This novel finding complements results from prospective clinical

This novel finding complements results from prospective clinical studies and provides further empirical support for cued recall as a specific indicator of prodromal AD, in line with recently proposed research criteria.48 Another surprisingly

simple test is the Clock Drawing test. AD patients show early difficulties in visuospatial Inhibitors,research,lifescience,medical processing and conceptual errors like misrepresentation of numbers in the command, but not in the copy, condition, pointing to deficits in semantic memory. The Trail Making Test A+B is a neuropsychological test of visual attention measuring mental processing speed, and the ability to switch between different tasks. It consists of two parts in which the subject is asked to connect a set of 25 dots as fast as possible while maintaining accuracy. Visual search speed, scanning and processing abilities, mental flexibility, and executive functioning can be assessed with this test. Regarding animal models, there are plenty of paradigmata available to test memory functions, but there is an overall lack of validated Inhibitors,research,lifescience,medical animal data that can be aligned with similar tests in human settings. Snigdha et al started with the comprehensive toolbox for Neurologic Behavioral Function from the National Institutes of Health (NIH) which contains evaluated tests Inhibitors,research,lifescience,medical for cognitive, motor, sensory, and emotional

function for use in epidemiologic and clinical studies spanning 3 to 85 years of age and analyzed strengths and limitations of available animal Inhibitors,research,lifescience,medical behavioral tests to find matches. They defined a preclinical battery that aims to parallel the NIH Toolbox, and may help to close the gap between data from different species.49 Subjective the following site cognitive impairment Subjective cognitive impairment without detectable objective memory deficit may no longer merely regarded as “normal aging” since it has been shown that it is a major risk factor for the Inhibitors,research,lifescience,medical development of dementia.50 A clear definition of what subjective memory impairment or subjective cognitive impairment actually mean is currently lacking. An international task force is, however, working on standard operating procedures that would

enable comparable study designs. A consensus regarding naming the concept “subjective cognitive impairment” in view of previously used terminology such as “subjective memory impairment” seems to be arising. Subjective cognitive impairment is defined as the individual coming up with the mere feeling Batimastat that something is not in order, without any objective parameters supporting that notion in the first place. Such a stage labeled subjective cognitive impairment may precede mild cognitive impairment in the continuum of Alzheimer disease manifestation. Using such a definition and without objective neuropsychological test alterations, the atrophy pattern of patients with subjective cognitive impairment seem to be related to the atrophy pattern seen in AD.

1B) In contrast, cooling increased the total sodium influx into

1B). In contrast, cooling increased the total sodium influx into the cell by different amounts: at 10°C in relation to 30°C, the area under the curve was multiplied by a factor of two for WT and by a factor of four for R1448H (Fig. 1C). Figure 1. A Raw data. Representative whole-cell current traces recorded

at different temperatures from HEK293 cells stably expressing either Inhibitors,research,lifescience,medical WT (left) or R1448H (right) mutant channels: 10°C (top), 20°C (middle) and 30°C (bottom). Note the … Steady-state activation curves were almost identical for WT and R1448H regardless of temperature (Fig. 2A, Table 1). Cooling decreased activation slope factor from ~-7mV to ~-10mV and potentials at half maximal activation were shifted by ~+8 mV to the right for WT and R1448H alike. Rise time of activation at 0 mV and higher was significantly increased in R1448H compared to WT (p ≤ 0.05, Fig. 2B). Steady-state inactivation differed significantly (p = 0.05) for the mutant as well: R1448H curves were significantly Inhibitors,research,lifescience,medical shifted to the left by ~6 mV and revealed an increase of slope factor by ~4 mV (Fig. 2A, C, D, Table 1). Since deactivation cannot be measured at room temperature, we cooled to 15°C, 10°C and 5°C to resolve sufficient data points for a fit. Deactivation time course was almost indistinguishable

