What are the treatment remission, response and extent of improvement rates after up to four trials of antidepressant therapies in real-world depressed patients? A reanalysis of the STAR*D study's patient-level data with fidelity to the original research protocol.

Objective: Reanalyse the patient-level data set of the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study with fidelity to the original research protocol and related publications.

Design: The study was open label and semirandomised examining the effectiveness of up to four optimised and increasingly aggressive, antidepressant therapies in depressed adults. Patients who failed to gain adequate relief from their level 1 trial on the SSRI citalopram could receive up to three additional treatment trials in levels 2-4.

Considerations for development of pharmacy support models for COVID-19 alternate care sites.

Purpose: Guidance on alternate care site planning based on the experience of a health-system pharmacy department in preparing for an expected surge in coronavirus disease 2019 (COVID-19) cases is provided.

Summary: In disaster response situations such as the COVID-19 pandemic, healthcare institutions may be compelled to transition to a contingency care model in which staffing and supply levels are no longer consistent with daily practice norms and, while usual patient care practices are maintained, establishment of alternate care sites (eg, a convention center) may be necessitated by high patient volumes. Available resources to assist hospitals and health systems in alternate care site planning include online guidance posted within the COVID-19 resources section of the US Army Corps of Engineers website, which provides recommended medication and supply lists; and the Federal Healthcare Resilience Task Force's alternate care site toolkit, a comprehensive resource for all aspects of alternate care site planning, including pharmacy services.

The large footprint of small-scale artisanal gold mining in Ghana.

Gold mining has played a significant role in Ghana's economy for centuries. Regulation of this industry has varied over time and while industrial mining is prevalent in the country, the expansion of artisanal mining, or Galamsey has escalated in recent years. Many of these artisanal mines are not only harmful to human health due to the use of Mercury (Hg) in the amalgamation process, but also leave a significant footprint on terrestrial ecosystems, degrading and destroying forested ecosystems in the region.

The Fallacy of Sham-Controlled Neurofeedback Trials: A Reply to Thibault and Colleagues (2018).

Sham-controlled neurofeedback (NFB) trials consistently find no separation on ADHD outcome measures leading many to conclude that NFB's beneficial effects are due to placebo. We deconstruct the NFB training methodology and findings of six sham-controlled trials that assessed for evidence of learning. All six studies found no evidence NFB subjects learned to self-modulate the targeted electroencephalogram (EEG).

Developmental assistance for child and adolescent mental health in low- and middle-income countries (2007-2014): Annual trends and allocation by sector, project type, donors and recipients.

Background: Globally, mental disorders are the leading cause of disability among children and adolescents. To date, there has been no estimate of developmental assistance supporting mental health projects that target children and adolescents (DAMH-CA). This study aimed to identify, describe and analyse DAMH-CA with respect to annual trends (2007-2014), sector, project type, recipient regions, and top donor and recipient countries, and estimate annual DAMH-CA per child/adolescent by region.

Interventions for Children Affected by Armed Conflict: a Systematic Review of Mental Health and Psychosocial Support in Low- and Middle-Income Countries.

Over one billion children under the age of 18 live in countries affected by armed conflict. This systematic review replicates an earlier study, aiming to provide a comprehensive update of the most current developments in interventions for children affected by armed conflict. For the period 2009-2015, a total of 1538 records were collected from PubMed, PsycINFO, and PILOTS.

Multi-site six month outcome study of complex psychiatric patients evaluated with addition of brain SPECT imaging.

Background: Psychiatric diagnoses are made primarily through clinical histories, with psychiatrists searching for DSM (Diagnostic and Statistical Manual of Mental Disorders)-driven symptom clusters, and outcomes for patients have not substantially improved in decades for many disorders.

Primary Study Objective: In this study, the research team examined the outcome impact of the addition of single photon emission computed tomography (SPECT) to the assessment of complex patients.

Design: The research team designed a multisite, prospective, 6-mo outcome study.

Specific ways brain SPECT imaging enhances clinical psychiatric practice.

