A Therapist-guided Smartphone App for Major Depression in Young Adults: A Randomized Clinical Trial

Background: Meru Health Program (MHP) is a therapist-guided, 8-week intervention for depression delivered via smartphone. The aim was to test its efficacy in patients with clinical depression in a Finnish university student health service. Methods: Patients (n=124, women 72.6%, mean age 25y) were stratified based on antidepressant status, and randomized into intervention group receiving MHP plus treatment as usual (TAU), and control group receiving TAU only. Depression, measured by the Patient Health Questionnaire-9 (PHQ-9) scale, was the primary outcome. After baseline (T0), follow-ups were at mid-intervention (T4), immediately post-intervention (T8); 3 months (T20), and 6 months (T32) post-intervention. Results: The intervention group and control group did not have significant differences in depression outcomes throughout end of treatment and follow-up. Among secondary outcomes, increase in resilience (d=0.32, p=0.03) and mindfulness (d=0.57, p=0.002), and reduction in perceived stress (d=-0.52, p=0.008) were greater in MHP+TAU versus TAU at T32; no differences were found in anxiety, sleep disturbances, and quality of life between groups. Post-hoc comparisons of patients on antidepressants showed significantly greater reduction in depression at T32 for MHP+TAU versus TAU (d=-0.73, p=0.01); patients not on antidepressants showed no between-group differences. Limitations: Limitations include unknown characteristics of TAU, potential bias from patients and providers not being blinded to treatment group, and failure to specify examination of differences by antidepressant status in the protocol. Conclusions: Most outcomes, including depression, did not significantly differ between MHP+TAU and TAU. Exploratory analysis revealed intervention effect at the end of the 6-month follow-up among patients on antidepressant medication.Background: Meru Health Program (MHP) is a therapist-guided, 8-week intervention for depression delivered via smartphone. The aim was to test its efficacy in patients with clinical depression in a Finnish university student health service.& nbsp; Methods: Patients (n=124, women 72.6%, mean age 25y) were stratified based on antidepressant status, and randomized into intervention group receiving MHP plus treatment as usual (TAU), and control group receiving TAU only. Depression, measured by the Patient Health Questionnaire-9 (PHQ-9) scale, was the primary outcome. After baseline (T0), follow-ups were at mid-intervention (T4), immediately post-intervention (T8); 3 months (T20), and 6 months (T32) post-intervention.& nbsp; Results: The intervention group and control group did not have significant differences in depression outcomes throughout end of treatment and follow-up. Among secondary outcomes, increase in resilience (d=0.32, p=0.03) and mindfulness (d=0.57, p=0.002), and reduction in perceived stress (d=-0.52, p=0.008) were greater in MHP+TAU versus TAU at T32; no differences were found in anxiety, sleep disturbances, and quality of life between groups. Post-hoc comparisons of patients on antidepressants showed significantly greater reduction in depression at T32 for MHP+TAU versus TAU (d=-0.73, p=0.01); patients not on antidepressants showed no between-group differences.& nbsp; Limitations: Limitations include unknown characteristics of TAU, potential bias from patients and providers not being blinded to treatment group, and failure to specify examination of differences by antidepressant status in the protocol.& nbsp; & nbsp;Conclusions: Most outcomes, including depression, did not significantly differ between MHP+TAU and TAU. Exploratory analysis revealed intervention effect at the end of the 6-month follow-up among patients on anti-depressant medication.Peer reviewe

The persistent cosmic web and its filamentary structure I: Theory and implementation

