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6 results on '"P. Pigeon"'

1. Are Veterans Getting Their Preferred Depression Treatment? A National Observational Study in the Veterans Health Administration

Author

Leung, Lucinda B, Ziobrowski, Hannah N, Puac-Polanco, Victor, Bossarte, Robert M, Bryant, Corey, Keusch, Janelle, Liu, Howard, Pigeon, Wilfred R, Oslin, David W, Post, Edward P, Zaslavsky, Alan M, Zubizarreta, Jose R, and Kessler, Ronald C

Subjects
Health Services and Systems, Biomedical and Clinical Sciences, Clinical Sciences, Health Sciences, Clinical Trials and Supportive Activities, Clinical Research, Depression, Behavioral and Social Science, Mental Health, Serious Mental Illness, Rehabilitation, Brain Disorders, Management of diseases and conditions, 7.1 Individual care needs, Mental health, Good Health and Well Being, Female, Humans, Male, Middle Aged, Patient Preference, Psychotherapy, Veterans, Veterans Health, major depression, treatment preferences, treatment adherence, General & Internal Medicine, Clinical sciences, Health services and systems, Public health
Abstract

BackgroundPhysician responsiveness to patient preferences for depression treatment may improve treatment adherence and clinical outcomes.ObjectiveTo examine associations of patient treatment preferences with types of depression treatment received and treatment adherence among Veterans initiating depression treatment.DesignPatient self-report surveys at treatment initiation linked to medical records.SettingVeterans Health Administration (VA) clinics nationally, 2018-2020.ParticipantsA total of 2582 patients (76.7% male, mean age 48.7 years, 62.3% Non-Hispanic White) MAIN MEASURES: Patient self-reported preferences for medication and psychotherapy on 0-10 self-anchoring visual analog scales (0="completely unwilling"; 10="completely willing"). Treatment receipt and adherence (refilling medications; attending 3+ psychotherapy sessions) over 3 months. Logistic regression models controlled for socio-demographics and geographic variables.Key resultsMore patients reported strong preferences (10/10) for psychotherapy than medication (51.2% versus 36.7%, McNemar χ21=175.3, p

Published
2022

2. Are Veterans Getting Their Preferred Depression Treatment? A National Observational Study in the Veterans Health Administration.

Author

Leung, Lucinda B, Ziobrowski, Hannah N, Puac-Polanco, Victor, Bossarte, Robert M, Bryant, Corey, Keusch, Janelle, Liu, Howard, Pigeon, Wilfred R, Oslin, David W, Post, Edward P, Zaslavsky, Alan M, Zubizarreta, Jose R, and Kessler, Ronald C

Subjects
Veterans, major depression, treatment adherence, treatment preferences, Serious Mental Illness, Clinical Research, Rehabilitation, Behavioral and Social Science, Mental Health, Brain Disorders, Depression, Clinical Trials and Supportive Activities, 7.1 Individual care needs, Mental health, Clinical Sciences, General & Internal Medicine
Abstract

BackgroundPhysician responsiveness to patient preferences for depression treatment may improve treatment adherence and clinical outcomes.ObjectiveTo examine associations of patient treatment preferences with types of depression treatment received and treatment adherence among Veterans initiating depression treatment.DesignPatient self-report surveys at treatment initiation linked to medical records.SettingVeterans Health Administration (VA) clinics nationally, 2018-2020.ParticipantsA total of 2582 patients (76.7% male, mean age 48.7 years, 62.3% Non-Hispanic White) MAIN MEASURES: Patient self-reported preferences for medication and psychotherapy on 0-10 self-anchoring visual analog scales (0="completely unwilling"; 10="completely willing"). Treatment receipt and adherence (refilling medications; attending 3+ psychotherapy sessions) over 3 months. Logistic regression models controlled for socio-demographics and geographic variables.Key resultsMore patients reported strong preferences (10/10) for psychotherapy than medication (51.2% versus 36.7%, McNemar χ21=175.3, p

Published
2021

3. Comorbid mental disorders, depression symptom severity, and role impairment among Veterans initiating depression treatment through the Veterans Health Administration

