A Promising New Strategy to Improve Treatment Outcomes for Patients with Depression.

Each year, ineffective medical management of patients with mental illness compromises the health and well-being of individuals, and also impacts communities and our society. A variety of interrelated factors have impeded the health system's ability to treat patients with behavior health conditions adequately. A key contributing factor is a lack of objective markers to help predict patient response to specific drugs that has led to patterns of "trial and error" prescribing. For many years, clinicians have sought objective data (eg, a laboratory or imaging test) to assist them in selecting appropriate treatments for individual patients. Electroencephalogram (EEG) findings coupled with medication outcomes data may provide a solution. "Crowdsourced" physician registries that reference clinical outcomes to individual patient physiology have been used successfully for cancers. These techniques are now being explored in the context of behavioral health care. The Psychiatric EEG Evaluation Registry (PEER) is one such approach. PEER is a clinical phenotypic database comprising more than 11,000 baseline EEGs and more than 39,000 outcomes of medication treatment for a variety of mental health diagnoses. Collective findings from 45 studies (3130 patients) provide compelling evidence for PEER as a relatively simple, inexpensive predictor of likely patient response to specific antidepressants and likely treatment-related side effects (including suicidal ideation).

Closed-Loop Intravenous Drug Administration Using Photoplethysmography.

An optically-based injection control system has been developed for preclinical use for an intravenous drug delivery application. Current clinical drug delivery for oncology typically provides for intravenous administration without an awareness of achieved plasma concentration, yet interpatient variability produces consequences ranging from toxicity to ineffectual treatments. We report a closed-loop injection system integrating a pulse-photoplethysmograph to measure the concentration of an injected agent in the circulating blood system using a previously described technique. A proportional-derivative (PD) controller manages the injection rate in real-time. The target function for the controller is the population estimate of the pharmacokinetic model developed using Bayesian statistics describing the injection phase of a calibration set of 22 injections in mice. The controlled set of eight injections showed a reduction in variance from the target injection phase concentration profile of 74.8%.

Aging in the United Kingdom and Europe--a snapshot of the future?

The implications for society of increasing life span to 120 years can only be guessed, but comparing the diversity of responses to aging in different countries may give insights into the possible effect. A European Union-funded study of the recipients of community care services in 11 European countries illustrates how such studies can help identify some of the issues. The study, made possible by the availability of a multidimensional standardized assessment for community care, illustrates how diversity of social and political history and culture results in widely different patterns of dependency in those cared for at home, different levels of formal care, and informal caregiver burden. There is wide variation in living arrangements, marital status, and dependency between countries. The average age of recipients of community care is approximately 82, regardless of the average age of the national population. In Italy, which has the oldest population in Europe, dependency in people supported at home in extended families is high, with little formal care and significant levels of informal caregiver burden. In contrast the Nordic countries have lower levels of dependency and greater proportions of people with no informal caregiver. In Germany, informal caregiver burden may be related to the regulatory mechanisms rather than dependency and levels of formal care. With a life expectancy of 120, it will be these 80-year-olds who will be caring for their parents. Although humankind is resourceful, it will require a unified approach to aging to overcome the challenging diversity in our societies.