Mobile-Application Based Cognitive Behavior Therapy (CBT) for Identifying and Managing Depression and Anxiety

Mobile technology is a cost effective and scalable platform for developing a therapeutic intervention. This paper discusses the development of a mobile application for people suffering with depression and anxiety. The application which we have developed is similar to a Cognitive Behavior Therapy (CBT) website, which is freely available on the internet. Past research has shown that CBT delivered over the internet is effective in alleviating the depressive symptoms in users. But, this delivery method is associated with some innate drawbacks, which caused user dropout and reduced adherence to the therapy. To overcome these shortfalls, from web based CBT delivery, a mobile application called MoodTrainer was developed. The application is equipped with mobile specific interventions and CBT modules which aim at delivering a dynamic supportive psychotherapy to the user. The mobile specific interventions using this application ensures that the user is constantly engaged with the application and focused to change the negative thought process. We present MoodTrainer as a self-efficacy tool and virtual CBT that is not meant to replace a clinical caregiver. Rather, it is a supportive tool that can be used to self-monitor, as well as a monitoring aid for clinicians

Engagement and Usability of a Cognitive Behavioral Therapy Mobile App Compared With Web-Based Cognitive Behavioral Therapy Among College Students: Randomized Heuristic Trial

Background: Recent evidence in mobile health has demonstrated that, in some cases, apps are an effective way to improve health care delivery. Health care interventions delivered via mobile technology have demonstrated both practicality and affordability. Lately, cognitive behavioral therapy (CBT) interventions delivered over the internet have also shown a meaningful impact on patients with anxiety and depression. Objective: Given the growing proliferation of smartphones and the trust in apps to support improved health behaviors and outcomes, we were interested in comparing a mobile app with Web-based methods for the delivery of CBT. This study aimed to compare the usability of a CBT mobile app called MoodTrainer with an evidence-based website called MoodGYM. Methods: We used convenience sampling to recruit 30 students from a large Midwestern university and randomly assigned them to either the MoodGYM or MoodTrainer user group. The trial period ran for 2 weeks, after which the students completed a self-assessment survey based on Nielsen heuristics. Statistical analysis was performed to compare the survey results from the 2 groups. We also compared the number of modules attempted or completed and the time spent on CBT strategies. Results: The results indicate that the MoodTrainer app received a higher usability score when compared with MoodGYM. Overall, 87% (13/15) of the participants felt that it was easy to navigate through the MoodTrainer app compared with 80% (12/15) of the MoodGYM participants. All MoodTrainer participants agreed that the app was easy to use and did not require any external assistance, whereas only 67% (10/15) had the same opinion for MoodGYM. Furthermore, 67% (10/15) of the MoodTrainer participants found that the navigation controls were easy to locate compared with 80% (12/15) of the MoodGYM participants. MoodTrainer users, on average, completed 2.5 modules compared with 1 module completed by MoodGYM users. Conclusions: As among the first studies to directly compare the usability of a mobile app–based CBT with smartphone-specific features against a Web-based CBT, there is an opportunity for app-based CBT as, at least in our limited trial, it was more usable and engaging. The study was limited to evaluate usability only and not the clinical effectiveness of the app

Searching for Lindbladians obeying local conservation laws and showing thermalization

We investigate the possibility of a Markovian quantum master equation (QME) that consistently describes a finite-dimensional system, a part of which is weakly coupled to a thermal bath. In order to preserve complete positivity and trace, such a QME must be of Lindblad form. For physical consistency, it should additionally preserve local conservation laws and be able to show thermalization. First, we show that the microscopically derived Redfield equation (RE) violates complete positivity unless in extremely special cases. We then prove that imposing complete positivity and demanding preservation of local conservation laws enforces the Lindblad operators and the lamb-shift Hamiltonian to be `local', i.e, to be supported only on the part of the system directly coupled to the bath. We then cast the problem of finding `local' Lindblad QME which can show thermalization into a semidefinite program (SDP). We call this the thermalization optimization problem (TOP). For given system parameters and temperature, the solution of the TOP conclusively shows whether the desired type of QME is possible up to a given precision. Whenever possible, it also outputs a form for such a QME. For a XXZ chain of few qubits, fixing a reasonably high precision, we find that such a QME is impossible over a considerably wide parameter regime when only the first qubit is coupled to the bath. Remarkably, we find that when the first two qubits are attached to the bath, such a QME becomes possible over much of the same paramater regime, including a wide range of temperatures

An Extremely Rare and Unusual Case of Retroperitoneal and Pelvic Metastasis from Squamous Cell Carcinoma of Vallecula

We report an extremely rare and unusual case of retroperitoneal and pelvic metastasis from primary squamous cell carcinoma of vallecula. Generally carcinoma oropharynx metastasizes to lungs, liver and bone while retroperitoneal and pelvic metastasis is rarely heard of. To the best of our knowledge this case is one of the scantly reported cases ever of this kind in the world.  A 60-year-old male presented with dysphagia and hoarseness of voice of four month duration.  Computed tomography (CT) scan face and neck showed growth right vallecula. Biopsy of lesion showed squamous cell carcinoma. Metastatic work up was negative. He received definitive chemo-radiation. Patient during follow up presented with dyspepsia, abdominal discomfort and weight loss. Whole body positron emission tomography (WB PET) scan revealed retroperitoneal and pelvic lymph node deposits which were confirmed as metastasis of squamous cell carcinoma by CT guided fine needle aspiration cytology (FNAC). Patient was exhibited palliative chemotherapy but his general condition deteriorated and he finally succumbed to his metastatic illness. This case is being reported to highlight its extreme rarity, the diagnostic and therapeutic challenges it presented and its overall dismal prognosis

