Objective User Engagement With Mental Health Apps: Systematic Search and Panel-Based Usage Analysis.

BACKGROUND: Understanding patterns of real-world usage of mental health apps is key to maximizing their potential to increase public self-management of care. Although developer-led studies have published results on the use of mental health apps in real-world settings, no study yet has systematically examined usage patterns of a large sample of mental health apps relying on independently collected data. OBJECTIVE: Our aim is to present real-world objective data on user engagement with popular mental health apps. METHODS: A systematic engine search was conducted using Google Play to identify Android apps with 10,000 installs or more targeting anxiety, depression, or emotional well-being. Coding of apps included primary incorporated techniques and mental health focus. Behavioral data on real-world usage were obtained from a panel that provides aggregated nonpersonal information on user engagement with mobile apps. RESULTS: In total, 93 apps met the inclusion criteria (installs: median 100,000, IQR 90,000). The median percentage of daily active users (open rate) was 4.0% (IQR 4.7%) with a difference between trackers (median 6.3%, IQR 10.2%) and peer-support apps (median 17.0%) versus breathing exercise apps (median 1.6%, IQR 1.6%; all z≥3.42, all P CONCLUSIONS: Although the number of app installs and daily active minutes of use may seem high, only a small portion of users actually used the apps for a long period of time. More studies using different datasets are needed to understand this phenomenon and the ways in which users self-manage their condition in real-world settings

Wave attenuation in glasses: Rayleigh and generalized-Rayleigh scattering scaling

The attenuation of long-wavelength phonons (waves) by glassy disorder plays a central role in various glass anomalies, yet it is neither fully characterized, nor fully understood. Of particular importance is the scaling of the attenuation rate $\Gamma(k)$ with small wavenumbers $k\!\to\!0$ in the thermodynamic limit of macroscopic glasses. Here we use a combination of theory and extensive computer simulations to show that the macroscopic low-frequency behavior emerges at intermediate frequencies in finite-size glasses, above a recently identified crossover wavenumber $k_\dagger$, where phonons are no longer quantized into bands. For $k\!<\!k_\dagger$, finite-size effects dominate $\Gamma(k)$, which is quantitatively described by a theory of disordered phonon bands. For $k\!>\!k_\dagger$, we find that $\Gamma(k)$ is affected by the number of quasilocalized nonphononic excitations, a generic signature of glasses that feature a universal density of states. In particular, we show that in a frequency range in which this number is small, $\Gamma(k)$ follows a Rayleigh scattering scaling $\sim\!k^{d+1}$ ($d$ is the spatial dimension), and that in a frequency range in which this number is sufficiently large, the recently observed generalized-Rayleigh scaling of the form $\sim\!k^{d+1}\log\!{(k_0/k)}$ emerges ($k_0\!>k_\dagger$ is a characteristic wavenumber). Our results suggest that macroscopic glasses --- and, in particular, glasses generated by conventional laboratory quenches that are known to strongly suppress quasilocalized nonphononic excitations --- exhibit Rayleigh scaling at the lowest wavenumbers $k$ and a crossover to generalized-Rayleigh scaling at higher $k$. Some supporting experimental evidence from recent literature is presented.Comment: 15 pages, 10 figures (including appendices). v2 includes a new appendix with 2 figures (Fig.7 & Fig.8

Using Phragmites australis(Iraqi plant) to remove the Lead (II) Ions form Aqueous solution.