Our objective was to ascertain in a prospective case series how often brain single photon emission computed tomography (SPECT) neuroimaging adds relevant information for diagnosis and/or treatment beyond current standard assessment tools in complex psychiatric cases. Charts of 109 consecutively evaluated outpatients from four psychiatrics clinics that routinely utilize SPECT imaging for complex cases were analyzed in two stages. In stage one, psychiatrists reviewed detailed clinical histories, mental status exams, and the structured clinical interview for DSM-IV, but not the results of SPECT studies, assigned a diagnosis based on DSM-IV criteria, and then developed a comprehensive treatment plan.

Efficacy and effectiveness of antidepressants: current status of research.

Background: This paper examines the current status of research on the efficacy and effectiveness of antidepressants.

Methods: This paper reviews four meta-analyses of efficacy trials submitted to America's Food and Drug Administration (FDA) and analyzes STAR*D (Sequenced Treatment Alternatives to Relieve Depression), the largest antidepressant effectiveness trial ever conducted.

Results: Meta-analyses of FDA trials suggest that antidepressants are only marginally efficacious compared to placebos and document profound publication bias that inflates their apparent efficacy.

Linking outcomes analysis to critical clinical pathways.

Expert decision-support soft-ware systems, when integrated with outcomes analyses, provide the opportunity to develop behavioral healthcare delivery systems in which providers are equipped to act decisively in a socially responsible manner. Key benefits of such systems include: enhancing the consistency and quality of clinical decision making across providers with varying professional backgrounds; providing a mechanism to ensure the rapid dissemination and implementation of new clinical research findings; performing severity-adjusted profiling of providers and programs based on the outcomes their services produce; and linking the prospective focus of clinical pathways with the retrospective rigor of outcomes analysis to accelerate advances in behavioral health. Integrating expert systems with outcomes analyses has the potential to rectify the historical failure by the behavioral healthcare professions to systematically link patient assessment data and their analysis to actual clinical decision making.

Translating research into practice: the implementation of an in-home crisis intervention triage and treatment service in the private sector.

This report focuses on the implementation and evaluation of a 24-hour-a-day, in-home crisis intervention, triage, and treatment service in a 110,000 member health maintenance organization. The in-home crisis intervention service averted the need for hospitalization in 80% of referred patients presenting for inpatient admission. A two-year analysis, involving more than 600 patients, found nearly four times fewer severe psychiatric relapses requiring readmission among patients triaged by the crisis intervention service, compared to patients hospitalized without going through its service.

Further generalization technology: Accounting for natural covariation in generalization assessment.

In recent years, the assessment of generalization effects has become a major priority of applied behavior analysis. In this paper we propose a set of procedures to increase the accuracy of generalization assessments by accounting for the degree of natural covariation between treated and untreated behaviors. Scatterplot analyses were used (a) to assess the amount of baseline and postbaseline covariation between behaviors, (b) to determine if the observed generalization effect was due to a preexisting covariation between the behaviors, and (c) to assess if there is a significant change in the strength of the relationship between the behaviors as a function of the intervention.

The effects of reciprocal peer tutoring and group contingencies on the academic performance of elementary school children.

We evaluated the effects of reciprocal peer tutoring combined with group reinforcement contingencies on the arithmetic performance of 12 underachieving fifth-grade students. Results indicated that the intervention increased the students' arithmetic performance to a level indistinguishable from their classmates during treatment and 12-week follow-up phases. Pre-, post-, and follow-up sociometric data indicated that the students who participated in the treatment groups increased their amount of peer affiliation with other treatment group members.

Chronic hydradenitis suppurativa: a report of 9 cases.

This paper describes the treatment of 9 patients suffering from hydradenitis suppurativa all of whom were treated by surgical excision. The aetiology, diagnosis and treatment by surgical excision are discussed.

Malignant gonadal tumour formation in intersexual states.

Two cases of malignant tumour are reported in phenotypically male hermaphrodites. The importance of establishing the presence of persistent Müllerian duct structures in pseudo-hermaphrodites is discussed in relation to prophylactic castration in anticipation of malignant change.

The effect of intravenous Aminoplex 5 on serum gastrin and gastric secretion.

Aminoplex 5 (Geistlich Ltd), which contains the essential amino-acids in laevo form plus sorbitol and 5% ethanol, may be infused intravenously for at least one hour in patients who are undergoing prolonged nasogastric suction without fear of great gastric hypersecretion of acid.