Heterogeneity of major depressive disorder (MDD) illness course complicates clinical decision-making. Although efforts to use symptom profiles or biomarkers to develop clinically useful prognostic ...subtypes have had limited success, a recent report showed that machine-learning (ML) models developed from self-reports about incident episode characteristics and comorbidities among respondents with lifetime MDD in the World Health Organization World Mental Health (WMH) Surveys predicted MDD persistence, chronicity and severity with good accuracy. We report results of model validation in an independent prospective national household sample of 1056 respondents with lifetime MDD at baseline. The WMH ML models were applied to these baseline data to generate predicted outcome scores that were compared with observed scores assessed 10-12 years after baseline. ML model prediction accuracy was also compared with that of conventional logistic regression models. Area under the receiver operating characteristic curve based on ML (0.63 for high chronicity and 0.71-0.76 for the other prospective outcomes) was consistently higher than for the logistic models (0.62-0.70) despite the latter models including more predictors. A total of 34.6-38.1% of respondents with subsequent high persistence chronicity and 40.8-55.8% with the severity indicators were in the top 20% of the baseline ML-predicted risk distribution, while only 0.9% of respondents with subsequent hospitalizations and 1.5% with suicide attempts were in the lowest 20% of the ML-predicted risk distribution. These results confirm that clinically useful MDD risk-stratification models can be generated from baseline patient self-reports and that ML methods improve on conventional methods in developing such models.
Days out of role because of health problems are a major source of lost human capital. We examined the relative importance of commonly occurring physical and mental disorders in accounting for days ...out of role in 24 countries that participated in the World Health Organization (WHO) World Mental Health (WMH) surveys. Face-to-face interviews were carried out with 62 971 respondents (72.0% pooled response rate). Presence of ten chronic physical disorders and nine mental disorders was assessed for each respondent along with information about the number of days in the past month each respondent reported being totally unable to work or carry out their other normal daily activities because of problems with either physical or mental health. Multiple regression analysis was used to estimate associations of specific conditions and comorbidities with days out of role, controlling by basic socio-demographics (age, gender, employment status and country). Overall, 12.8% of respondents had some day totally out of role, with a median of 51.1 a year. The strongest individual-level effects (days out of role per year) were associated with neurological disorders (17.4), bipolar disorder (17.3) and post-traumatic stress disorder (15.2). The strongest population-level effect was associated with pain conditions, which accounted for 21.5% of all days out of role (population attributable risk proportion). The 19 conditions accounted for 62.2% of all days out of role. Common health conditions, including mental disorders, make up a large proportion of the number of days out of role across a wide range of countries and should be addressed to substantially increase overall productivity.
The gut of healthy human neonates is usually devoid of viruses at birth, but quickly becomes colonized, which-in some cases-leads to gastrointestinal disorders
. Here we show that the assembly of the ...viral community in neonates takes place in distinct steps. Fluorescent staining of virus-like particles purified from infant meconium or early stool samples shows few or no particles, but by one month of life particle numbers increase to 10
per gram, and these numbers seem to persist throughout life
. We investigated the origin of these viral populations using shotgun metagenomic sequencing of virus-enriched preparations and whole microbial communities, followed by targeted microbiological analyses. Results indicate that, early after birth, pioneer bacteria colonize the infant gut and by one month prophages induced from these bacteria provide the predominant population of virus-like particles. By four months of life, identifiable viruses that replicate in human cells become more prominent. Multiple human viruses were more abundant in stool samples from babies who were exclusively fed on formula milk compared with those fed partially or fully on breast milk, paralleling reports that breast milk can be protective against viral infections
. Bacteriophage populations also differed depending on whether or not the infant was breastfed. We show that the colonization of the infant gut is stepwise, first mainly by temperate bacteriophages induced from pioneer bacteria, and later by viruses that replicate in human cells; this second phase is modulated by breastfeeding.
Objective: Although social phobia is common, treatment remains low. In order to gauge public health implications of this low treatment, information is needed on the impairments caused by social ...phobia.
Method: A computer literature review searched for the terms ‘social anxiety disorder’ and ‘social phobia’ in the MEDLINE and PsycLIT databases. New analyses were carried out in the US National Comorbidity Survey.
