Most people with mental health disorders fail to receive timely access to adequate care. US Hispanic/Latino individuals are particularly underrepresented in mental health care and are historically a ...very difficult population to recruit into clinical trials; however, they have increasing access to mobile technology, with over 75% owning a smartphone. This technology has the potential to overcome known barriers to accessing and utilizing traditional assessment and treatment approaches.
This study aimed to compare recruitment and engagement in a fully remote trial of individuals with depression who either self-identify as Hispanic/Latino or not. A secondary aim was to assess treatment outcomes in these individuals using three different self-guided mobile apps: iPST (based on evidence-based therapeutic principles from problem-solving therapy, PST), Project Evolution (EVO; a cognitive training app based on cognitive neuroscience principles), and health tips (a health information app that served as an information control).
We recruited Spanish and English speaking participants through social media platforms, internet-based advertisements, and traditional fliers in select locations in each state across the United States. Assessment and self-guided treatment was conducted on each participant's smartphone or tablet. We enrolled 389 Hispanic/Latino and 637 non-Hispanic/Latino adults with mild to moderate depression as determined by Patient Health Questionnaire-9 (PHQ-9) score≥5 or related functional impairment. Participants were first asked about their preferences among the three apps and then randomized to their top two choices. Outcomes were depressive symptom severity (measured using PHQ-9) and functional impairment (assessed with Sheehan Disability Scale), collected over 3 months. Engagement in the study was assessed based on the number of times participants completed active surveys.
We screened 4502 participants and enrolled 1040 participants from throughout the United States over 6 months, yielding a sample of 348 active users. Long-term engagement surfaced as a key issue among Hispanic/Latino participants, who dropped from the study 2 weeks earlier than their non-Hispanic/Latino counterparts (P<.02). No significant differences were observed for treatment outcomes between those identifying as Hispanic/Latino or not. Although depressive symptoms improved (beta=-2.66, P=.006) over the treatment course, outcomes did not vary by treatment app.
Fully remote mobile-based studies can attract a diverse participant pool including people from traditionally underserved communities in mental health care and research (here, Hispanic/Latino individuals). However, keeping participants engaged in this type of "low-touch" research study remains challenging. Hispanic/Latino populations may be less willing to use mobile apps for assessing and managing depression. Future research endeavors should use a user-centered design to determine the role of mobile apps in the assessment and treatment of depression for this population, app features they would be interested in using, and strategies for long-term engagement.
Clinicaltrials.gov NCT01808976; https://clinicaltrials.gov/ct2/show/NCT01808976 (Archived by WebCite at http://www.webcitation.org/70xI3ILkz).
We present the stable carbon (δ13C) and oxygen (δ18O) isotopic composition of 75 serial samples (tooth enamels) from five mammalian fossil groups, which include giraffids, equids, bovids, tragulids, ...and suids, to reconstruct their diet and habitat. These mammalian faunas were recovered from a late Miocene Middle Siwalik succession exposed in Nurpur, Himachal Pradesh, India (8.14–5.26 Ma). The average δ13C data of the studied mammals, that is, −13.30 ± 0.71 (giraffids), −11.29 ± 0.63 (equids), −12.68 ± 0.49‰ (bovids), −12.97 ± 1.11 (tragulids), and −12.01 ± 0.47 (suids) indicates a mainly C3 diet with a minor component of C4 grass (up to 17%) and a habitat dominant by forest/woodland. The average δ18O value of giraffids (−5.83 ± 0.85) is slightly enriched as compared to other herbivore mammals, such as equids (−8.85 ± 1.71), bovids (−7.86 ± 0.62‰), tragulids (−8.26 ± 1.92), and suids (−10.65 ± 0.23). It suggests that the browsing giraffids could likely intake water from enriched 18O sources, whereas the other browsing mammals consume water from depleted 18O sources in the local ecosystem. However, the δ18O values indicate the existence of a warm, humid climate and more precipitation in the Siwalik during the late Miocene.
The stable carbon (δ13C) data of Nurpur mammals suggests that they lived in the forest and woodland, with some patches of grassland. The oxygen (δ18O) values indicate that they acquired their drinking water from 18O depleted vegetation and standing water sources.
Bipolar disorder (BD) is a mood disorder with different phases alternating between euthymia, manic or hypomanic episodes, and depressive episodes. While motor abnormalities are commonly seen during ...depressive or manic episodes, not much attention has been paid to postural abnormalities during periods of euthymia and their association with illness burden. We collected 24-hour posture data in 32 euthymic participants diagnosed with BD using a shirt-based wearable. We extracted a set of nine time-domain features, and performed unsupervised participant clustering. We investigated the association between posture variables and 12 clinical characteristics of illness burden. Based on their postural dynamics during the daytime, evening, or nighttime, participants clustered in three clusters. Higher illness burden was associated with lower postural variability, in particular during daytime. Participants who exhibited a mostly upright sitting/standing posture during the night with frequent nighttime postural transitions had the highest number of lifetime depressive episodes. Euthymic participants with BD exhibit postural abnormalities that are associated with illness burden, especially with the number of depressive episodes. Our results contribute to understanding the role of illness burden on posture changes and sleep consolidation in periods of euthymia.
