Durability of deep transcranial magnetic stimulation for veterans with treatment resistant depression with comorbid suicide risk and PTSD symptoms.

Evidence supports transcranial magnetic stimulation (TMS) as an effective treatment for symptoms of depression and PTSD; however, there has been limited investigation into the durability of symptoms reduction. The Hampton Veterans Affairs Medical Center's (HVAMC) rTMS clinic used H-coil for dTMS for Veterans with treatment-resistant depression and tracked symptomology at multiple times points up to six months post-treatment. Veterans underwent 30 session of dTMS treatment using the Hesed coil (H1 coil). The PHQ-9, PCL-5, and BSS were administered to Veterans at four time points: pretreatment, post-treatment, three months after treatment, and six months after treatment. In aggregate, there were clinically significant reductions in symptoms of depression (43.47%), PTSD (44.14%) and suicidal ideation (54.02%) at the six month follow-up relative to pretreatment. Results provide evidence of the impact and durability of dTMS on symptoms of MDD, PTSD, and suicidal ideation among Veterans with treatment-resistant depression.

Reducing capture zone uncertainty with a systematic sensitivity analysis.

The U.S. Environmental Protection Agency has established several methods to delineate wellhead protection areas (WHPAs) around community wells in order to protect them from surface contamination sources. Delineating a WHPA often requires defining the capture zone for a well. Generally, analytical models or arbitrary setback zones have been used to define the capture zone in areas where little is known about the distribution of hydraulic head, hydraulic conductivity, or recharge. Numerical modeling, however, even in areas of sparse data, offers distinct advantages over the more simplified analytical models or arbitrary setback zones. The systematic approach discussed here calibrates a numerical flow model to regional topography and then applies a matrix of plausible recharge to hydraulic conductivity ratios (R/K) to investigate the impact on the size and shape of the capture zone. This approach does not attempt to determine the uncertainty of the model but instead yields several possible capture zones, the composite of which is likely to contain the actual capture zone. A WHPA based on this composite capture zone will protect ground water resources better than one based on any individual capture zone. An application of the method to three communities illustrates development of the R/K matrix and demonstrates that the method is particularly well suited for determining capture zones in alluvial aquifers.