Site differences in treatment outcomes are not often highlighted when the results of multisite randomized clinical trials (MRCTs) are reported. In the primary analyses of a six-site MRCT, the ...Treatment of SSRI-resistant Depression in Adolescents (TORDIA), there was substantial variation by site in the performance of a medication-only condition and a combined medication plus Cognitive Behavioral Therapy (CBT) condition. Two potential primary causes of site differences in MRCT outcomes are examined in this paper: sampling factors, particularly clinical characteristics of participants, and treatment protocol factors, particularly fidelity. We found that differences in the clinical characteristics of participants at baseline across-site and within-site/across conditions were the most salient explanators for site differences and differences within sites across conditions in outcome. Study findings are discussed with respect to the overall study outcomes in TORDIA as well as MRCTs in general.
An electronic decision support tool based on a binary integer program has been designed for use by Capital Program Coordination (CPC) in the Royal Canadian Navy. By indicating the optimal allocation ...of the budget (planning space) for the next three years, this tool can quickly and effectively assist financial planners in making decisions that will result in the adoption of more valuable non-strategic projects over the long term. A simple online algorithm that can guide financial planners when deciding to adopt certain projects each year has also been developed: CPC should not adopt a Low or Medium Priority project by using the final 40 percent of planning space in any given year. This new approach has improved the objective function by significantly reducing the number of times that the adoption of a High Priority project is delayed throughout the planning horizon over several simulation trials. Keywords: Operations Research, Military Financial Planning, Online Algorithm
We explore the interactions between optimal mass transport theory and the geometry of the underlying (and other related) spaces. In particular, we present a sketch of the proof of Luis Caffarelli's ...contraction theorem and consider its geometric consequences and possible extensions, especially in the context of spherical geometry. We study also the concept of Hessian metrics — one of the geometric tools implemented by Eugenio Calabi in his investigation of the properties of solutions of the general Monge-Ampère equation for the Euclidean space ( R n, dRn) — and we summarize one of the significant contributions arising from Calabi's work as a lower Ricci curvature bound. In the end, we give an exposition of the author's recent results concerning modified Hessian pseudo-metrics. These results generalize a portion of Calabi's theory of Hessian metrics to n-dimensional space forms of constant positive sectional curvature and lead to new lower Ricci curvature bounds. We emphasize throughout this dissertation those connections relating the theory of optimal mass transport and curvature bounds.
The Structured Interview for the DSM-III Personality Disorders was administered to 23 currently affectively ill adolescents and their parents. Interviews were videotaped and rerated; interrater ...agreement was moderate (weighted K = 0.49; unweighted K = 0.59). Moreover, there was evidence of convergent validity for Cluster II traits and disorders (borderline, histrionic, narcissistic), insofar as these diagnoses were associated with higher scores on the novelty-seeking subscale of the Tridimensional Personality Questionnaire as predicted. Cluster II patients tended to have higher rates of attention deficit disorder and bipolar disorder, and higher rates of suicidal gestures among second-degree relatives. Some difficulty was encountered differentiating symptoms of affective illness from those of personality disorder and in deciding when personality traits were impairing enough to call them disorders. Reliability may be improved by: (1) interviewing patients when out of affective episode; and (2) using standardized functional impairment criteria for differentiating personality style from disorder. Additional work is advocated to learn if personality disorders are precursors, epiphenomena, or the consequences of affective disorder.
Objective: To compare clinical features of depressed subjects without alcoholism but with a family history of alcoholism to a depressed group without alcoholism and without a family history of ...alcoholism.
Method: Clinical and demographic data of 209 depressed subjects without a history of alcoholism in first‐degree relatives and 73 depressed individuals with a history of alcoholism in first‐degree relatives were compared. Subjects with a personal history of alcoholism were excluded.
Results: Depressed subjects with a family history of alcoholism have a significantly higher prevalence of reported childhood physical and sexual abuse and post‐traumatic stress disorder (PTSD), make more suicide attempts, and have greater intent to die at the time of their most lethal suicide attempt, compared to depressed subjects without a family history of alcoholism.
Conclusion: Depressed patients with a family history of alcoholism are at greater risk for suicidal behavior and PTSD and may require more careful management.
Whether offspring of parents with bipolar disorder (BP) are at specifically high risk to develop BP and other psychiatric disorders has not been adequately studied.
To evaluate lifetime prevalence ...and specificity of psychiatric disorders in offspring of parents with BP-I and BP-II.
Offspring aged 6 to 18 years who have parents with BP and community control subjects were interviewed with standardized instruments. All research staff except the statistician were blind to parental diagnoses.
Parents with BP were recruited primarily through advertisement and outpatient clinics. Control parents were ascertained by random-digit dialing and were group matched for age, sex, and neighborhood to parents with BP.
Three hundred eighty-eight offspring of 233 parents with BP and 251 offspring of 143 demographically matched control parents.
Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) Axis I disorders.
Adjusting for demographic factors, living with 1 vs both biological parents, both biological parents' non-BP psychopathology, and within-family correlations, offspring of parents with BP showed high risk for BP spectrum disorders (odds ratio OR = 13.4; 95% confidence interval CI, 2.9-61.6) and any mood (OR = 5.2; 95% CI, 2.3-11.4), anxiety (OR = 2.3; 95% CI, 1.3-4.0), and Axis I (OR = 2.2; 95% CI, 1.5-3.3) disorders. Offspring of parents with BP with high socioeconomic status showed more disruptive behavior disorders and any Axis I disorders than offspring of control parents with high socioeconomic status. Families in which both parents had BP had more offspring with BP than families with only 1 parent with BP (OR = 3.6; 95% CI, 1.1-12.2). More than 75.0% of offspring who developed BP had their first mood episode before age 12 years, with most of these episodes meeting criteria for BP not otherwise specified and, to a lesser degree, major depression.
Offspring of parents with BP are at high risk for psychiatric disorders and specifically for early-onset BP spectrum disorders. These findings further support the familiality and validity of BP in youth and indicate a need for early identification and treatment.
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