An individualized treatment rule to optimize probability of remission by continuation, switching, or combining antidepressant medications after failing a first-line antidepressant in a two-stage randomized trial

2021 ◽  
pp. 1-10
Author(s):  
Ronald C. Kessler ◽  
Toshi A. Furukawa ◽  
Tadashi Kato ◽  
Alex Luedtke ◽  
Maria Petukhova ◽  
...  
Keyword(s):  
Pragmatic Trial ◽  
Secondary Analysis ◽  
Individualized Treatment ◽  
Second Line ◽  
Open Label ◽  
Individual Level ◽  
Ensemble Machine Learning ◽  
Medication Selection ◽  
The Individual ◽  
Optimized Treatment

Abstract Background There is growing interest in using composite individualized treatment rules (ITRs) to guide depression treatment selection, but best approaches for doing this are not widely known. We develop an ITR for depression remission based on secondary analysis of a recently published trial for second-line antidepression medication selection using a cutting-edge ensemble machine learning method. Methods Data come from the SUN(^_^)D trial, an open-label, assessor blinded pragmatic trial of previously-untreated patients with major depressive disorder from 48 clinics in Japan. Initial clinic-level randomization assigned patients to 50 or 100 mg/day sertraline. We focus on the 1549 patients who failed to remit within 3 weeks and were then rerandomized at the individual-level to continuation with sertraline, switching to mirtazapine, or combining mirtazapine with sertraline. The outcome was remission 9 weeks post-baseline. Predictors included socio-demographics, clinical characteristics, baseline symptoms, changes in symptoms between baseline and week 3, and week 3 side effects. Results Optimized treatment was associated with significantly increased cross-validated week 9 remission rates in both samples [5.3% (2.4%), p = 0.016 50 mg/day sample; 5.1% (2.7%), p = 0.031 100 mg/day sample] compared to randomization (30.1–30.8%). Optimization was also associated with significantly increased remission in both samples compared to continuation [24.7% in both: 11.2% (3.8%), p = 0.002 50 mg/day sample; 11.7% (3.9%), p = 0.001 100 mg/day sample]. Non-significant gains were found for optimization compared to switching or combining. Conclusions An ITR can be developed to improve second-line antidepressant selection, but replication in a larger study with more comprehensive baseline predictors might produce stronger and more stable results.

scholarly journals Modulation of corticomotor excitability in response to distal focal cooling

PeerJ ◽  
2018 ◽  
Vol 6 ◽  
pp. e6163 ◽  
Author(s):  
Yekta Ansari ◽  
Anthony Remaud ◽  
François Tremblay
Keyword(s):  
Skin Temperature ◽  
Motor Evoked Potentials ◽  
Secondary Analysis ◽  
Initial Study ◽  
Primary Analysis ◽  
Single Digit ◽  
Corticomotor Excitability ◽  
Individual Level ◽  
Cooling Phase ◽  
The Individual

Background Thermal stimulation has been proposed as a modality to facilitate motor recovery in neurological populations, such as stroke. Recently (Ansari, Remaud & Tremblay, 2018), we showed that application of cold or warm stimuli distally to a single digit produced a variable and short lasting modulation in corticomotor excitability. Here, our goal was to extend these observations to determine whether an increase in stimulation area could elicit more consistent modulation. Methods Participants (n = 22) consisted of a subset who participated in our initial study. Participants were asked to come for a second testing session where the thermal protocol was repeated but with extending the stimulation area from single-digit (SD) to multi-digits (MD, four fingers, no thumb). As in the first session, skin temperature and motor evoked potentials (MEPs) elicited with transcranial magnetic stimulation were measured at baseline (BL, neutral gel pack at 22 °C), at 1 min during the cooling application (pre-cooled 10 °C gel pack) and 5 and 10 min post-cooling (PC5 and PC10). The analysis combined the data obtained previously with single-SD cooling (Ansari, Remaud & Tremblay, 2018) with those obtained here for MD cooling. Results At BL, participants exhibited comparable measures of resting corticomotor excitability between testing sessions. MD cooling induced similar reductions in skin temperature as those recorded with SD cooling with a peak decline at C1 of respectively, −11.0 and −10.3 °C. For MEPs, the primary analysis revealed no main effect attributable to the stimulation area. A secondary analysis of individual responses to MD cooling revealed that half of the participants exhibited delayed MEP facilitation (11/22), while the other half showed delayed inhibition (10/22); which was sustained in the post-cooling phase. More importantly, a correlation between variations in MEP amplitude recorded during the SD cooling session with those recorded in the second session with MD cooling, revealed a very good degree of correspondence between the two at the individual level. Conclusion These results indicate that increasing the cooling area in the distal hand, while still eliciting variable responses, did produce more sustained modulation in MEP amplitude in the post-cooling phase. Our results also highlight that responses to cooling in terms of either depression or facilitation of corticomotor excitability tend to be fairly consistent in a given individual with repeated applications.

