Faith E. Parsons

Centralized, Stepped, Patient Preference-Based Treatment for Patients With Post-Acute Coronary Syndrome Depression CODIACS Vanguard Randomized Controlled Trial

IMPORTANCE Controversy remains about whether depression can be successfully managed after acute coronary syndrome (ACS) and the costs and benefits of doing so. OBJECTIVE To determine the effects of providing post-ACS depression care on depressive symptoms and health care costs. DESIGN Multicenter randomized controlled trial. SETTING Patients were recruited from 2 private and 5 academic ambulatory centers across the United States. PARTICIPANTS A total of 150 patients with elevated depressive symptoms (Beck Depression Inventory [BDI] score ≥10) 2 to 6 months after an ACS, recruited between March 18, 2010, and January 9, 2012. INTERVENTIONS Patients were randomized to 6 months of centralized depression care (patient preference for problem-solving treatment given via telephone or the Internet, pharmacotherapy, both, or neither), stepped every 6 to 8 weeks (active treatment group; n = 73), or to locally determined depression care after physician notification about the patients depressive symptoms (usual care group; n = 77). MAIN OUTCOME MEASURES Change in depressive symptoms during 6 months and total health care costs. RESULTS Depressive symptoms decreased significantly more in the active treatment group than in the usual care group (differential change between groups, -3.5 BDI points; 95% CI, -6.1 to -0.7; P = .01). Although mental health care estimated costs were higher for active treatment than for usual care, overall health care estimated costs were not significantly different (difference adjusting for confounding, -

Dimensional structure and correlates of posttraumatic stress symptoms following suspected acute coronary syndrome

325; 95% CI, -

Design and baseline data from the vanguard of the Comparison of Depression Interventions after Acute Coronary Syndrome (CODIACS) randomized controlled trial.

2639 to

Treatment rates for PTSD and depression in recently hospitalized cardiac patients

1989; P = .78). CONCLUSIONS For patients with post-ACS depression, active treatment had a substantial beneficial effect on depressive symptoms. This kind of depression care is feasible, effective, and may be cost-neutral within 6 months; therefore, it should be tested in a large phase 3 pragmatic trial. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01032018.

The discovery of the ‘transient’ male Tibetan wild ass: alternative ‘sneaky’ mating tactics in a wild equid?

BACKGROUND Posttraumatic stress disorder (PTSD) is a heterogeneous construct, and some have suggested that PTSD triggered by acute coronary syndrome (ACS) may differ from PTSD due to prototypical traumas. METHODS We conducted the first examination of the latent structure of PTSD symptoms after suspected ACS in 399 adults in the REactions to Acute Care and Hospitalization (REACH) study, an observational cohort study of patients recruited from the emergency department during evaluation for ACS. Using confirmatory factor analysis, we compared the 4-factor dysphoria, 4-factor numbing, and 5-factor dysphoric arousal models of PTSD. RESULTS Although all models fit well, the dysphoria model was selected as the best-fitting model. Further, there was measurement invariance of the dysphoria model by sex. PTSD dimensions evidenced differential associations with indicators of threat perception during ACS evaluation and adherence to cardioprotective medication. LIMITATIONS One limitation of this investigation is the use of self-report measures. In addition, only one-third of the sample was diagnosed with ACS at discharge; the remaining participants received diagnoses such as chest pain without a cardiac diagnosis, another symptom/disease process (e.g., hypertensive chronic kidney disease), or another cardiac disease. CONCLUSIONS Findings suggest that suspected ACS-related PTSD symptoms are best-represented by a 4-factor structure distinguishing between specific (e.g., re-experiencing) and non-specific (dysphoria) symptoms of PTSD that has received support in the broader PTSD literature.

The temporal multimodal influence of optical and auditory cues on the repellent behaviour of ring-billed gulls (Larus delewarensis)

This paper describes the rationale and design of the vanguard for the Comparison of Depression Interventions after Acute Coronary Syndrome (CODIACS), a multicenter, randomized, controlled trial of a patient preference-based, stepped care protocol for persistent depressive symptoms after acute coronary syndrome (ACS). The overall aim of the vanguard phase was to determine whether the patient-preference, stepped care protocol, which is based on the intervention used in the recent Coronary Psychosocial Evaluation Studies (COPES) trial, was feasible in patients with recent ACS who were recruited from 5 geographically diverse sites. Innovative design features of this trial include randomization to either initial patient-preference of treatment or to a referred care arm in which the primary care provider decided upon care. Additionally, delivery of psychotherapy was accomplished by telephone, or webcam, depending upon patient preference. The vanguard phase provides estimates of eligibility and screening/enrollment ratios, patient acceptance of screening, and retention. In this report, we describe the innovative features and the baseline results of the vanguard phase of CODIACS. The data from this vanguard study will be used to finalize planning for a large, phase III clinical trial designed to evaluate the effect of treatment on depressive symptoms, coronary events, and death.