Inhibitors,research,lifescience,medical for mutant and WT except for the near-threshold voltage of -70 mV (Fig. 2E). Table 1. Boltzmann parameters of G(V) and SSFI curves. Figure 2. A Activation and steady-state fast inactivation. Activation and steady-state fast Inhibitors,research,lifescience,medical inactivation curves for WT and R1448H. Voltage dependence of activation was determined by 50 ms selleck chemicals depolarizing pulses to the indicated potentials from a holding potential … For threshold-near potentials, the time constants of fast inactivation Inhibitors,research,lifescience,medical Th form the open state were smaller for R1448H than WT while at more depolarized potentials, they were larger than for WT (Fig. 3: OSI). The difference in time constants was especially prominent in the voltage range of -60 to -30 mV and markedly increased

with cooling. Cooling slowed fast inactivation of WT and R1448H at all voltages Tofacitinib Citrate purchase tested and shifted the point of intersection of WT and R1448H curves to more negative Batimastat potentials. Figure 3. Time constants. Time constants from and into the fast inactivated-state were plotted against the corresponding membrane potentials. Recovery, entry (Closedstate inactivation, CSI) and inactivation from the openstate (OSI) were determined for WT and R1448H … Additionally, R1448H reduced voltage dependence of Th for all temperatures tested. R1448H accelerated entry into closed-state inactivation (CSI) by about two-fold on average (Fig. 3: CSI, Table 2). The left-shift of the steady-state inactivation curve may explain this enhanced closed-state inactivation. The mutation reduced its voltage dependence, possibly by the removed S4 charge, and slowed the open-state inactivation.

This will permit some patients to sit up on the ambulance stretch

This will permit some patients to sit up on the Perifosine chemical structure ambulance stretcher and

be taken to a low acuity or ambulatory area of the ED, rather than being left on a backboard in a high acuity or trauma area. Paramedics will record their findings on a simple Paramedic Data Form and in their paramedic ambulance care report. Ongoing education a) Study Champions will be identified among the EMS service. These “champions” will be paramedics who will serve as a local resource for the participating paramedics. The champion will be responsible for initial training, continuing education, and trouble-shooting issues brought up by the Inhibitors,research,lifescience,medical paramedics. They also helped recruitment significantly during the validation study. b) Continuing education will be provided to all paramedics at least every six months and will be done by study champions in the Erlotinib HCl format of small group sessions, such as during daily morning briefings, while the paramedics are Inhibitors,research,lifescience,medical on duty. c) Newsletters will be developed and distributed to all study paramedics on a monthly basis. These will include tips on assessment and feedback on enrollment. d) Local study champions will monitor

staff turnover and ensure that new paramedics are trained for the study in a timely fashion. Outcome measures and data collection Data collection The following outcome Inhibitors,research,lifescience,medical data will be Inhibitors,research,lifescience,medical collected by dedicated study personnel who will review daily patient logs, ED patient records, diagnostic imaging reports, and in-patient records. All participating paramedics will complete a Paramedic Data Form at the time of each patient assessment as well as document patient care on their province wide Ambulance Call Reports. Additional study data will be recorded on a Case Record Form. All outcomes

will be collected during the run-in and evaluation periods, but the run-in data will not be used in the final analysis (this run-in phase may be shortened if no issues are identified). Measures of safety (primary study outcomes) a) Number of Inhibitors,research,lifescience,medical missed cervical spine GSK-3 injuries, i.e. number of clinically important c-spine injuries (as defined previously) identified in patients who have had their c-spine cleared by paramedics. We will know the presence of fracture or cervical spine injury from review of diagnostic imaging reports in the patient record. We also propose to institute a strategy of surveillance to identify the uncommon occurrence of a fracture missed because no radiography was ordered. ED Patient Visit Logs at each receiving hospitals will be monitored for 30 days to identify return visits by patients who do not undergo radiography during their initial ED visit. In addition, we will review the Neurosurgery Patient Logs at our regional neurosurgical centre (The Ottawa Hospital, Civic Campus).

Therefore, the efficacy is tested at rather high doses, which, in

Therefore, the efficacy is tested at rather high doses, which, in the case of SSRIs particularly, may not be necessary. This method encourages the clinicians to use the maximum tolerated dose rather than the minimal effective dose. In studies with fixed-dose design, higher doses are started abruptly, most often without gradual

escalation, or with a short titration time, unlike in clinical practice. Thus, Inhibitors,research,lifescience,medical early discontinuation could be expected because there may be more side effects in the higher dosage group. For those dropouts, the possibility of good subsequent response cannot be excluded. This can lead to a discrepancy between the results for the ITT and completer cases analyses. In addition, the clinical response to antidepressants is not observed immediately. In some patients, more than 3 weeks are required before an improvement in symptoms becomes obvious, Inhibitors,research,lifescience,medical while side effects appear soon after starting treatment. A final point is that, in clinical trials, patients represent a carefully selected cohort in order to ensure Inhibitors,research,lifescience,medical comparable baseline populations. In clinical practice, patients often have affective disorders with more comorbid conditions and are likely to receive more complex drug regimens. Determination of response is highly individual and does not necessarily