Author

Ziobrowski, Hannah N, Leung, Lucinda B, Bossarte, Robert M, Bryant, Corey, Keusch, Janelle N, Liu, Howard, Puac-Polanco, Victor, Pigeon, Wilfred R, Oslin, David W, Post, Edward P, Zaslavsky, Alan M, Zubizarreta, Jose R, and Kessler, Ronald C

Subjects
Serious Mental Illness, Brain Disorders, Anxiety Disorders, Depression, Mental Health, Behavioral and Social Science, Mental health, Good Health and Well Being, Comorbidity, Cross-Sectional Studies, Humans, Mental Disorders, Stress Disorders, Post-Traumatic, Veterans, Veterans Health, Depression symptom severity, Functioning, Role impairment, Veterans Health Administration, Medical and Health Sciences, Psychology and Cognitive Sciences, Psychiatry
Abstract

BackgroundPsychiatric comorbidities may complicate depression treatment by being associated with increased role impairments. However, depression symptom severity might account for these associations. Understanding the independent associations of depression severity and comorbidity with impairments could help in treatment planning. This is especially true for depressed Veterans, who have high psychiatric comorbidity rates.Methods2,610 Veterans beginning major depression treatment at the Veterans Health Administration (VHA) were administered a baseline self-report survey that screened for diverse psychiatric comorbidities and assessed depression severity and role impairments. Logistic and generalized linear regression models estimated univariable and multivariable associations of depression severity and comorbidities with impairments. Population attributable risk proportions (PARPs) estimated the relative importance of depression severity and comorbidities in accounting for role impairments.ResultsNearly all patients (97.8%) screened positive for at least one comorbidity and half (49.8%) for 4+ comorbidities. The most common positive screens were for generalized anxiety disorder (80.2%), posttraumatic stress disorder (77.9%), and panic/phobia (77.4%). Depression severity and comorbidities were significantly and additively associated with impairments in multivariable models. Associations were attenuated much less for depression severity than for comorbidities in multivariable versus univariable models. PARPs indicated that 15-60% of role impairments were attributable to depression severity and 5-32% to comorbidities.LimitationsThe screening scales could have over-estimated comorbidity prevalence. The cross-sectional observational design cannot determine either temporal or causal priorities.ConclusionsAlthough positive screens for psychiatric comorbidity are pervasive among depressed VHA patients, depression severity accounts for most of the associations of these comorbidities with role impairments.

Published
2021

4. Treatment Differences in Primary and Specialty Settings in Veterans with Major Depression

Author

Puac-Polanco, Victor, Leung, Lucinda B, Bossarte, Robert M, Bryant, Corey, Keusch, Janelle N, Liu, Howard, Ziobrowski, Hannah N, Pigeon, Wilfred R, Oslin, David W, Post, Edward P, and Kessler, Ronald C

Subjects
Health Services and Systems, Health Sciences, Behavioral and Social Science, Brain Disorders, Health Services, Clinical Research, Depression, Serious Mental Illness, Mental Health, Mental health, Good Health and Well Being, Delivery of Health Care, Integrated, Depressive Disorder, Major, Humans, Mental Health Services, United States, United States Department of Veterans Affairs, Veterans, Comorbidity, Integrated Health Care Systems, Military Medicine, Primary Health Care, Psychotherapy, Self-Report, Veterans Health, Public Health and Health Services, General & Internal Medicine, Health services and systems
Abstract

IntroductionThe Veterans Health Administration (VHA) supports the nation's largest primary care-mental health integration (PC-MHI) collaborative care model to increase treatment of mild to moderate common mental disorders in primary care (PC) and refer more severe-complex cases to specialty mental health (SMH) settings. It is unclear how this treatment assignment works in practice.MethodsPatients (n = 2610) who sought incident episode VHA treatment for depression completed a baseline self-report questionnaire about depression severity-complexity. Administrative data were used to determine settings and types of treatment during the next 30 days.ResultsThirty-four percent (34.2%) of depressed patients received treatment in PC settings, 65.8% in SMH settings. PC patients had less severe and fewer comorbid depressive episodes. Patients with lowest severity and/or complexity were most likely to receive PC antidepressant medication treatment; those with highest severity and/or complexity were most likely to receive combined treatment in SMH settings. Assignment of patients across settings and types of treatment was stronger than found in previous civilian studies but less pronounced than expected (cross-validated AUC = 0.50-0.68).DiscussionBy expanding access to evidence-based treatments, VHA's PC-MHI increases consistency of treatment assignment. Reasons for assignment being less pronounced than expected and implications for treatment response will require continued study.

