elevated topography on the GSC correlates with a confined zone of low-velocity, high-temperature mantle connecting the plume stem and ridge at depths of ∼100 km. At this site on the ridge, plume-driven upwelling involving deep melting of partially dehydrated, recycled ancient oceanic crust, plus plate-limited shallow melting of anhydrous peridotite, generate E-MORB and larger amounts of melt than elsewhere on the GSC. The first-order control on plume stem to ridge flow is rheological rather than gravitational, and strongly influenced by flow regimes initiated when the plume was on axis (>5 Ma). During subsequent northeast ridge migration material upwelling in the plume stem appears to have remained “anchored” to a contact point on the GSC. This deep, confined NE plume stem-to-ridge flow occurs via a network of melt channels, embedded within the normal spreading and advection of plume material beneath the Nazca plate, and coincides with locations of historic volcanism. Our observations require a more dynamically complex model than proposed by most studies, which rely on radial solid-state outflow of heterogeneous plume material to the ridge.We thank Galápagos National Park authorities and CDRS for permitting fieldwork in Galápagos. D. Villagomez and D. Toomey generously shared their extensive seismic data set for Galápagos, and D. McKenzie kindly provided help with temperature calculations. End-member compositions of Galápagos mantle reservoirs in Figure 4 were estimated from principal component analysis; data related to these calculations are available in the supporting information. We are grateful to Kaj Hoernle and two anonymous reviewers for their constructive comments on an earlier version of this manuscript. The research was funded by the University of Cambridge, Geological Society of London, NERC (RG57434), and NSF (EAR 0838461, EAR 0944229, and EAR-11452711).This is the final published version of the article. It first appeared at http://dx.doi.org/10.1002/2015GC00572

Diagnostic stability among chronic patients with functional psychoses: an epidemiological and clinical study

<p>Abstract</p> <p>Background</p> <p>Diagnostic stability and illness course of chronic non-organic psychoses are complex phenomena and only few risk factors or predictors are known that can be used reliably. This study investigates the diagnostic stability during the entire course of illness in patients with non-organic psychoses and attempts to identify non-psychopathological risk factors or predictors.</p> <p>Method</p> <p>100 patients with functional psychosis were initially characterised using the Operational Criteria Checklist for Psychotic Illness and Affective Illness (OPCRIT), medical records and health registers. To study the stability of diagnoses (i.e. shifts per time), we used registry data to define four measures of diagnostic variation that were subsequently examined in relation to four possible measures of time (i.e. observation periods or hospitalisation events). Afterwards, we identified putative co-variables and predictors of the best measures of diagnostic stability.</p> <p>Results</p> <p>All four measures of diagnostic variation are very strongly associated with numbers-of-hospitalisations and less so with duration-of-illness, duration-of-hospitalisation and with year-of-first-admission. The four measures of diagnostic variation corrected for numbers-of-hospitalisations were therefore used to study the diagnostic stability. Conventional predictors of illness course – e.g. age-of-onset and premorbid-functioning – are not significantly associated with stability. Only somatic-comorbidity is significantly associated with two measures of stability, while family-history-of-psychiatric-illness and global-assessment-of-functioning (GAF) scale score show a trend. However, the traditional variables age-of-first-admission, civil-status, first-diagnosis-being-schizophrenia and somatic-comorbidity are able to explain two-fifth of the variation in numbers-of-hospitalisations.</p> <p>Conclusion</p> <p>Diagnostic stability is closely linked with the contact between patient and the healthcare system. This could very likely be due to fluctuation of disease manifestation over time or presence of co-morbid psychiatric illness in combination with rigid diagnostic criteria that are unable to capture the multiple psychopathologies of the functional psychoses that results in differential diagnoses and therefore diagnostic instability. Not surprisingly, somatic-comorbidity was found to be a predictor of diagnostic variation thereby being a non-psychiatric confounder.</p

Does publication bias inflate the apparent efficacy of psychological treatment for major depressive disorder? A systematic review and meta-analysis of US national institutes of health-funded trials

Background The efficacy of antidepressant medication has been shown empirically to be overestimated due to publication bias, but this has only been inferred statistically with regard to psychological treatment for depression. We assessed directly the extent of study publication bias in trials examining the efficacy of psychological treatment for depression. Methods and Findings We identified US National Institutes of Health grants awarded to fund randomized clinical trials comparing psychological treatment to control conditions or other treatments in patients diagnosed with major depressive disorder for the period 1972–2008, and we determined whether those grants led to publications. For studies that were not published, data were requested from investigators and included in the meta-analyses. Thirteen (23.6%) of the 55 funded grants that began trials did not result in publications, and two others never started. Among comparisons to control conditions, adding unpublished studies (Hedges’ g = 0.20; CI95% -0.11~0.51; k = 6) to published studies (g = 0.52; 0.37~0.68; k = 20) reduced the psychotherapy effect size point estimate (g = 0.39; 0.08~0.70) by 25%. Moreover, these findings may overestimate the "true" effect of psychological treatment for depression as outcome reporting bias could not be examined quantitatively. Conclusion The efficacy of psychological interventions for depression has been overestimated in the published literature, just as it has been for pharmacotherapy. Both are efficacious but not to the extent that the published literature would suggest. Funding agencies and journals should archive both original protocols and raw data from treatment trials to allow the detection and correction of outcome reporting bias. Clinicians, guidelines developers, and decision makers should be aware that the published literature overestimates the effects of the predominant treatments for depression