Lead remediation was achieved using simple cost, effective and eco-friendly way from industrial wastewater. Phragmitesaustralis (P.a) (Iraqi plant), was used as anovel biomaterial to remove lead ions from synthesized waste water. Different parameters which affected on adsorption processes were investigated like adsorbent dose, pH, contact time, and adsorbent particle size, to reach the optimized conditions (maximum adsorption). The adsorption of Pb (?) on (P.a) involved fast and slow process as a mechanism steps according to obey two theoretical adsorption isotherms; Langmuir and Freundlich. The thermos dynamic adsorption parameters were evaluated also. The (?H) obtained positive value that meanes adsorption of lead ions was an endothermic processwhile (?G)values were negative which means that adsorption of lead ions was a spontaneous process and the decrease in (?G) with temperature increasing revealed that lead ions adsorption on (P.a) became favorable with temperature increasin

A plain language summary on assessing the long-term effectiveness of cladribine tablets in people living with relapsing multiple sclerosis: The CLASSIC-MS study

Cladribina; Multiple sclerosis; RelapsesCladribina; Esclerosi múltiple; RecaigudesCladribina; Esclerosis múltiple; RecaídasWhat is this summary about? Previous studies have shown that people living with multiple sclerosis (MS) treated with cladribine tablets have fewer relapses (where new symptoms occur or existing symptoms get worse for 24 hours or more) and delayed disability progression (slowing down of the disease getting worse). The CLASSIC-MS study looked at the long-term effectiveness of treatment with cladribine tablets in people living with MS who had taken part in the original CLARITY and CLARITY Extension clinical studies. What were the results? Results showed that people treated with cladribine tablets maintained their mobility (the ability to move freely) for longer and experienced other positive effects long after their treatment ended, including being less likely to need further treatment for their MS. What do the results mean? The results obtained from CLASSIC-MS show that the benefits of taking cladribine tablets carry on even when patients stop taking the treatment

Assessment of potential cardiotoxic side effects of mitoxantrone in patients with multiple sclerosis

Previous studies showed that mitoxantrone can reduce disability progression in patients with multiple sclerosis (MS). There is, however, concern that it may cause irreversible cardiomyopathy with reduced left ventricular (LV) ejection fraction (EF) and congestive heart failure. The aim of this prospective study was to investigate cardiac side effects of mitoxantrone by repetitive cardiac monitoring in MS patients. The treatment protocol called for ten courses of a combined mitoxantrone (10 mg/m(2) body surface) and methylprednisolone therapy. Before each course, a transthoracic echocardiogram was performed to determine the LV end-diastolic diameter, the end-systolic diameter and the fractional shortening; the LV-EF was calculated. Seventy-three patients participated (32 males; age 48 +/- 12 years, range 20-75 years; 25 with primary progressive, 47 with secondary progressive and 1 with relapsing-remitting MS) who received at least four courses of mitoxantrone. Three of the 73 patients were excluded during the study (2 patients discontinued therapy; 1 patient with a previous history of ischemic heart disease developed atrial fibrillation after the second course of mitoxantrone). The mean cumulative dose of mitoxantrone was 114.0 +/- 33.8 mg. The mean follow-up time was 23.4 months (range 10-57 months). So far, there has been no significant change in any of the determined parameters (end-diastolic diameter, end-systolic diameter, fractional shortening, EF) over time during all follow-up investigations. Mitoxantrone did not cause signs of congestive heart failure in any of the patients. Further cardiac monitoring is, however, needed to determine the safety of mitoxantrone after longer follow-up times and at higher cumulative doses. Copyright (C) 2005 S. Karger AG, Basel