Comparison of Different Algorithms for Sentiment Analysis: Psychological Stress Notes

OBJECTIVE Posttraumatic stress disorder (PTSD) and depression are common after evaluation for suspected acute coronary syndrome (ACS), and are associated with poor prognosis. However, it is unclear whether patients discharged after suspected ACS access treatments for subsequent psychological distress. We examined self-reported rates of receiving psychotherapy and/or medication for psychological distress in patients one month after a suspected ACS event. METHODS A sample of 448 adults (age 60.4±12.5; 47.8% female; 52.7% Hispanic, 32.1% Black) presenting to the emergency department with suspected ACS were recruited for the REactions to Acute Care and Hospitalization (REACH) study, an ongoing cohort study of medical and psychological outcomes after ACS evaluation. Socio-demographics and depressive symptoms were assessed in-hospital, and PTSD symptoms related to the suspected ACS event were queried via phone one month after enrollment. Participants also indicated whether they received either medication or counseling to deal with their emotions and coping after their heart problem. RESULTS Approximately 15% (n=68) of the sample reported receiving some form of treatment. Treatment rate did not differ significantly as a function of demographics, ACS status, or insurance coverage, ps>0.1. Over a quarter of participants (25.3%) who screened positive for PTSD and/or depression reported receiving treatment. Participants with PTSD and depression had a higher treatment rate (47.6%) vs. those with only depression (12.8%) or PTSD (30%) or no psychopathology (10.3%). CONCLUSION Findings suggest that 1 in 4 patients who screened positive for PTSD and/or depression reported receiving counseling or medication in the first month after a suspected ACS event.

Using SAS® Arrays to Calculate Bouts of Moderate to Vigorous Physical Activity from Minute-by-Minute Fitbit Data

Male asses usually consist of two classes, social bachelors and solitary, territorial males. However, our observations of the Tibetan wild ass (Equus kiang) suggested a third class may exist. Unexpectedly, unidentified males were often found courting females within another male’s territory. To test our hypothesis that a new social class existed, we compared 12 social behaviours among three putative groups. The third male-type spent less time herding and demonstrating flehmen, while spending more time retreating, trotting and in proximity of females, where they were more likely to engage in courtship and urine-marking. Based on increased time spent among females within other territories, the most courtship events, and minimal time invested in each courtship, they appear to employ ‘sneaky’ mating tactics. We discuss whether these ‘transient’ males are demonstrating an adaptive alternative mating strategy, or whether these behaviours result from a discrete developmental stage of bachelors unready to challenge a rival.

Using Behavioral Analytics to Increase Exercise: A Randomized N-of-1 Study

Abstract Context. A generation of new animal repellents is based on the premise that threat stimuli are best interpreted through multiple sensory pathways. Ring-billed gulls (RBG; Larus delawarensis) offer a unique opportunity to assess the efficacy of multimodal repellents over time. This pest species is repelled by both auditory and optical cues and persists in stable populations, often remaining in the same colony for life. This distinctive attribute makes it possible to assess colonies independently over time and space. Aims. We assessed the unimodal (single-cue treatment) and multimodal (paired-cue) response by RBG to auditory (conspecific distress call) and optical (green or red laser) cues, along with a double-negative control (flashlight aimed at ground, background noise). Methods. All stimuli were investigated separately and together within a 3 × 2 factorial design randomised by treatment and site. We predicted that paired stimuli would generate more pronounced (number of gulls fleeing from a roost) and faster (flight initiation time) responses than stimuli presented alone with a control. Key results. The distress call was more effective than either visual signal and almost nullified our ability to detect a multimodal response. However, the multimodal influence was detected on two levels. Gulls were more likely to flee from either paired treatment (optical + auditory) than from unimodal stimuli (laser light only; P < 0.001) and gulls fled more quickly from multiple cues (P < 0.001). A more subtle, but important, benefit was observed in that – over time – gulls were more likely to flee from either paired treatment (optical or auditory), but not from unimodal treatments (P < 0.005). The latter response may have been due to a fear-conditioned generalisation. Conclusions. We provide evidence and a causal mechanism to address why multimodal stimuli may be more efficacious as deterrents than single-mode treatments. This species may be more effectively managed, over longer periods of time, through the use of multimodal repellents. Implications. A better understanding of how multimodal repellents function may help frame novel approaches to animal conservation and to assay better tools and repellents for wildlife management. Even modest multimodal benefits may justify their use, if they delay habituation over time.

The Influence of Daily Stress on Sedentary Behavior: Group and Person (N of 1) Level Results of a 1-Year Observational Study

To visualize and compare three text analysis algorithms of sentiment (AFINN, Bing, Syuzhet), applied to 1549 ecologically assessed self-report stress notes obtained by smartphone, in order to gain insights about stress measurement and management.