correspond to that performed under controlled clinical trial conditions. Clinical implications The studies that have evaluated the dose-response relationship of SSRIs and SNRIs have been equivocal, with considerable difficulties in establishing a clear optimal dose or dose range in the treatment of major depression. Clinicians who increase Inhibitors,research,lifescience,medical the dose of an SSRI in an early nonresponder or partial responder, ie, before at least 3 weeks at fixed dose, and then Inhibitors,research,lifescience,medical see improvement may conclude that the subsequent response proved that

the patient needed a higher dose. However, it may be that the patient simply needed a longer time on the drug to achieve the response. This issue was confirmed by three prospective studies on dose augmentation.41-43 This casts doubt on Anacetrapib the customary practice of increasing dosage when there is nonresponse early in treatment, according to dose-adjusted trial designs reported between 1980 and 2004. The majority of selleckbio depressed patients should be treated with a low dosage of SSRIs and SNRI, generally corresponding to one tablet per day. Increasing the dose may CC5013 perhaps be beneficial for some patients with depression, in particular those with severe depression. An antidepressant for which this strategy may be relevant, in order to increase the number of responders, is venlafaxine. Although this has not been often studied, if higher dosages are required, they will be better tolerated if achieved through dose titration.

A meta-analysis of twin studies estimated the heritability to be

A meta-analysis of twin selleck chemical Bortezomib studies estimated the heritability to be 81% (confidence interval 73% to 90% )3 and a recent Swedish study of more than 2 million families

estimated it to be 64%. 4 Of all the known risk factors for schizophrenia, genetics is the single largest one. No precise mode of inheritance is known, and less than one third of patients with schizophrenia have a family history. Elucidation of etiological factors remains the overwhelming challenge Inhibitors,research,lifescience,medical to schizophrenia researchers. In fact, the most effective method for identification of genetic risk factors for schizophrenia is not clear, and this has led to a number of approaches, including epigenetics, being adopted, in an attempt to clarify the genetic etiology. Since the initial observation that schizophrenia has a polygenic Inhibitors,research,lifescience,medical mode of inheritance and availability of polymorphic markers for genetic mapping, many attempts have been made to find susceptibility genes for schizophrenia using either the methods of linkage or association.5,6 One of the early strategies used to begin unraveling the genetic contribution of schizophrenia was the investigation of chromosomal aberrations and familial syndromes with schizophrenia-like phenotypes. Chromosomal aberrations have been reported in families with schizophrenia and other psychiatric disorders.7,8 The

deletion of a section of 22q11 leads to the phenotype Inhibitors,research,lifescience,medical of velocardiofacial (DiGeorge) syndrome that includes abnormalities in facial features, the palate, Inhibitors,research,lifescience,medical and midline heart defects. Patients with 22q11 deletion syndrome exhibit psychotic symptoms resembling schizophrenia at a frequency of 18%, a rate that is much higher than the overall 1% prevalence of schizophrenia in the general population. On the other hand, when focusing on populations of patients who have the diagnosis of schizophrenia, at least 2% of these individuals are reported to have 22q11 deletions compared with the 0.025% prevalence Inhibitors,research,lifescience,medical in the general population.9,10 This region of 22q11 harbours

the COMT and PRODH genes among others (Table I). Table I Some schizophrenia candidate genes and their association with schizophrenia according to chromosomal location, genetic association, biology/animal models, expression alterations, and meta-analysis results. The number of “+” indicates the … A AV-951 number of other chromosomal aberrations have been associated with schizophrenia. On chromosome one, a balanced (1;11)(q42.1;q14.3) translocation, which disrupted the DISC1 gene (Table I), was found in a large Scottish family with high frequency of psychiatric disorders including schizophrenia.22,56,57 More recently, another family of mother-daughter pair with schizophrenia was identified with t(9;14)(q34;q13) translocation which disrupts the NPAS3 (neuronal selleck Dorsomorphin Period Aryl hydrocarbon receptor Single-minded) gene,58,59 that codes for a transcription factor implicated in neurogenesis.