Individual-level characteristics associated with oral HIV test acceptability among Peruvian men who have sex with men and transgender women: a cross-sectional study

2018 ◽  
Vol 94 (7) ◽  
pp. 528-533 ◽  
Author(s):  
Juan A Flores ◽  
Brandon Brown ◽  
Segundo R León ◽  
Hugo Sánchez ◽  
Jerome T Galea
Keyword(s):  
Health Centre ◽  
Secondary Analysis ◽  
Prevalence Ratio ◽  
Transgender Women ◽  
Cross Sectional ◽  
Individual Level ◽  
Factors Associated ◽  
Hiv Test ◽  
Sex With Men ◽  
The Individual

ObjectivesPeruvian men who have sex with men (MSM) and transgender women (TGW) are highly vulnerable to HIV infection (HIV), but stigma, access issues and fear of venipuncture hamper testing. The oral HIV test—which uses oral fluids and provides results in 20 minutes—could reduce these barriers. The objective of this study was to determine the acceptability of the oral HIV test and the individual-level factors associated with its acceptability among MSM and TGW.MethodsWe conducted a cross-sectional secondary analysis among Peruvian MSM and TGW attending a community-based health centre between February 2012 and February 2013 to determine the individual-level factors associated with oral HIV test acceptability.ResultsOf 334 participants, 88% were MSM and 12% TGW. Overall, 85% of participants indicated their acceptability of the oral HIV test. Acceptability was higher in MSM than TGW (85.7% vs 80.0%) but this difference was not significant. Factors associated with acceptability in MSM were: tertiary or higher education (prevalence ratio (PR)=1.18, 95% CI 1.06 to 1.32 and PR=1.16, 95% CI 1.03 to 1.30, respectively); sex with drug use (PR=1.19, 95% CI 1.05 to 1.36); believing that HIV is transmitted by saliva (PR=1.20, 95% CI 1.08 to 1.33); and potential use of the oral test at home (PR=1.56, 95% CI 1.32 to 1.85). The only factor associated with lower acceptability was having had first anal intercourse between 14 and 19 years of age (PR=0.89, 95% CI 0.80 to 0.98).ConclusionsWe identified the individual factors associated with oral HIV test acceptability among Peruvian MSM and TGW. Expanded use of the oral HIV test to increase testing rates among Peruvian MSM and TGW is recommended.Trial registration numberNCT01387412, post-results.

Abstract 244: Racial Disparities In Cardiopulmonary Training Status in the United States

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Shaun K McGovern ◽  
Andrew Murray ◽  
Benjamin S Abella ◽  
Marion Leary ◽  
Audrey L Blewer
Keyword(s):  
Secondary Analysis ◽  
The United States ◽  
Training Status ◽  
Individual Level ◽  
Significant Difference ◽  
Chi Squared ◽  
Random Digit Dial ◽  
Nationally Representative ◽  
The Individual ◽  
Cpr Training

Background: Survival from out-of-hospital cardiac arrest varies by race, possibly due to poor penetration of CPR training in minority communities. Targeted trainings and campaigns to increase access to CPR education have sought to address these gaps, yet it is unknown if these initiatives have equalized training rates. Objectives: We sought to examine racial variation of CPR training status on the individual-level by assessing current CPR training and ever CPR trained status. We hypothesized that whites would be more likely to hold current CPR training and be ever trained in CPR compared to minorities. Methods: As a secondary analysis to a previous random digit dial survey of a nationally-representative adult sample, we defined CPR training status of individuals as currently trained (only ≤2 years) and ever trained. Chi-squared test and multivariate logistic regression were used to determine variation by race. Results: From 09/2015-11/2015, 9,022 individuals completed the national survey. Of those, 65% had been CPR trained at some point in time, while 18% reported being currently trained. Minorities were significantly less likely to ever be trained in CPR compared to whites (54.9% vs 70.8%, p<0.01). However, minorities and whites were equally as likely to be currently CPR trained (18.2% vs. 18.2%, p=0.99); no significant difference was found when adjusting for age, sex, and education (p=ns). Probability of training status by age displayed variation between groups (Figure 1). Conclusions: Significant disparities by race were observed in those ever trained in CPR, however no significant difference exists in attainment of current CPR training. Increased access to CPR education and targeted training campaigns may have closed the gap in current CPR training status disparities. Continued surveillance of CPR training rates is needed to monitor these findings over time.