We present DisPerSE, a novel approach to the coherent multi-scale identification of all types of astrophysical structures, and in particular the filaments, in the large scale distribution of matter in the Universe. This method and corresponding piece of software allows a genuinely scale free and parameter free identification of the voids, walls, filaments, clusters and their configuration within the cosmic web, directly from the discrete distribution of particles in N-body simulations or galaxies in sparse observational catalogues. To achieve that goal, the method works directly over the Delaunay tessellation of the discrete sample and uses the DTFE density computed at each tracer particle; no further sampling, smoothing or processing of the density field is required. The idea is based on recent advances in distinct sub-domains of computational topology, which allows a rigorous application of topological principles to astrophysical data sets, taking into account uncertainties and Poisson noise. Practically, the user can define a given persistence level in terms of robustness with respect to noise (defined as a "number of sigmas") and the algorithm returns the structures with the corresponding significance as sets of critical points, lines, surfaces and volumes corresponding to the clusters, filaments, walls and voids; filaments, connected at cluster nodes, crawling along the edges of walls bounding the voids. The method is also interesting as it allows for a robust quantification of the topological properties of a discrete distribution in terms of Betti numbers or Euler characteristics, without having to resort to smoothing or having to define a particular scale. In this paper, we introduce the necessary mathematical background and describe the method and implementation, while we address the application to 3D simulated and observed data sets to the companion paper.Comment: A higher resolution version is available at http://www.iap.fr/users/sousbie together with complementary material. Submitted to MNRA

Long-Term Outcomes of a Therapist-Supported, Smartphone-Based Intervention for Elevated Symptoms of Depression and Anxiety : Quasiexperimental, Pre-Postintervention Study

Background: Depression is one of the most common mental health disorders and severely impacts one's physical, psychological, and social functioning. To address access barriers to care, we developed Ascend-a smartphone-delivered, therapist-supported, 8-week intervention based on several evidence-based psychological treatments for depression and anxiety. A previous feasibility study with 102 adults with elevated depression reported that Ascend is associated with a postintervention reduction in depression symptoms. Objective: We aimed to examine whether Ascend is associated with a reduction in symptoms of anxiety, and importantly, whether reductions in symptoms of depression and anxiety are maintained up to 12-months postintervention. Methods: We assessed whether the previously reported, end-of-treatment improvements seen in the 102 adults with elevated symptoms of depression extended up to 12 months posttreatment for depression symptoms (measured by the Patient Health Questionnaire-9 [PHQ-9]) and up to 6 months posttreatment for anxiety symptoms (added to the intervention later and measured using the Generalized Anxiety Disorder-7 [GAD-7] scale). We used linear mixed effects models with Tukey contrasts to compare time points and reported intention-to-treat statistics with a sensitivity analysis. Results: The intervention was associated with reductions in symptoms of depression that were maintained 12 months after the program (6.67-point reduction in PHQ-9 score, 95% CI 5.59-7.75; P= 10) reported clinically significant improvement at the 12-month follow-up (at least 50% reduction in PHQ-9 score and postprogram score Conclusions: There is limited evidence on whether outcomes associated with smartphone-based interventions for common mental health problems are maintained posttreatment. Participants who enrolled in Ascend experienced clinically significant reductions in symptoms of depression and anxiety that were maintained for up to 1 year and 6 months after the intervention, respectively. Future randomized trials are warranted to test Ascend as a scalable solution to the treatment of depression and anxiety.Peer reviewe

Using Gamma-Ray Burst Prompt Emission to Probe Relativistic Shock Acceleration

It is widely accepted that the prompt transient signal in the 10 keV - 10 GeV band from gamma-ray bursts (GRBs) arises from multiple shocks internal to the ultra-relativistic expansion. The detailed understanding of the dissipation and accompanying acceleration at these shocks is a currently topical subject. This paper explores the relationship between GRB prompt emission spectra and the electron (or ion) acceleration properties at the relativistic shocks that pertain to GRB models. The focus is on the array of possible high-energy power-law indices in accelerated populations, highlighting how spectra above 1 MeV can probe the field obliquity in GRB internal shocks, and the character of hydromagnetic turbulence in their environs. It is emphasized that diffusive shock acceleration theory generates no canonical spectrum at relativistic MHD discontinuities. This diversity is commensurate with the significant range of spectral indices discerned in prompt burst emission. Such system diagnostics are now being enhanced by the broadband spectral coverage of bursts by the Fermi Gamma-Ray Space Telescope; while the Gamma-Ray Burst Monitor (GBM) provides key diagnostics on the lower energy portions of the particle population, the focus here is on constraints in the non-thermal, power-law regime of the particle distribution that are provided by the Large Area Telescope (LAT).Comment: 15 pages, 2 figures. Accepted for publication in Advances of Space Researc

