Digital Therapeutics for Mental Health: Is Attrition the Achilles Heel?

Digit therapeutics are novel software devices that clinicians may utilize in delivering quality mental health care and ensuring positive outcomes. However, uptake of digital therapeutics and clinically tested software-based programs remains low. This article presents possible reasons for attrition and low engagement in clinical studies investigating digital therapeutics, analyses of studies in which engagement was high, and design constructs that may encourage user engagement. The aim is to shed light on the importance of real-world attrition data of digital therapeutics, and important characteristics of medical devices that have positively influenced user engagement. The findings presented in this article will be useful to relevant stakeholders and medical device experts tasked with addressing the gap between software medical design and user engagement present in digital therapeutic clinical trials.Comment: 11 pages, 1 tabl

Preliminary evaluation of spectral, normal and meteorological crop stage estimation approaches

Several of the projects in the AgRISTARS program require crop phenology information, including classification, acreage and yield estimation, and detection of episodal events. This study evaluates several crop calendar estimation techniques for their potential use in the program. The techniques, although generic in approach, were developed and tested on spring wheat data collected in 1978. There are three basic approaches to crop stage estimation: historical averages for an area (normal crop calendars), agrometeorological modeling of known crop-weather relationships agrometeorological (agromet) crop calendars, and interpretation of spectral signatures (spectral crop calendars). In all, 10 combinations of planting and biostage estimation models were evaluated. Dates of stage occurrence are estimated with biases between -4 and +4 days while root mean square errors range from 10 to 15 days. Results are inconclusive as to the superiority of any of the models and further evaluation of the models with the 1979 data set is recommended

The metabolism of nitrogen, calcium and phosphorus in undernourished children. 8. The metabolism of nitrogen, calcium and phosphorus, and the digestibility coefficient and biological value of the proteins and the net protein utilization on poor Indian diets based on rice, maize or a mixture of rice and maize

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The Monoclonal Antibody Cocktail in SARS-CoV 2: A Bonanza for Patients With Chronic Lymphocytic Leukemia?

Monoclonal antibody cocktail is currently one of the most promising approaches being studied in the management of severe acute respiratory syndrome coronavirus 2 (SARS CoV-2). We present a case of an elderly patient with coronavirus disease (COVID-19) and Chronic lymphocytic leukaemia (CLL) who had recurrent episodes of desaturation and admission in intensive care unit (ICU) despite receiving the treatment for moderate to severe COVID-19. After careful selection, weighing the benefits and risks, the patient was started on the combination of the two monoclonal antibodies, casirivimab and imdevimab. The results suggest that this could be a game changer in COVID-19 with a focused approach of management of COVID-19 positive patients especially in the vulnerable population

Quantifying the regional water footprint of biofuel production by incorporating hydrologic modeling

A spatially explicit life cycle water analysis framework is proposed, in which a standardized water footprint methodology is coupled with hydrologic modeling to assess blue water, green water (rainfall), and agricultural grey water discharge in the production of biofuel feedstock at county-level resolution. Grey water is simulated via SWAT, a watershed model. Evapotranspiration (ET) estimates generated with the Penman-Monteith equation and crop parameters were verified by using remote sensing results, a satellite-imagery-derived data set, and other field measurements. Crop irrigation survey data are used to corroborate the estimate of irrigation ET. An application of the concept is presented in a case study for corn-stover-based ethanol grown in Iowa (United States) within the Upper Mississippi River basin. Results show vast spatial variations in the water footprint of stover ethanol from county to county. Producing 1 L of ethanol from corn stover growing in the Iowa counties studied requires from 4.6 to 13.1 L of blue water (with an average of 5.4 L), a majority (86%) of which is consumed in the biorefinery. The county-level green water (rainfall) footprint ranges from 760 to 1000 L L-1. The grey water footprint varies considerably, ranging from 44 to 1579 L, a 35-fold difference, with a county average of 518 L. This framework can be a useful tool for watershed-or county-level biofuel sustainability metric analysis to address the heterogeneity of the water footprint for biofuels

Exercise Fails to Improve Neurocognition in Depressed Middle-Aged and Older Adults

