The VA augmentation and switching treatments for improving depression outcomes (VAST-D) study: Rationale and design considerations.

Because two-thirds of patients with Major Depressive Disorder do not achieve remission with their first antidepressant, we designed a trial of three "next-step" strategies: switching to another antidepressant (bupropion-SR) or augmenting the current antidepressant with either another antidepressant (bupropion-SR) or with an atypical antipsychotic (aripiprazole). The study will compare 12-week remission rates and, among those who have at least a partial response, relapse rates for up to 6 months of additional treatment. We review seven key efficacy/effectiveness design decisions in this mixed "efficacy-effectiveness" trial.

The U.S.-Mexico border: a time-trend analysis of border-crossing injuries.

BACKGROUND: Policies over the past 15 years have resulted in changes to the physical border between the U.S. and Mexico, as well as increases in the number of border patrol agents. PURPOSE: The purpose of this study is to characterize the trends and epidemiology of physically traumatic border-crossing injuries sustained over an 8-year period in San Diego County. METHODS: This is a time-series study using existing data collected by the University of California, San Diego Level 1 Trauma Center between 2000 and 2007. This study includes data for individuals traumatically injured owing to a jump or fall in an attempt to cross over the border fence. Time-trend analysis was conducted using Poisson regression. A multiple linear regression was conducted to determine whether there was an increase in the severity of injuries to border crossers between 2000 and 2007. RESULTS: Analysis demonstrated a significant increase in the number of those injured each year specifically as a result of jumping or falling from the border fence, from 13 in 2000 to 52 in 2007, even though there was a decrease in the number of apprehensions for illegal entry into the U.S. On average, each year, the injury severity decreased by 0.38 between the years 2000 and 2007. CONCLUSIONS: Jumping and falling injuries at the San Diego-Mexico border increased during a time when apprehensions were decreasing. Further studies are needed to identify strategies to mitigate this problem.