Molecular mechanism underlying the impact of vitamin D on disease activity of MS

Objective: Some previous studies suggest modest to strong effects of 25-hydroxyvitamin D (25(OH)D) on multiple sclerosis (MS) activity. The objective of this study was to explore the mechanistic rationale that may explain potential clinical effects of 25(OH)D. Methods: This study measured serum 25(OH)D levels and global gene expression profiles over a course of up to 2 years in patients starting treatment with interferon beta-1b (IFNB-1b) after a clinically isolated syndrome. MS disease activity was assessed by the number of gadolinium-enhancing lesions present on repeated magnetic resonance imaging (MRIs). Results: The number of gadolinium-enhancing lesions was highly significantly associated with 25(OH)D levels. Conducting various systems-level analyses on the molecular level, multiple lines of evidence indicated that 25(OH)D regulates expression dynamics of a large gene–gene interaction system which primarily regulates immune modulatory processes modulating MS activity. The vitamin D response element was significantly enriched in this system, indicating a direct regulation of this gene interaction network through the vitamin D receptor. With increasing 25(OH)D levels, resulting regulation of this system was associated with a decrease in MS activity. Within the complex network of genes that are regulated by 25(OH)D, well-described targets of IFNB-1b and a regulator of sphingosine-1-phosphate bioavailability were found. The 25(OH)D effects on MS activity were additively enhanced by IFNB-1b. Interpretation Here, we provide mechanistic evidence that an unbalanced 25(OH)D gene expression system may affect MS activity. Our findings support a potential benefit of monitoring and managing vitamin D levels (e.g., through supplementation) in early MS patients treated with IFN-beta-1b

Long-term follow-up of patients with relapsing multiple sclerosis from the CLARITY/CLARITY Extension cohort of CLASSIC-MS : an ambispective study

Background: CLASSIC-MS evaluated the long-term efficacy of cladribine tablets in patients with relapsing multiple sclerosis. Objective: Report long-term mobility and disability beyond treatment courses received in CLARITY/CLARITY Extension. Methods: This analysis represents CLASSIC-MS patients who participated in CLARITY with/without participation in CLARITY Extension, and received ⩾1 course of cladribine tablets or placebo (N = 435). Primary objective includes evaluation of long-term mobility (no wheelchair use in the 3 months prior to first visit in CLASSIC-MS and not bedridden at any time since last parent study dose (LPSD), i.e. Expanded Disability Status Scale (EDSS) score <7). Secondary objective includes long-term disability status (no use of an ambulatory device (EDSS < 6) at any time since LPSD). Results: At CLASSIC-MS baseline, mean ± standard deviation EDSS score was 3.9 ± 2.1 and the median time since LPSD was 10.9 (range = 9.3-14.9) years. Cladribine tablets-exposed population: 90.6% (N = 394), including 160 patients who received a cumulative dose of 3.5 mg/kg over 2 years. Patients not using a wheelchair and not bedridden: exposed, 90.0%; unexposed, 77.8%. Patients with no use of an ambulatory device: exposed, 81.2%; unexposed, 75.6%. Conclusion: With a median 10.9 years' follow-up after CLARITY/CLARITY Extension, findings suggest the sustained long-term mobility and disability benefits of cladribine tablets

The 11-year long-term follow-up study from the randomized BENEFIT CIS trial

L

Interferon β-1a in relapsing multiple sclerosis: four-year extension of the European IFNβ-1a Dose-C omparison Study

Background: Multiple sclerosis (MS) is a chronic disease requiring long-term monitoring of treatment. Objective: To assess the four-year clinical efficacy of intramuscular (IM) IFNb-1a in patients with relapsing MS from the European IFNb-1a Dose-C omparison Study. Methods: Patients who completed 36 months of treatment (Part 1) of the European IFNb-1a Dose-C omparison Study were given the option to continue double-blind treatment with IFNb-1a 30 mcg or 60 mcg IM once weekly (Part 2). Analyses of 48-month data were performed on sustained disability progression, relapses, and neutralizing antibody (NA b) formation. Results: O f 608/802 subjects who completed 36 months of treatment, 493 subjects continued treatment and 446 completed 48 months of treatment and follow-up. IFNb-1a 30 mcg and 60 mcg IM once weekly were equally effective for up to 48 months. There were no significant differences between doses over 48 months on any of the clinical endpoints, including rate of disability progression, cumulative percentage of patients who progressed (48 and 43, respectively), and annual relapse rates; relapses tended to decrease over 48 months. The incidence of patients who were positive for NAbs at any time during the study was low in both treatment groups. Conclusion: C ompared with 60-mcg IM IFNb-1a once weekly, a dose of 30 mcg IM IFNb-1a once weekly maintains the same clinical efficacy over four years