Purpose: Although cross-sectional studies have demonstrated an association between higher levels of aerobic fitness and improved neurocognitive function, there have been relatively few interventional studies investigating this relationship, and results have been inconsistent. We assessed the effects of aerobic exercise on neurocognitive function in a randomized controlled trial of patients with major depressive disorder (MDD). Methods: Two-hundred and two sedentary men (n = 49) and women (n = 153), aged 40 yr and over and who met diagnostic criteria for MDD, were randomly assigned to the following: a) supervised exercise, b) home-based exercise, c) sertraline, or d) placebo pill. Before and after 4 months of treatment, participants completed measures of: Executive Function (Trail Making Test BA difference score, Stroop Color/Word, Ruff 2 & 7 Test, Digit Symbol), Verbal Memory (Logical Memory, Verbal Paired Associates), and Verbal Fluency/Working Memory (Animal Naming, Controlled Oral Word Association Test, Digit Span). Multivariate analyses of covariance were performed to test the effects of treatment on posttreatment neuropsychological test scores, with baseline neuropsychological test scores, age, education, and change in depression scores entered as covariates. Results: The performance of exercise participants was no better than participants receiving placebo across all neuropsychological tests. Exercise participants performed better than participants receiving sertraline on tests of executive function but not on tests of verbal memory or verbal fluency/ working memory. Conclusions: We found little evidence to support the benefits of an aerobic exercise intervention on neurocognitive performance in patients with MDD. Originally published Medicine and Science in Sport and Exercise, Vol. 40, No. 7, July 200

Cardiovascular disease risk, vascular health and erectile dysfunction among middle-aged, clinically depressed men

Erectile dysfunction (ED) is especially common in men with major depressive disorder (MDD). This study examined the extent to which risk factors for cardiovascular disease (CVD) and vascular dysfunction were associated with ED severity in a series of MDD patients

Florbetapir F 18 amyloid PET and 36-month cognitive decline:a prospective multicenter study

This study was designed to evaluate whether subjects with amyloid beta (Aβ) pathology, detected using florbetapir positron emission tomorgraphy (PET), demonstrated greater cognitive decline than subjects without Aβ pathology. Sixty-nine cognitively normal (CN) controls, 52 with recently diagnosed mild cognitive impairment (MCI) and 31 with probable Alzheimer's disease (AD) dementia were included in the study. PET images obtained in these subjects were visually rated as positive (Aβ+) or negative (Aβ−), blind to diagnosis. Fourteen percent (10/69) of CN, 37% (19/52) of MCI and 68% (21/31) of AD were Aβ+. The primary outcome was change in ADAS-Cog score in MCI subjects after 36 months; however, additional outcomes included change on measures of cognition, function and diagnostic status. Aβ+ MCI subjects demonstrated greater worsening compared with Aβ− subjects on the ADAS-Cog over 36 months (5.66±1.47 vs −0.71±1.09, P=0.0014) as well as on the mini-mental state exam (MMSE), digit symbol substitution (DSS) test, and a verbal fluency test (P<0.05). Similar to MCI subjects, Aβ+ CN subjects showed greater decline on the ADAS-Cog, digit-symbol-substitution test and verbal fluency (P<0.05), whereas Aβ+ AD patients showed greater declines in verbal fluency and the MMSE (P<0.05). Aβ+ subjects in all diagnostic groups also showed greater decline on the CDR-SB (P<0.04), a global clinical assessment. Aβ+ subjects did not show significantly greater declines on the ADCS-ADL or Wechsler Memory Scale. Overall, these findings suggest that in CN, MCI and AD subjects, florbetapir PET Aβ+ subjects show greater cognitive and global deterioration over a 3-year follow-up than Aβ− subjects do

Cerebrovascular Risk Factors, Vascular Disease, and Neuropsychological Outcomes in Adults With Major Depression

To investigate the relationship of cerebrovascular risk factors (CVRFs), endothelial function, carotid artery intima medial thickness (IMT), and neuropsychological performance in a sample of 198 middle-aged and older individuals with major depressive disorder (MDD). Neuropsychological deficits are common among adults with MDD, particularly among those with CVRFs and potentially persons with subclinical vascular disease