Feasibility and Efficacy of the Addition of Heart Rate Variability Biofeedback to a Remote Digital Health Intervention for Depression

A rise in the prevalence of depression underscores the need for accessible and effective interventions. The objectives of this study were to determine if the addition of a treatment component showing promise in treating depression, heart rate variability-biofeedback (HRV-B), to our original smartphone-based, 8-week digital intervention was feasible and whether patients in the HRV-B ("enhanced") intervention were more likely to experience clinically significant improvements in depressive symptoms than patients in our original ("standard") intervention. We used a quasi-experimental, non-equivalent (matched) groups design to compare changes in symptoms of depression in the enhanced group (n = 48) to historical outcome data from the standard group (n = 48). Patients in the enhanced group completed a total average of 3.86 h of HRV-B practice across 25.8 sessions, and were more likely to report a clinically significant improvement in depressive symptom score post-intervention than participants in the standard group, even after adjusting for differences in demographics and engagement between groups (adjusted OR 3.44, 95% CI [1.28-9.26], P = .015). Our findings suggest that adding HRV-B to an app-based, smartphone-delivered, remote intervention for depression is feasible and may enhance treatment outcomes.Peer reviewe

Screening for Major Depressive Disorder in Children and Adolescents: A Systematic Review for the U.S. Preventive Services Task Force

BACKGROUND: Major depressive disorder (MDD) is common among children and adolescents and is associated with functional impairment and suicide. PURPOSE: To update the 2009 U.S. Preventive Services Task Force (USPSTF) systematic review on screening for and treatment of MDD in children and adolescents in primary care settings. DATA SOURCES: Several electronic searches (May 2007 to February 2015) and searches of reference lists of published literature. STUDY SELECTION: Trials and recent systematic reviews of treatment, test-retest studies of screening, and trials and large cohort studies for harms. DATA EXTRACTION: Data were abstracted by 1 investigator and checked by another; 2 investigators independently assessed study quality. DATA SYNTHESIS: Limited evidence from 5 studies showed that such tools as the Beck Depression Inventory and Patient Health Questionnaire for Adolescents had reasonable accuracy for identifying MDD among adolescents in primary care settings. Six trials evaluated treatment. Several individual fair- and good-quality studies of fluoxetine, combined fluoxetine and cognitive behavioral therapy, escitalopram, and collaborative care demonstrated benefits of treatment among adolescents, with no associated harms. LIMITATION: The review included only English-language studies, narrow inclusion criteria focused only on MDD, high thresholds for quality, potential publication bias, limited data on harms, and sparse evidence on long-term outcomes of screening and treatment among children younger than 12 years. CONCLUSION: No evidence was found of a direct link between screening children and adolescents for MDD in primary care or similar settings and depression or other health-related outcomes. Evidence showed that some screening tools are accurate and some treatments are beneficial among adolescents (but not younger children), with no evidence of associated harms. PRIMARY FUNDING SOURCE: Agency for Healthcare Research and Quality

On the nature of two low M-dot X-ray bursters: 1RXS J170854.4-321857 and 1RXS J171824.2-402934

We carried out Chandra observations of two low-luminosity low-mass X-ray binaries, 1RXS J170854.4-321857 and 1RXS J171824.2-402934, for which previously single X-ray bursts had been detected with the Wide Field Cameras (WFCs) on board BeppoSAX. Both were detected in our Chandra observations in an actively accreting state three to eight years after the X-ray bursts, with 0.5-10 keV luminosities between 5x10^34 and 2x10^36 erg/s. The apparently persistent nature is remarkable for 1RXS J171824.2-402934 given its low luminosity of 0.001L_Edd. The persistence of both sources also distinguishes them from 5 other low-L bursters, which have also been seen during bursts with the WFCs but were not detected during Chandra observations above a luminosity of 10^33 erg/s. Those are probably transient rather than persistent sources.Comment: accepted for publication in Astronomy & Astrophysics, 7 pages, 5 figure

Spectral states evolution of 4U 1728-34 observed by INTEGRAL and RXTE: non-thermal component detection