Published
2021

5. Four-wave Mixing of Gigawatt power, Long-wave Infrared Radiation in Gases and Semiconductors

Author

Pigeon, Jeremy James

Subjects
Optics, Physics, infrared, laser, nonlinear optics, optics, photonics
Abstract

The nonlinear optics of gigawatt power, 10 �m, 3 and 200 ps long pulses propagating in gases and semiconductors has been studied experimentally and numerically. In this work, the development of a high-repetition rate, picosecond, CO2 laser system has enabled experiments using peak intensities in the range of 1 – 10 GW/cm2, approximately one thousand times greater than previous nonlinear optics experiments in the long-wave infrared (LWIR) spectral region. The first measurements of the nonlinear refractive index of the atomic and molecular gases Kr, Xe, N2, O2 and the air at a wavelength near 10 �m were accomplished by studying the four-wave mixing (FWM) of dual-wavelength, 200 ps CO2 laser pulses. These measurements indicate that the nonlinearities of the diatomic molecules N2, O2 and the air are dominated by the molecular contribution to the nonlinear refractive index. Supercontinuum (SC) generation covering the infrared spectral range, from 2 – 20 �m, was realized by propagating 3 ps, 10 �m pulses in an approximately 7 cm long, Cr-doped GaAs crystal. Temporal measurements of the SC radiation show that pulse splitting accompanies the generation of such broadband light in GaAs. The propagation of 3 ps, 10 �m pulses in GaAs was studied numerically by solving the Generalized Nonlinear Schr�dinger Equation (GNLSE). These simulations, combined with analytic estimates, were used to determine that stimulated Raman scattering combined with a modulational instability caused by the propagation of intense LWIR radiation in the negative group velocity dispersion region of GaAs are responsible for the SC generation process. The multiple FWM of a 106 GHz, 200 ps CO2 laser beat-wave propagating in GaAs was used to generate a broadband FWM spectrum that was compressed by the negative group velocity dispersion of GaAs and NaCl crystals to form trains of high-power, picosecond pulses at a wavelength near 10 �m. Experimental FWM spectra obtained using 165 and 882 GHz beat-waves revealed an unexpected and rapid decrease in the FWM yield that was not predicted by the GNLSE model that accounts for third-order nonlinearities alone. These results suggest that the effective nonlinear refractive index of GaAs, having formidable second- and third-order susceptibilities, may be altered by quadratic nonlinearities.

Published
2017

6. Generation of ultra-broadband, mid-IR radiation in GaAs pumped by picosecond 10 µm laser pulses

Author

Pigeon, Jeremy

Subjects
Electrical engineering, carbon dioxide laser, nonlinear optics, supercontinuum generation
Abstract

Production of ultra-broadband radiation in the "molecular fingerprint region", from 2 - 20 µm is of practical interest for applications in optical coherence tomography, broadband spectroscopy and LIDAR measurements of gases. To date, supercontinuum generation in optical fibers has been limited to ~ 4.5 µm in the mid-IR range. In this thesis we describe an experiment in which supercontinuum radiation from 2 - 20 µm is generated using a 67 mm GaAs crystal pumped with a train of picosecond CO2 laser pulses. In addition to spectral measurements, we have measured the temporal profile of the laser pulse after the interaction and observed splitting of the picosecond pulses into finer structure. Simulation show that such temporal structure may arise from modulational instability. Simulations further indicate that the observed spectral width is strongly influenced by stimulated Raman scattering and the use of a train of picosecond CO2 laser pulses.

Published
2014

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