101 However, the difference in craving was not long-lasting, as t

101 However, the difference in craving was not long-lasting, as the experimental and placebo levels of craving were not statistically different 1 week after the intervention. One possibility for this absence of a difference is that propranolol impairment was transient. Another possibility, suggested by a visual inspection of the graphical presentation of the effect (Figure 1), is that the propranolol-induced impairment in craving is relatively constant. Future research should examine whether reduction in craving translates to a reduction in relapse rates and substance abuse. Implications of forgetting for clinical

practice: some #selleck chemical keyword# speculative ideas Constitutive forgetting may provide important functional contributions to the hippocampus. For example, the loss of hippocampus-dependent spatial and contextual memory may be instrumental for generalization effects and the development of schemas.102 On the other hand, because systematic forgetting processes may control the life-time of memories,

their deregulation could lead to accelerated and Inhibitors,research,lifescience,medical even pathological forms of memory loss, as seen in senescence and some dementias, such as Alzheimer’s disease (AD). In the latter, β-amyloid causes increases in postsynaptic calcium, which promotes internalization and altered trafficking of synaptic α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) Inhibitors,research,lifescience,medical and NMDA receptors, notably increased AMPA removal by engaging Inhibitors,research,lifescience,medical pathways involved in LTD.103 This suggests that forgetting processes as described above may be involved in the pathology of AD, and the accelerated forgetting of episodic content typical for the disease might drive the autobiographical impairment and eventual loss of a self-narrative. It is thus possible that the eventual synapse loss and cell death, which characterize the final stages of AD, are driven in part by forgetting processes that spiral out of control. Traditional views of AD assume that dementia is the

Inhibitors,research,lifescience,medical result of neuron death or dysfunction in the affected areas. While provocative but possible, one explanation for this condition is that uncontrolled forgetting maybe be one of the mechanisms leading to cell dysfunction and death. Therapeutic approaches could therefore target certain steps in molecular pathways associated with forgetting, and possibly at time points well before the devastating stages AV-951 of the disease manifest. Drugs that affect the synaptic removal of AMPA receptors might prove effective in preventing steps that eventually lead to synapse deterioration, as synapse stability critically depends on the glutamate (GluA2) and AMPA receptors.104 In animal models, it has been shown that the peptide GluA23Y, which competitively prevents internalization of GluA2-dependent AMPA receptors, can prevent long-term depression, a possible physiological model of plasticity mechanisms involved in forgetting.

Montgomery et al reported that a significant and sustained post-

Montgomery et al. reported that a significant and sustained post-operative elevations of CA 19-9 serum levels preceded clinical or radiologic detection of recurrence by 2 weeks to 5 months (median 3.5 months) and that an elevated post-operative CA 19-9 serum levels >180 U/mL was associated with a disease free survival of 12 months compared to 35 months for patients with post-operative CA 19-9 serum levels <180 U/mL (50). In this study, patients whose postoperative CA 19-9 values normalized by 3 to 6 months (<37 U/mL) had a longer disease free

survival (24 vs. 10 months, P<0.04) and median survival (34 vs. 13 months, Inhibitors,research,lifescience,medical P<0.04). Hernandez et al. analyzed data from 96 surgically resected pancreatic cancer patients in whom CA 19-9 serum Inhibitors,research,lifescience,medical levels were drawn at baseline, 4 weeks, and 12-week intervals following surgery and for whom CA 19-9 velocity was calculated (rate of change in CA 19-9 levels over a 4-week period). These authors found that CA 19-9 velocity was a better predictor of

overall survival than baseline CA 19-9 serum levels (P<0.001). Patients with disease progression had a CA 19-9 velocity of 131 U/mL/4-weeks compared to a velocity of 1 U/ml/4-weeks at 22 months for Inhibitors,research,lifescience,medical patients without disease progression (P<0.001) (51). In summary, the above results imply that clinical or radiologic post-operative recurrence is often preceded or associated with elevated CA 19-9 serum levels by 2-6 months. Elevation of post-operative CA 19-9 serum levels or failure of the CA 19-9 serum levels to normalize in the post-operative period suggest the presence of residual tumor or remnant disease and is associated with a poor prognosis. Limitations that undermine the utility