Correlation of progression-free survival at 6 months (PFS6) with overall survival at 12 months (OS12) in an analysis of 10 trials of second-line therapy for advanced urothelial carcinoma (UC).

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 4525-4525 ◽  
Author(s):  
Benjamin Maughan ◽  
Kenneth M. Boucher ◽  
Neeraj Agarwal ◽  
Toni K. Choueiri ◽  
Angela Q. Qu ◽  
...  
Keyword(s):  
Phase Ii ◽  
Survival Data ◽  
Pearson Correlation ◽  
Second Line ◽  
Phase Ii Trials ◽  
Second Line Therapy ◽  
Individual Level ◽  
Line Therapy ◽  
The Individual ◽  
The Relationship

4525 Background: Second-line therapy of advanced UC is a significant unmet need. While phase II trials have relied on response rate (RR) as a primary endpoint, response may not be suitable for assessing cytostatic agents and does not capture duration of benefit. We hypothesized that PFS6 correlates with OS12 and may be a robust intermediate endpoint for phase II trials. Methods: Ten trials with individual patient progression and survival data (n=646) evaluating chemotherapy and/or biologics following chemotherapy were combined. Progression was defined as tumor progression (RECIST 1.0 in 9 trials, WHO in 1 trial), or death from any cause. Unadjusted and adjusted binomial confidence intervals for PFS6, OS12 and response were reported, with adjustment for variability between trials using random effects models. The relationship between PFS6 and OS12 was assessed at the trial level using Pearson correlation and weighted linear regression with larger studies having more influence. The relationship between PFS6 and OS12 at the individual level was assessed using Pearson chi-square test with Yates continuity correction. Statistical analyses employed “R” statistical computing software, version 2.8.0. Results: 59% had visceral metastasis and performance status was 0, 1 and 2 in 50, 39 and 8%, respectively. Median age was 65 years (31-88) and 77% were male. PFS6 was 22% (95% CI: 17-24%), and adjusted PFS6 was 23% (95% CI: 15-34%). The OS12 was 20% (95% CI: 17-24%), and adjusted OS12 was 21% (95% CI: 15-29%). The Pearson correlation between trial level PFS6 and OS12 was 0.66 (p = 0.037). The individual level agreement between PFS6 and OS12 was seen in 82% of patients (kappa = 0.45). Among 560 patients evaluable for response and OS, the RR was 22% (95% CI: 18-25%) and adjusted RR was 21% (95% CI: 13-32%). Trial level Pearson correlation between response and OS12 was 0.37 (p = 0.30), and individual level agreement was seen in 78% (kappa=0.36). Conclusions: PFS6 is associated with OS12 at the trial and individual levels in patients receiving second-line therapy for advanced UC. The association of response with OS was suboptimal. Validation of PFS6 is warranted.

Differential Effects of Competence and Morality on Self-Esteem at the Individual and the Collective Level

2020 ◽  
Vol 51 (3) ◽  
pp. 183-198
Author(s):  
Wiktor Soral ◽  
Mirosław Kofta
Keyword(s):  
Self Esteem ◽  
Differential Effects ◽  
Individual Level ◽  
The Subject ◽  
The Individual

Abstract. The importance of various trait dimensions explaining positive global self-esteem has been the subject of numerous studies. While some have provided support for the importance of agency, others have highlighted the importance of communion. This discrepancy can be explained, if one takes into account that people define and value their self both in individual and in collective terms. Two studies ( N = 367 and N = 263) examined the extent to which competence (an aspect of agency), morality, and sociability (the aspects of communion) promote high self-esteem at the individual and the collective level. In both studies, competence was the strongest predictor of self-esteem at the individual level, whereas morality was the strongest predictor of self-esteem at the collective level.