Results: The literature shows that social phobia has serious effects on role functioning and quality of life. These effects are least severe for pure non‐generalized social phobia and most severe for comorbid generalized social phobia with avoidant personality disorder. The most direct impairments involve social interactions and information processing errors in these interactions. Indirect effects are even more important. Three indirect effects are highlighted: effects on secondary mental (e.g. depression), substance (e.g. alcoholism) and physical (e.g. cardiovascular disease) disorders; effects on normative role transitions (e.g. educational attainment); and effects on help‐seeking.
Conclusion: Given the early age of onset and impacts on secondary disorders and early adult life course transitions, the greatest public health impact of increasing treatment of social phobia is likely to be achieved by developing programs targeted at early identification and treatment through schools.
To examine cross-national patterns and correlates of lifetime and 12-month comorbid DSM-IV anxiety disorders among people with lifetime and 12-month DSM-IV major depressive disorder (MDD).
Nationally ...or regionally representative epidemiological interviews were administered to 74 045 adults in 27 surveys across 24 countries in the WHO World Mental Health (WMH) Surveys. DSM-IV MDD, a wide range of comorbid DSM-IV anxiety disorders, and a number of correlates were assessed with the WHO Composite International Diagnostic Interview (CIDI).
45.7% of respondents with lifetime MDD (32.0-46.5% inter-quartile range (IQR) across surveys) had one of more lifetime anxiety disorders. A slightly higher proportion of respondents with 12-month MDD had lifetime anxiety disorders (51.7%, 37.8-54.0% IQR) and only slightly lower proportions of respondents with 12-month MDD had 12-month anxiety disorders (41.6%, 29.9-47.2% IQR). Two-thirds (68%) of respondents with lifetime comorbid anxiety disorders and MDD reported an earlier age-of-onset (AOO) of their first anxiety disorder than their MDD, while 13.5% reported an earlier AOO of MDD and the remaining 18.5% reported the same AOO of both disorders. Women and previously married people had consistently elevated rates of lifetime and 12-month MDD as well as comorbid anxiety disorders. Consistently higher proportions of respondents with 12-month anxious than non-anxious MDD reported severe role impairment (64.4 v. 46.0%; χ 2 1 = 187.0, p < 0.001) and suicide ideation (19.5 v. 8.9%; χ 2 1 = 71.6, p < 0.001). Significantly more respondents with 12-month anxious than non-anxious MDD received treatment for their depression in the 12 months before interview, but this difference was more pronounced in high-income countries (68.8 v. 45.4%; χ 2 1 = 108.8, p < 0.001) than low/middle-income countries (30.3 v. 20.6%; χ 2 1 = 11.7, p < 0.001).
Patterns and correlates of comorbid DSM-IV anxiety disorders among people with DSM-IV MDD are similar across WMH countries. The narrow IQR of the proportion of respondents with temporally prior AOO of anxiety disorders than comorbid MDD (69.6-74.7%) is especially noteworthy. However, the fact that these proportions are not higher among respondents with 12-month than lifetime comorbidity means that temporal priority between lifetime anxiety disorders and MDD is not related to MDD persistence among people with anxious MDD. This, in turn, raises complex questions about the relative importance of temporally primary anxiety disorders as risk markers v. causal risk factors for subsequent MDD onset and persistence, including the possibility that anxiety disorders might primarily be risk markers for MDD onset and causal risk factors for MDD persistence.
Research on the structure of co-morbidity among common mental disorders has largely focused on current prevalence rather than on the development of co-morbidity. This report presents preliminary ...results of the latter type of analysis based on the US National Comorbidity Survey Replication Adolescent Supplement (NCS-A).
A national survey was carried out of adolescent mental disorders. DSM-IV diagnoses were based on the Composite International Diagnostic Interview (CIDI) administered to adolescents and questionnaires self-administered to parents. Factor analysis examined co-morbidity among 15 lifetime DSM-IV disorders. Discrete-time survival analysis was used to predict first onset of each disorder from information about prior history of the other 14 disorders.
Factor analysis found four factors representing fear, distress, behavior and substance disorders. Associations of temporally primary disorders with the subsequent onset of other disorders, dated using retrospective age-of-onset (AOO) reports, were almost entirely positive. Within-class associations (e.g. distress disorders predicting subsequent onset of other distress disorders) were more consistently significant (63.2%) than between-class associations (33.0%). Strength of associations decreased as co-morbidity among disorders increased. The percentage of lifetime disorders explained (in a predictive rather than a causal sense) by temporally prior disorders was in the range 3.7-6.9% for earliest-onset disorders specific phobia and attention deficit hyperactivity disorder (ADHD) and much higher (23.1-64.3%) for later-onset disorders. Fear disorders were the strongest predictors of most other subsequent disorders.