Inhibitors,research,lifescience,medical Inhibitors,research,lifescience,medical of CA 19-9 serum level as a preferred tumor marker for pancreatic cancer. Despite multiple clinical applications for CA 19-9 serum levels in pancreatic cancer patients, the diagnostic utility of CA 19-9 is limited due to a low or modest sensitivity (79-81%) in symptomatic patients and a low PPV (0.9%) which makes it suboptimal screening test (12,14,16,18,19). Even among individuals at higher risk of pancreatic cancer (hereditary pancreatitis, family history of pancreatic cancer, Peutz-Jeghers syndrome), CA 19-9 serum levels fail to identify early/small tumors Anacetrapib or precancerous lesions in 10-15% of patients (68), is elevated in only 80-85% of pancreatic cancer patients (12,14,20). The CA 19-9 serum levels are not predictive of tumor location or differentiation. As noted earlier, CA 19-9 serum levels may be elevated in a variety of non-pancreatic neoplastic conditions resulting in a high false positive rate (10-30%). Benign conditions associated with elevated serum CA 19-9 levels selleck screening library include ovarian cyst, heart failure, hashimoto’s thyroiditis, rheumatoid arthritis and diverticulitis (16-19,69-74) (Table 6).

4,6,7 This issue is further aggravated by the 1- to 2-year waitin

4,6,7 This issue is further aggravated by the 1- to 2-year waiting list for entering a presurgical evaluation program in the majority of epilepsy surgery centers. Several reasons underlie the above situation, including the patients’ and physicians’ legitimate fear of a postoperative permanent neurological deficit, the frequently insidious course of chronic epilepsy,8 the relatively low yield of long-term postoperative seizure freedom (~ 60% after 10 years of follow-up),9 the paucity of randomized control trials (RCTs) demonstrating the efficacy of surgical Romidepsin solubility therapy over antiepileptic drugs (AEDs),10 the complexity and heterogeneity Inhibitors,research,lifescience,medical of surgical treatments,

and the limited resources dedicated to the presurgical evaluation of epilepsy patients. Some of these reasons can now be challenged. For instance, major safety progress has been made in the field of neurosurgery, with a risk of unexpected vascular or infectious complications Inhibitors,research,lifescience,medical resulting in a residual disabling neurological impairment of about 1% in experienced epilepsy surgery groups.2,11 Thus,

the risk of seizurerelated death or serious injury in drug-resistant patients refusing epilepsy surgery (about 1 % per year), is significantly higher than the major morbidity/mortality associated with surgical treatment (about l%in total). The suboptimal Inhibitors,research,lifescience,medical yield of postoperative long-term seizure freedom must also be balanced with the much worse figures reported in patients who have not been operated on, only 5% to 14% of whom will achieve seizure remission.12,13 Altogether, the available data in the literature strongly suggest that epilepsy surgery is Inhibitors,research,lifescience,medical significantly more efficacious than medical treatment. Eligibility criteria for presurgical evaluation and epilepsy surgery Patient selection for epilepsy surgery is a two-step procedure that first aims to identify Inhibitors,research,lifescience,medical potential surgical candidates who should benefit from a presurgical evaluation, and then to determine in each assessed individual whether

the risk:benefit ratio for surgery is acceptable. Three main criteria must be fulfilled to enter the first Brefeldin_A step: (i) the patient (or his or her parents for young children and patients with intellectual impairment) needs to understand the objective of the presurgical evaluation and to agree on the clearly possibility of a surgical treatment; (ii) the patient should suffer from disabling seizures despite appropriate medical therapy; and (iii) available imaging and electroclinical data should be consistent with the possibility of a surgically remediable epileptic syndrome. The first criterion is minor, but should not be overlooked, since it often represents a limiting factor in patients who would otherwise be considered good surgical candidates. The second criterion relies on the definition of disability and drug resistance.

