Does stage of illness impact treatment response in bipolar disorder? Empirical treatment data and their implication for the staging model and early intervention

Objective: The staging model suggests that early stages of bipolar disorder respond better to treatments and have a more favourable prognosis. This study aims to provide empirical support for the model, and the allied construct of early intervention.

Methods: Pooled data from mania, depression, and maintenance studies of olanzapine were analyzed. Individuals were categorized as having had 0, 1–5, 6–10, or >10 prior episodes of illness, and data were analyzed across these groups.

Results: Response rates for the mania and maintenance studies ranged from 52–69% and 10–50%, respectively, for individuals with 1–5 previous episodes, and from 29–59% and 11–40% for individuals with >5 previous episodes. These rates were significantly higher for the 1–5 group on most measures of response with up to a twofold increase in the chance of responding for those with fewer previous episodes. For the depression studies, response rates were significantly higher for the 1–5 group for two measures only. In the maintenance studies, the chance of relapse to either mania or depression was reduced by 40–60% for those who had experienced 1–5 episodes or 6–10 episodes compared to the >10 episode group, respectively. This trend was statistically significant only for relapse into mania for the 1–5 episode group (p = 0.005).

Conclusion: Those individuals at the earliest stages of illness consistently had a more favourable response to treatment. This is consistent with the staging model and

Setting the stage : from prodrome to treatment resistance in bipolar disorder

Bipolar disorder is common, and both difficult to detect and diagnose. Treatment is contingent on clinical needs, which differ according to phase and stage of the illness. A staging model could allow examination of the longitudinal course of the illness and the temporal impact of interventions and events. It could allow for a structured examination of the illness, which could set the stage for algorithms that are tailored to the individuals needs. A staging model could further provide as structure for assessment, gauging treatment and outcomes. The model incorporates prodromal stages and emphasizes early detection and algorithm appropriate intervention where possible. At the other end of the spectrum, the model attempts to operationalize treatment resistance. The utility of the model will need to be validated by empirical research.

A stage model of intranet technology implementation and management

In the seventies, Nolan was the first to address the need for a descriptive stage theory concerning the planning, organizing, and controlling activities associated with managing the organizational computer resource. The arrival of newer technologies such as those based on the Internet calls for fresh approaches in terms of their implementation and management. Intranet technology – which is based on Internet technology – differs from other types of IT in terms of its use and implementation. We propose a four-stage model for intranet implementation and management. Each stage is portrayed by seven general characteristics. We propose that in order to ensure intranet institutionalization, three existential crises must be overcome. Firstly, if the intranet is not nurtured by a sponsor it cannot evolve beyond its experimental beginnings. Secondly, if a critical mass of both users and content cannot be reached simultaneously, the intranet will not progress. Finally, if the intranet remains uncontrolled, it will be perceived to be useless and therefore users will abandon it.

Managing the crises in intranet implementation : a stage model

In the seventies, Nolan was the first to address the need for a descriptive stage theory concerning the planning, organizing and controlling activities associated with managing the organizational computer resource. The arrival of newer technologies, such as those based on the Internet, calls for fresh approaches in terms of their implementation and management. Intranet technology, which is based on Internet technology, differs from other types of IT in terms of its characteristics, use and implementation. We propose a four-stage model for intranet implementation and management. Each stage is portrayed by seven general characteristics. We propose that, in order to ensure intranet institutionalization, three existential crises must be overcome. First, if a sponsor does not nurture the intranet, it cannot evolve beyond its experimental beginnings. Second, if a critical mass of both users and content cannot be reached simultaneously, the intranet will not progress. Finally, if the intranet remains uncontrolled, it will be perceived to be useless, and therefore users will abandon it.

Chemical immobilization of adult female Weddell seals with tiletamine and zolazepam: effects of age, condition and stage of lactation

Background

Chemical immobilization of Weddell seals (Leptonychotes weddellii) has previously been, for the most part, problematic and this has been mainly attributed to the type of immobilizing agent used. In addition to individual sensitivity, physiological status may play an important role. We investigated the use of the intravenous administration of a 1:1 mixture of tiletamine and zolazepam (Telazol®) to immobilize adult females at different points during a physiologically demanding 5–6 week lactation period. We also compared performance between IV and IM injection of the same mixture.
Results

The tiletamine:zolazepam mixture administered intravenously was an effective method for immobilization with no fatalities or pronounced apnoeas in 106 procedures; however, there was a 25 % (one animal in four) mortality rate with intramuscular administration. Induction time was slightly longer for females at the end of lactation (54.9 ± 2.3 seconds) than at post-parturition (48.2 ± 2.9 seconds). In addition, the number of previous captures had a positive effect on induction time. There was no evidence for effects due to age, condition (total body lipid), stage of lactation or number of captures on recovery time.
Conclusion

We suggest that intravenous administration of tiletamine and zolazepam is an effective and safe immobilizing agent for female Weddell seals. Although individual traits could not explain variation in recovery time, we suggest careful monitoring of recovery times during longitudinal studies (> 2 captures). We show that physiological pressures do not substantially affect response to chemical immobilization with this mixture; however, consideration must be taken for differences that may exist for immobilization of adult males and juveniles. Nevertheless, we recommend a mass-specific dose of 0.50 – 0.65 mg/kg for future procedures with adult female Weddell seals and a starting dose of 0.50 mg/kg for other age classes and other phocid seals.

Harajuku : urban stage-set Q & A

Harajuku is arguably one of the most exciting and vibrant fashion precincts of Tokyo. Through a series of questions and answers, Harajuku Urban Stage-Set captures the urban character of the precinct and the complexity of that unique place

Dramatic stage lights ON/OFF

A sound effect of stage lights coming on with a sense of drama . . . a great stinger to accompany the imagery of lights being turned on and off.

Detecting K-complexes for sleep stage identification using nonsmooth optimisation

The process of sleep stage identification is a labour-intensive task that involves the specialized interpretation of the polysomnographic signals captured from a patient’s overnight sleep session. Automating this task has proven to be challenging for data mining algorithms because of noise, complexity and the extreme size of data. In this paper we apply nonsmooth optimization to extract key features that lead to better accuracy. We develop a specific procedure for identifying K-complexes, a special type of brain wave crucial for distinguishing sleep stages. The procedure contains two steps. We first extract “easily classified” K-complexes, and then apply nonsmooth optimization methods to extract features from the remaining data and refine the results from the first step. Numerical experiments show that this procedure is efficient for detecting K-complexes. It is also found that most classification methods perform significantly better on the extracted features.

A two stage vector quantization approach via self-organizing map

In this paper, a two-stage algorithm for vector quantization is proposed based on a self-organizing map (SOM) neural network. First, a conventional self-organizing map is modified to deal with dead codebooks in the learning process and is then used to obtain the codebook distribution structure for a given set of input data. Next, subblocks are classified based on the previous structure distribution with a prior criteria. Then, the conventional LBG algorithm is applied to these sub-blocks for data classification with initial values obtained via the SOM. Finally, extensive simulations illustrate that the proposed two-stage algorithm is very effective.