Adolescent mental disorders are highly co-morbid. The strong associations of temporally primary fear disorders with many other later-onset disorders suggest that fear disorders might be promising targets for early interventions.
Abstract
The unknown cause of the correlation between Type Ia supernova (SN Ia) Hubble residuals and their host-galaxy masses (the “mass step”) may bias cosmological parameter measurements. To better ...understand the mass step, we develop a SALT3 light-curve model for SN cosmology that uses the host-galaxy masses of 296 low-redshift SNe Ia to derive a spectral energy distribution–host-galaxy mass relationship. The resulting model has larger Ca
ii
H and K, Ca
ii
near-infrared triplet, and Si
ii
equivalent widths for SNe in low-mass host galaxies at 2.2–2.7
σ
significance; this indicates higher explosion energies per unit mass in low-mass-hosted SNe. The model has phase-dependent changes in SN Ia colors as a function of host mass, indicating intrinsic differences in mean broadband light curves. Although the model provides a better fit to the SN data overall, it does not substantially reduce data–model residuals for a typical light curve in our sample nor does it significantly reduce Hubble residual dispersion. This is because we find that previous SALT models parameterized most host-galaxy dependencies with their first principal component, although they failed to model some significant spectral variations. Our new model is luminosity and cosmology independent, and applying it to data reduces the mass step by 0.021 ± 0.002 mag (uncertainty accounts for correlated data sets); these results indicate that ∼35% of the mass step can be attributed to luminosity-independent effects. This SALT model version could be trained using alternative host-galaxy properties and at different redshifts, and therefore will be a tool for understanding redshift-dependent correlations between SNe Ia and their host properties as well as their impact on cosmological parameter measurements.
We use 1169 Pan-STARRS supernovae (SNe) and 195 low-z (z < 0.1) SNe Ia to measure cosmological parameters. Though most Pan-STARRS SNe lack spectroscopic classifications, in a previous paper we ...demonstrated that photometrically classified SNe can be used to infer unbiased cosmological parameters by using a Bayesian methodology that marginalizes over core-collapse (CC) SN contamination. Our sample contains nearly twice as many SNe as the largest previous SN Ia compilation. Combining SNe with cosmic microwave background (CMB) constraints from Planck, we measure the dark energy equation-of-state parameter w to be −0.989 0.057 (stat+sys). If w evolves with redshift as w(a) = w0 + wa(1 − a), we find w0 = −0.912 0.149 and wa = −0.513 0.826. These results are consistent with cosmological parameters from the Joint Light-curve Analysis and the Pantheon sample. We try four different photometric classification priors for Pan-STARRS SNe and two alternate ways of modeling CC SN contamination, finding that no variant gives a w differing by more than 2% from the baseline measurement. The systematic uncertainty on w due to marginalizing over CC SN contamination, , is the third-smallest source of systematic uncertainty in this work. We find limited (1.6 ) evidence for evolution of the SN color-luminosity relation with redshift, a possible systematic that could constitute a significant uncertainty in future high-z analyses. Our data provide one of the best current constraints on w, demonstrating that samples with ∼5% CC SN contamination can give competitive cosmological constraints when the contaminating distribution is marginalized over in a Bayesian framework.
Poly(methyl methacrylate) (PMMA)-based dielectric materials are of prime interest for many electronic and power devices. However, the low dielectric constant and hydrophobic nature of PMMA limit its ...success in many applications. This work presents an environmentally friendly approach to surface-functionalize PMMA, exploring the use of dopamine (DOPA), to develop multifunctional polymers with enhanced dielectric properties. The reaction of dopamine with plasma pre-activated PMMA was carried out in an aqueous medium without using any toxic chemicals. The functionalized PMMA films exhibited enhanced dielectric properties compared to pristine PMMA films. As an example, below 100 Hz, the dielectric constant of functionalized PMMA films increased by 70% compared to pristine PMMA films. Interestingly, functionalization changed the storage modulus and the T sub(g) of PMMA. The enhanced dielectric properties of the functionalized PMMA films may originate from the excellent intrinsic properties of DOPA, which was effectively functionalized on the surface of PMMA.
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