The result is that a true genome-wide study can be

The result is that a true genome-wide study can be performed by actually genotyping as few as 300 000 to 1 million SNPs.7,8 However, because so many tests are being performed, it is necessary to obtain a very strongly significant P value to be sure that the result is thenthereby really significant. This is known as “genome-wide significance” and the consensus is that this should be about 108 or less.9 Because the effects sizes of common variants are generally small, it is usually necessary to include a large number of subjects in the study in order to have the power

to detect a genome-wide significant P value (Figure 1.) Figure 1. The power to detect a Inhibitors,research,lifescience,medical causal variant that is perfectly tagged by a genotyped marker (assuming dominant model, minor allele frequency=0.2, Inhibitors,research,lifescience,medical frequency of disease is 1% and equa numbers of cases and controls). To have a good chance of detecting a variant … Major discoveries with GWAS The

success of GWAS has been very variable for different disease areas. Some diseases have Inhibitors,research,lifescience,medical found common variants with very strong effects, and managed to track these down to the causal variant. An inspiring example is an intronic variant in BCL11A that was found in two GWAS studies to associate with fetal hemoglobin (HbF) levels in healthy adults,10, 11 and also to modify the presentation of (3-thalassemia, and associate with HbF levels in patients with sickle-cell disease.11 This finding was soon followed up with a functional study that showed that the variant associated with high HbF12 reduced the expression of BCL11A,13 and that reduction of BCL11A expression caused increase in levels of gamma-globin in Inhibitors,research,lifescience,medical adult human red blood progenitor cells, which led to increased Inhibitors,research,lifescience,medical levels of HbF13 These findings clearly suggest that BCL11A serves as an inhibitor of HbF production and that directed repression of BCL11A could be developed as a clinical tool to ameliorate the presentation

of thalassemias and sickle-cell disease. These findings in turn have led to further understanding of developmental and species-specific changes in globin regulation.14. On the less inspirational side, however, other diseases, like hypertension, have been thoroughly and carefully investigated using Anacetrapib huge numbers of patients and controls with very little progress.15 Here we outline some of the highest impact findings of GWAS and where (if anywhere) they have led us. As might be expected by the laws of natural selection, there are not many common genetic variants that confer a strong predisposition to common diseases. Such variants would be expected to have been selected against, and thus maintained at low population frequencies. However, there are some phenotypes that might be expected to have selleck inhibitor dodged the purifying effects of selection.

Similarly, many studies have long no-treatment periods for observ

Similarly, many studies have long no-treatment periods for observation and diagnostic purposes. Clinicians are not likely to withhold treatment from severely ill patients in whom immediate treatment is seen as an absolute necessity. Thus, only those patients who can tolerate a long no-treatment period are sellekchem recruited. These patients are likely to be less severely ill. It has long been observed Inhibitors,research,lifescience,medical that severity and placebo response are inversely related. If advertising is used as the primary source of recruitment, a group of high-likelihood placebo responders, the “worried well,” arc often the ones recruited. If, on the other hand, the recruitment is largely from product information active clinic or

practice populations, there is likely to be preferential treatment of nonresponders under the justification that it

is inappropriate to “rock the boat” for patients that are doing well by switching to a new treatment. Study operations In large, multiple-site studies, recruitment is often set as a horse-race with enrollment Inhibitors,research,lifescience,medical concluded when the overall study sample is achieved. Payment to sites is largely on a per-patient basis. Therefore, as the study recruitment goal appears closer, there is a financial incentive to enroll subjects Inhibitors,research,lifescience,medical while enrollment is still possible. Over time, that could lead to a drift in criteria: mild symptoms are seen as more serious, and borderline eligibility gets to be considered acceptable. This erosion of severity promotes placebo responder recruitment. In combination treatment

studies, operational concerns minimize differences between pharmacological and Inhibitors,research,lifescience,medical psychosocial treatments. Typically, the approach to pharmacotherapy is rigid with fixed dosing and short duration – an approach uncharacteristic of clinical practice. Clinicians in the pharmacotherapy arm must behave robotically and in a manner unlike the way they generally work. Training and supervision are minimal. Those doing the psychosocial treatment, on the other Inhibitors,research,lifescience,medical hand, are typically highly selected, well-paid, well-trained, and closely supervised. We therefore commonly encounter trials in which expertly done psychotherapy beats poorly done pharmacotherapy, and cannot separate the operational aspects from the true clinical effect of the different treatment approaches. Outcome measures In psychiatry trials in general, Batimastat and in depression trials in particular, there is a tradition of using too many measures, most of which are rating scales or self-report forms of dubious validity and notorious unreliability. Measures are selected because they have worked in the past, and are therefore uninformed by contemporary science and knowledge of etiology or pathophysiology. There are few examples of composite, event-based measures, such as are typically used in cardiovascular trials (major adverse cardiac events, MACE), in mental health. We need to have more.