We report results of a one-year monitoring of the low mass X-ray binary (LMXB) source (atoll type) 4U 1728-34 with INTEGRAL and RXTE. Three time intervals were covered by INTEGRAL, during which the source showed strong spectral evolution. We studied the broad-band X-ray spectra in detail by fitting several models in the different sections of the hardness-intensity diagram. The soft states are characterised by prominent blackbody emission plus a contribution from a Comptonized emission. The hard states are characterised by the presence of an excess flux with respect to the Comptonization model above 50 keV while the soft component is fainter. To obtain an acceptable fit to the data this excess is modeled either with a power law with photon index Gamma ~ 2 or a Comptonization (CompPS) spectrum implying the presence of hybrid thermal and non-thermal electrons in a corona. This makes 4U 1728-34 one of the few LMXBs of atoll type showing non-thermal emission at high energy. From our analysis, it is also apparent that the presence of the hard tail is more prominent as the overall spectrum becames harder. We discuss also alternative models which can discribe these hard states.Comment: Accepted for publication in MNRAS (accepted 2011 April 20. Received 2011 April 20; in original form 2010 December 07); 9 pages, 7 figure

A therapist-guided smartphone app for major depression in young adults: A randomized clinical trial

Background: Meru Health Program (MHP) is a therapist-guided, 8-week intervention for depression delivered via smartphone. The aim was to test its efficacy in patients with clinical depression in a Finnish university student health service. Methods: Patients (n=124, women 72.6%, mean age 25y) were stratified based on antidepressant status, and randomized into intervention group receiving MHP plus treatment as usual (TAU), and control group receiving TAU only. Depression, measured by the Patient Health Questionnaire-9 (PHQ-9) scale, was the primary outcome. After baseline (T0), follow-ups were at mid-intervention (T4), immediately post-intervention (T8); 3 months (T20), and 6 months (T32) post-intervention. Results: The intervention group and control group did not have significant differences in depression outcomes throughout end of treatment and follow-up. Among secondary outcomes, increase in resilience (d=0.32, p=0.03) and mindfulness (d=0.57, p=0.002), and reduction in perceived stress (d=-0.52, p=0.008) were greater in MHP+TAU versus TAU at T32; no differences were found in anxiety, sleep disturbances, and quality of life between groups. Post-hoc comparisons of patients on antidepressants showed significantly greater reduction in depression at T32 for MHP+TAU versus TAU (d=-0.73, p=0.01); patients not on antidepressants showed no between-group differences. Limitations: Limitations include unknown characteristics of TAU, potential bias from patients and providers not being blinded to treatment group, and failure to specify examination of differences by antidepressant status in the protocol. Conclusions: Most outcomes, including depression, did not significantly differ between MHP+TAU and TAU. Exploratory analysis revealed intervention effect at the end of the 6-month follow-up among patients on anti-depressant medication.</p

Beliefs and practices of healthcare providers regarding obesity: a systematic review

Despite the implementation of various intervention measures, the number of obese individuals remain high; thus, it is important to consider what is contributing to this scenario. Authors have been striving to understand the role healthcare providers, especially in primary healthcare, seem to play in this context. The present review aims to synthesize the main investigation results regarding beliefs, attitudes, and practices of healthcare providers, as they seem to negatively influence the practitioner’s actions. The words “obesity”, “beliefs”, “healthcare professionals”, “general practitioners”, “attitudes”, “practices”, “health physicians”, and “family practitioners” were entered into databases, such as EBSCOHost, ScienceDirect, PsychInfo, PubMed, and SciELO. Thirteen studies from 1991 to 2011 were reviewed. The data indicate a lack of appropriate understanding and adequate competence regarding obesity, which likely contributes to ambivalent belief development and negative attitudes toward obese individuals, who are described as unmotivated, lazy, and lacking self-control. These professionals consider it hard to deal with obesity, manifesting low expectations of success regarding weight loss, thus considering themselves unsuccessful. Their practices are inconsistent, mirroring a certain skepticism towards the efficacy of available interventions. Either during graduation or as active practitioners, it is imperative to make healthcare providers aware of the impact their beliefs regarding obesity can exert on their practices, as these may impair appropriate and effective treatment delivery to obese individuals