Adenoid cystic carcinoma of lung: An oncologic rarity treated with definitive chemo-radiation

Adenoid Cystic Carcinoma is a rare variant of adenocarcinoma originating mainly from salivary glands of the head and neck region distributed throughout the upper aerodigestive tract with a propensity for perineural invasion. Primary adenoid cystic carcinoma of lungs is exceedingly rare accounting for a mere 0.04 to 0.2 percent of all pulmonary neoplasms. The existing scant case reports about this lung malignancy mostly describe small lung lesions managed with upfront surgery followed by adjuvant radiotherapy. We hereby present this case of primary lung parenchymal pathology where the disease was treated with definitive chemo-radiation and to the best of our knowledge; this case is one of the rarest and earliest reports of upfront chemo-radiation in an inoperable primary lung parenchymal ACC. A 43-year-old woman presented with complaints of cough, severe dyspnea, right sided chest pain associated with occasional hemoptysis. Radiographic imaging of thorax showed a large mass lesion with smooth margins measuring 10.2 × 7.3 × 6.8 cm right lower lobe with invasion of adjacent vital structures. Image guided biopsy and immunohistochemical analysis confirmed the diagnosis. She was eventually treated with definitive radiotherapy with concurrent chemotherapy as she was deemed inoperable. Post therapy evaluation by imaging showed a partial response to chemo-radiation, however there was significant symptomatic relief. In view of CD 117 positivity, she has started on oral imatinib mesylate. Presently she is on follow up with a karnofsky performance status of 90%. A thorough review of literature also reveals that our case may be the largest adenoid cystic primary parenchymal pulmonary pathology ever reported

Impact of radiotherapy on psychological, financial, and sexual aspects in postmastectomy carcinoma breast patients: A prospective study and management

Objective: The aim of this study was to assess the impact of radiotherapy (RT) on psychological, financial, and sexual aspects in postmastectomy carcinoma breast patients affecting their quality of life (QOL) before, during, and after RT with a strong emphasis on their management and rehabilitation aspects. Methods: A cross-sectional study carried out in a specialized institution, comprising sixty women. Two standardized questionnaires European Organization for Research and Treatment of Cancer (EORTC) 30-item Quality of Life Questionnaire and Quality of Life Questionnaire breast cancer-23 (QLQ-BR23) for health-related quality, translated and validated for the Hindi language were used. The scores' manual of the EORTC was used to calculate the domain scores of the questionnaires. Results: According to the first questionnaire, the emotional function was most affected even at onset of RT treatment and it was worst at the completion of RT treatment with a mean score of 63.75. The global QOL score was also worst at the end of radiation treatment with a mean score of 32.36, while the score 3 months after completion of treatment was 68.16. The symptoms with the highest scores were insomnia with a worst scoring at completion of treatment (29.99), fatigue (26.57), and pain (23.05). According to the QLQ-BR23, the mean score for side effects such as sexual functioning was minimum 0.55 at the completion of RT, which improved to 11.66 on the first follow-up after 3 months. Mean future perspective score which was 57.22 before the start of RT which was reduced to 50.55 at completion, which means that many women experience side effects of RT and impaired sexual satisfaction. Conclusions: Women with breast cancer showed changes in the following domains: financial, emotional, sexual satisfaction, and future prospects. The most frequently mentioned symptoms were fatigue, insomnia, and pain

Imaging Findings of a Survivor of Avalanche without Any Life Support at Very High Altitude and Extreme Low Temperatures

Survival at high altitude is very challenging and in spite of adequate training and acclimatization, injuries are frequent. The fate of mountaineers and soldiers at such areas largely depends on the mercy of the climate. An avalanche causes physical trauma, cold injury and asphyxia to the victim. The patient in our report had diffuse cerebral edema, bilateral pulmonary consolidation and pneumothorax. In spite of the best efforts the victim succumbed to the injuries. There are many incidents of high altitude accidents in India. This case report is of a soldier deployed at the high altitude, is a lone ever reported survivor above 5000 meters, under 35 feet snow and below - 45°C for greater than 5 days of exposure to an avalanch

An Extremely Rare and Unusual Case of Retroperitoneal and Pelvic Metastasis from Squamous Cell Carcinoma of Vallecula

We report an extremely rare and unusual case of retroperitoneal and pelvic metastasis from primary squamous cell carcinoma of vallecula. Generally carcinoma oropharynx metastasizes to lungs, liver and bone while retroperitoneal and pelvic metastasis is rarely heard of. To the best of our knowledge this case is one of the scantly reported cases ever of this kind in the world.  A 60-year-old male presented with dysphagia and hoarseness of voice of four month duration.  Computed tomography (CT) scan face and neck showed growth right vallecula. Biopsy of lesion showed squamous cell carcinoma. Metastatic work up was negative. He received definitive chemo-radiation. Patient during follow up presented with dyspepsia, abdominal discomfort and weight loss. Whole body positron emission tomography (WB PET) scan revealed retroperitoneal and pelvic lymph node deposits which were confirmed as metastasis of squamous cell carcinoma by CT guided fine needle aspiration cytology (FNAC). Patient was exhibited palliative chemotherapy but his general condition deteriorated and he finally succumbed to his metastatic illness. This case is being reported to highlight its extreme rarity, the diagnostic and therapeutic challenges it presented and its overall dismal prognosis.</p