Multiple sclerosis (MS) is a chronic neurodegenerative disease. Current monitoring practices predominantly rely on brief and infrequent assessments, which may not be representative of the real-world ...patient experience. Smartphone technology provides an opportunity to assess people's daily-lived experience of MS on a frequent, regular basis outside of episodic clinical evaluations.
The objectives of this study were to evaluate the feasibility and utility of capturing real-world MS-related health data remotely using a smartphone app, "elevateMS," to investigate the associations between self-reported MS severity and sensor-based active functional tests measurements, and the impact of local weather conditions on disease burden.
This was a 12-week, observational, digital health study involving 3 cohorts: self-referred participants who reported an MS diagnosis, clinic-referred participants with neurologist-confirmed MS, and participants without MS (controls). Participants downloaded the elevateMS app and completed baseline assessments, including self-reported physical ability (Patient-Determined Disease Steps PDDS), as well as longitudinal assessments of quality of life (Quality of Life in Neurological Disorders Neuro-QoL Cognitive, Upper Extremity, and Lower Extremity Function) and daily health (MS symptoms, triggers, health, mobility, pain). Participants also completed functional tests (finger-tapping, walk and balance, voice-based Digit Symbol Substitution Test DSST, and finger-to-nose) as an independent assessment of MS-related cognition and motor activity. Local weather data were collected each time participants completed an active task. Associations between self-reported baseline/longitudinal assessments, functional tests, and weather were evaluated using linear (for cross-sectional data) and mixed-effects (for longitudinal data) regression models.
A total of 660 individuals enrolled in the study; 31 withdrew, 495 had MS (n=359 self-referred, n=136 clinic-referred), and 134 were controls. Participation was highest in clinic-referred versus self-referred participants (median retention: 25.5 vs 7.0 days). The top 5 most common MS symptoms, reported at least once by participants with MS, were fatigue (310/495, 62.6%), weakness (222/495, 44.8%), memory/attention issues (209/495, 42.2%), and difficulty walking (205/495, 41.4%), and the most common triggers were high ambient temperature (259/495, 52.3%), stress (250/495, 50.5%), and late bedtime (221/495, 44.6%). Baseline PDDS was significantly associated with functional test performance in participants with MS (mixed model-based estimate of most significant feature across functional tests β: finger-tapping: β=-43.64, P<.001; DSST: β=-5.47, P=.005; walk and balance: β=-.39, P=.001; finger-to-nose: β=.01, P=.01). Longitudinal Neuro-QoL scores were also significantly associated with functional tests (finger-tapping with Upper Extremity Function: β=.40, P<.001; walk and balance with Lower Extremity Function: β=-99.18, P=.02; DSST with Cognitive Function: β=1.60, P=.03). Finally, local temperature was significantly associated with participants' test performance (finger-tapping: β=-.14, P<.001; DSST: β=-.06, P=.009; finger-to-nose: β=-53.88, P<.001).
The elevateMS study app captured the real-world experience of MS, characterized some MS symptoms, and assessed the impact of environmental factors on symptom severity. Our study provides further evidence that supports smartphone app use to monitor MS with both active assessments and patient-reported measures of disease burden. App-based tracking may provide unique and timely real-world data for clinicians and patients, resulting in improved disease insights and management.
Multiband elastic optical network (MB-EON) technology can help to sustain exponential traffic growth in the optical backbone network. However, multiband operation creates high inter-channel ...stimulated Raman scattering, leading to a high nonlinear impairment (NLI) that may severely affect the optical signal-to-noise ratio (OSNR) of a lightpath. Additionally, the severity of NLI on the channel of interest depends upon the choice of allocated wavelength. Hence, appropriate channel allocation may cumulatively lead to a higher network capacity. This paper proposes a quality-aware resource provisioning scheme in the context of MB-EON that selectively chooses the available channels from different bands in order to achieve the maximum network capacity in the long run. A deep neural network-assisted quality of transmission estimator is considered to estimate the OSNR of a lightpath with accuracy of 99.65% and 0.012 dB variance in estimation error. The performance of our algorithm in the proposed scheme, namely, optical signal-to-noise ratio adaptive first–last-fit (OA-FLF), is analyzed for two geographically diverse networks, namely, BT-UK and the 24-node USA network, in terms of traffic admissibility, quality of established lightpaths, and contiguous aligned available slot ratio (CAASR), and compared with four state-of-the-art baseline algorithms: first fit, last fit, route adaptive first–last-fit, and distance adaptive first–last-fit. Numerical results indicate that the proposed algorithm outperforms all of the baseline algorithms in terms of traffic admissibility. Reported results show that, compared to the baseline algorithms, consideration of the effect of NLI before resource allocation in the OA-FLF algorithm can provide a maximum gain of nearly 30% in terms of traffic admissibility for smaller networks such as BT-UK, whereas, for longer geography such as the 24-node USA network, this traffic admissibility gain becomes close to 61% till 1% blocking.