Metonymy in Dance: Ballet Bunheads Take a Cognitive Turn

2019 ◽  
Vol 37 (1) ◽  
pp. 18-34
Author(s):  
Edward C. Warburton
Keyword(s):  
Identity Formation ◽  
Cognitive Science ◽  
Artistic Development ◽  
Individual Level ◽  
Figures Of Speech ◽  
Self Image ◽  
Level I ◽  
Dance Educators ◽  
The Individual ◽  
Metaphor And Metonymy

This essay considers metonymy in dance from the perspective of cognitive science. My goal is to unpack the roles of metaphor and metonymy in dance thought and action: how do they arise, how are they understood, how are they to be explained, and in what ways do they determine a person's doing of dance? The premise of this essay is that language matters at the cultural level and can be determinative at the individual level. I contend that some figures of speech, especially metonymic labels like ‘bunhead’, can not only discourage but dehumanize young dancers, treating them not as subjects who dance but as objects to be danced. The use of metonymy to sort young dancers may undermine the development of healthy self-image, impede strong identity formation, and retard creative-artistic development. The paper concludes with a discussion of the influence of metonymy in dance and implications for dance educators.

Exploring the effect of weight loss on food reward at the individual level

2019 ◽  
Author(s):  
Pauline Oustric ◽  
Kristine Beaulieu ◽  
Nuno Casanova ◽  
Francois Husson ◽  
Catherine Gibbons ◽  
...  
Keyword(s):  
Weight Loss ◽  
Food Reward ◽  
Individual Level ◽  
The Individual

The “individual” in Johann Friedrich Overbeck’s and Franz Liszt’s Seven Sacraments

2013 ◽  
Vol 54 (4) ◽  
pp. 339-356
Author(s):  
Dolores Pesce
Keyword(s):  
Nineteenth Century ◽  
Franz Liszt ◽  
Individualized Treatment ◽  
Sacred Art ◽  
The Individual ◽  
Individual Voice ◽  
Emotional Effects ◽  
The Church

In the preface to his Septem sacramenta (1878–1884), Franz Liszt acknowledged its stimulus — drawings completed in 1862 by the German painter J. F. Overbeck (1789–1869). This essay explores what Liszt likely meant by his and Overbeck’s “diametrically opposed” approaches and speculates on why the composer nonetheless acknowledged the artist’s work. Each man adopted an individualized treatment of the sacraments, neither in line with the Church’s neo-Thomistic philosophy. Whereas the Church insisted on the sanctifying effects of the sacraments’ graces, Overbeck emphasized the sacraments as a means for moral edification, and Liszt expressed their emotional effects on the receiver. Furthermore, Overbeck embedded within his work an overt polemical message in response to the contested position of the pope in the latter half of the nineteenth century. For many in Catholic circles, he went too far. Both works experienced a problematic reception. Yet, despite their works’ reception, both Overbeck and Liszt believed they had contributed to the sacred art of their time. The very individuality of Overbeck’s treatment seems to have stimulated Liszt. True to his generous nature, Liszt, whose individual voice often went unappreciated, publicly recognized an equally individual voice in the service of the Church.

Personality change and environmental concerns

2020 ◽  
Author(s):  
Christopher James Hopwood ◽  
Ted Schwaba ◽  
Wiebke Bleidorn
Keyword(s):  
Personality Traits ◽  
Personality Change ◽  
Environmental Concerns ◽  
Big Five Personality ◽  
German Population ◽  
Individual Level ◽  
Sustainable Behavior ◽  
Nationally Representative ◽  
The Individual ◽  
Over Time

Personal concerns about climate change and the environment are a powerful motivator of sustainable behavior. People’s level of concern varies as a function of a variety of social and individual factors. Using data from 58,748 participants from a nationally representative German sample, we tested preregistered hypotheses about factors that impact concerns about the environment over time. We found that environmental concerns increased modestly from 2009-2017 in the German population. However, individuals in middle adulthood tended to be more concerned and showed more consistent increases in concern over time than younger or older people. Consistent with previous research, Big Five personality traits were correlated with environmental concerns. We present novel evidence that increases in concern were related to increases in the personality traits neuroticism and openness to experience. Indeed, changes in openness explained roughly 50% of the variance in changes in environmental concerns. These findings highlight the importance of understanding the individual level factors associated with changes in environmental concerns over time, towards the promotion of more sustainable behavior at the individual level.

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