The advent of the next generation of connected and autonomous cars offers immense opportunities for both users as well as service providers. In particular, fiber-wireless (FiWi) based ...vehicle-to-infrastructure (V2I) network can facilitate some of the stringent requirements of sixth-generation (6G) vehicular networks, including higher capacity, lower delay, and ubiquitous connectivity. FiWi based V2I network integrates the next generation passive optical network 2 (NG-PON2) with IEEE 802.11p based V2I network. In this work, we first review the various kinds of vehicular data traffic and their desired key performance indicators (KPIs), namely throughput, delay, and reliability. Depending on the KPI requirements, the V2I traffic is classified among four classes and assigned to different transmission containers (T-CONTs) of the optical network unit (ONU). Further, in order to minimize the delay of the network, we propose a machine learning (ML) based T-CONT priority assignment wavelength allocation algorithm that minimizes the number of wavelength switching instances in the PON. The performance of the proposed ML-based wavelength allocation algorithm is compared with the other approaches, namely random and equal T-CONT based wavelength allocation algorithms. Simulation results demonstrate the efficiency of the proposed algorithm vis-a-vis other approaches in terms of end-to-end (e2e) delay, throughput, and reliability.
Soft silicone‐based artificial skin is essential in soft robotics because of high elongation, safe human interaction, low energy requirements and ease of manufacturing. Inspired by nature, several ...attempts have been made to fabricate morphing structures using synthetic soft skin. In this study, a novel elastomeric skin is demonstrated featuring embedded actuators and micro‐fluidic channels, that is capable of grasping objects. The actuators are twisted, and mandrel coiled nylon artificial muscles, with nichrome heaters that overcome key challenges in developing synthetic soft skin. The desired properties of a morphing skin are being low‐cost, lightweight, highly deformable, compact size, silent cyclic actuation, fast response, and long life. The actuators are fabricated from 160 μm diameter resistance wires wrapped on twisted nylon 6 fishing line precursor fibers of 800 μm diameter. The wrapped nichrome (0.42 mm pitch) along with the twisted precursor fibers are coiled on a 1.4 mm diameter mandrel rod to obtain high strain. This muscle termed twisted, and mandrel coiled polymer fishing line muscle with nichrome TCPFLNMC is embedded in soft skin samples and tested. Characterization results on the actuators (3.2 mm in diameter) showed remarkable tensile actuation of ~36% strain from loaded length at 0.99 MPa for an input power of 4.9 W, a blocked stress of 1.27 MPa, an actuation frequency of 0.04 Hz, and a lifecycle >22,000 cycles. These actuators, when embedded in the soft skin of 4 mm thick, showed ~50% bending strain within 10s and a cyclic behavior with active water cooling. A soft gripper fabricated with TCPFLNMC embedded soft skin is integrated to our child‐sized humanoid robot (HBS Robot) demonstrating its potential in grasping unconventional and deformable objects, hence advancing the progress in soft robotics.
This study identified the synergistic effect of NPK, Borax, ZnSO4 and MgSO4 with different concentrations on the postharvest quality and shelf life of strawberry stored at ambient conditions. This ...study was conducted in completely randomized Block design. Strawberry fruits were treated with different concentration of NPK, Borax, ZnSO4 and MgSO4 and stored at ambient temperature for 4 days. Changes in fruit’s physiological loss of weight, firmness, total soluble solid, titrable acidity, and ascorbic acid were periodically recorded. The results indicated that the treatment T8 (NPK @0.5% + Borax @0.25% + Znso4 @0.25%+ Mgso4 @0.25%) significantly reduced the decrease of physiological loss of weight, total soluble solids, titrable acidity, ascorbic acid, reducing sugar, non- reducing sugar and total sugar content. The results showed that treatment T8 (NPK @0.5% + Borax @0.25% + Znso4 @0.25%+ Mgso4 @0.25%) is the most effective treatment for improving the postharvest quality and prolong the shelf life of strawberry when stored at ambient condition.
Right-sided native valve infective endocarditis (IE) refers to IE involving the tricuspid or pulmonic valve. In developing countries, septic abortion is still prevalent due to instrumental delivery ...by untrained personnel. We report a case of a 22-year-old lady with right-sided IE and pulmonary septic embolization complicating septic abortion. The patient was treated with IV antibiotics, however, she succumbed to the illness following worsening respiratory distress and cardiac arrest.
An unusual case of hypopituitarism Anand, Vishal; Singh, Abhishek Pratap; Anand, Aditya ...
International journal of research in medical sciences,
02/2022, Letnik:
10, Številka:
3
Journal Article
Odprti dostop
Lymphocytic hypophysitis represents a difficult diagnostic and therapeutic challenge. The clinical presentation of this inflammatory condition may mimic that of a pituitary adenoma with apoplexy. We ...report a case of a 45 years old male patient with acute adrenal crisis complicating chronic hypopituitarism secondary to lymphocytic hypophysitis. The patient was managed acutely with high dose steroids and supportive measures, and is currently doing well.
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