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Major Depressive Disorder (MDD) is prevalent, often chronic, and requires ongoing monitoring of symptoms to track response to treatment and identify early indicators of relapse. Remote Measurement Technologies (RMT) provide an exciting opportunity to transform the measurement and management of MDD, via data collected from inbuilt smartphone sensors and wearable devices alongside app-based questionnaires and tasks.
To describe the amount of data collected during a multimodal longitudinal RMT study, in an MDD population.
RADAR-MDD is a multi-centre, prospective observational cohort study. People with a history of MDD were provided with a wrist-worn wearable, and several apps designed to: a) collect data from smartphone sensors; and b) deliver questionnaires, speech tasks and cognitive assessments and followed-up for a maximum of 2 years.
A total of 623 individuals with a history of MDD were enrolled in the study with 80% completion rates for primary outcome assessments across all timepoints. 79.8% of people participated for the maximum amount of time available and 20.2% withdrew prematurely. Data availability across all RMT data types varied depending on the source of data and the participant-burden for each data type. We found no evidence of an association between the severity of depression symptoms at baseline and the availability of data. 110 participants had > 50% data available across all data types, and thus able to contribute to multiparametric analyses.
RADAR-MDD is the largest multimodal RMT study in the field of mental health. Here, we have shown that collecting RMT data from a clinical population is feasible.
Ambulatory monitoring is gaining popularity in mental and somatic health care to capture an individual's wellbeing or treatment course in daily-life. Experience sampling method collects subjective time-series data of patients' experiences, behavior, and context. At the same time, digital devices allow for less intrusive collection of more objective time-series data with higher sampling frequencies and for prolonged sampling periods. We refer to these data as parallel data. Combining these two data types holds the promise to revolutionize health care. However, existing ambulatory monitoring guidelines are too specific to each data type, and lack overall directions on how to effectively combine them.
Literature and expert opinions were integrated to formulate relevant guiding principles.
Experience sampling and parallel data must be approached as one holistic time series right from the start, at the study design stage. The fluctuation pattern and volatility of the different variables of interest must be well understood to ensure that these data are compatible. Data have to be collected and operationalized in a manner that the minimal common denominator is able to answer the research question with regard to temporal and disease severity resolution. Furthermore, recommendations are provided for device selection, data management, and analysis. Open science practices are also highlighted throughout. Finally, we provide a practical checklist with the delineated considerations and an open-source example demonstrating how to apply it.
The provided considerations aim to structure and support researchers as they undertake the new challenges presented by this exciting multidisciplinary research field.
To determine the association between long-term leisure-time physical activity/inactivity and eating behaviours in twin pairs discordant for physical activity for 30 years.
Co-twin control design with cross-sectional data collection using questionnaire on eating habits and 5 d food diary. Differences in eating behaviours between physically active and inactive co-twins were analysed with pairwise tests.
Sixteen same-sex twin pairs (seven monozygotic and nine dizygotic, mean age 60 years) discordant for physical activity, selected from the Finnish Twin Cohort on the basis of physical activity discordance for 30 years, blinded to their possible differences in eating behaviours.
The eating habits questionnaire revealed that physically active co-twins more frequently reported that it is easy to eat according to need, whereas overeating and/or restrictive eating was more common among the inactive co-twins (P = 0·035). Avoiding calories was more common among the active than inactive co-twins (P = 0·034). Based on food diaries the physically active co-twins had daily energy intake on average 15·5 kJ/kg higher than their inactive co-twins (P = 0·030). The active co-twins also had a higher intake of vitamin C (P = 0·004), total water (P = 0·044), legumes and nuts (P = 0·015) and sweets (P = 0·036), as well as a lower energy-adjusted intake of meat (P = 0·013).
The physically active persons seem to eat more but not necessarily healthier food. However, habitual physical activity may help in eating according to need and in reaching and maintaining a healthy body composition. Therefore, it is necessary to incorporate both dietary and physical activity advice into health counselling.
Physical activity has become a major public health concern even in early childhood. This article exemplifies physical activity promotion in practice as described by public health nurses from Finnish primary health care.
We gathered the data by purposive sampling in five regional focus groups with 24 informants working in child health clinics provided for all families with children below school age. Statements associated with physical activity promotion were extracted out of verbatim transcripts. Frequency counting complemented qualitative analysis of the content of statements.
Child-centred evaluation provided by public health nurses focused on motor development, basic sporting skills and amount of activities outdoors and play and exercising habits of the child. Family-centred evaluation focused on the general activity level of the family or a member of the family and resources for physical activity. Activation and support included nearly the same issues brought up for discussion during check-ups, as a basis for counselling, or as points of reinforcement. Contradictory to a family approach in health care, most of the statements (78% out of 223 statements) were child centred. Forcefulness of statements revealed that assessment of physical abilities, including motor development, was the only topic applied with every child. Other topics were more selectively targeted for children and families with mild special needs: for example overweight, clumsy, insomniac, or restless children and sedentary families.
Even though special needs should receive specific attention in health care, we suggest more concern on physical activity of every child and the whole family in practice in order to meet modern health promotional challenges. Although the Finnish child health clinic system is unique due to its vast coverage and frequent contacts with every child and the family, the findings from this explorative research might inspire other community practitioners to start analysing their own work in view of this research.
Hirschsprung's disease (HD) is characterized by an absence of ganglion cells in the nerve plexuses of the distal large bowel. The lack of ganglion cells produces a functional obstruction and leads to dilatation of the bowel that is proximal to the aganglionic zone. The commonly quoted incidence of HD is 1:5000. The classic description of HD was first presented in detail by a Danish pediatrician, Harald Hirschsprung in 1886. The absence of ganglion cells in the distal large bowel was first reported by Tittel, but the crucial role of this finding as the primary pathology was not appreciated until the late 1940s. In 1948 the first successful operation for HD was performed by Swenson and Bill. This was a rectosigmoidectomy and later became known as the Swenson operation.
The functional obstruction caused by a lack of enteric ganglion cells in the distal bowel results in severe constipation and failure to thrive and may be fatal because of enterocolitis. The exact embryologic mechanism of the development of HD is controversial but the most favored theory is defective neuronal migration. Several genes (RET, GDNF, EDN3, ETRB) have been shown to cause HD both in humans and animal models. However, single gene defects explain only a minority of HD cases; in the majority, the cause of HD is probably multifactorial and multigenic.
In its classic form HD is restricted to the rectosigmoid region. Classic HD comprises 75–80% of all patients.
Mechanisms responsible for the formation of a misfit dislocation in a lattice-mismatched system have been studied using Molecular Dynamics simulations of a two-dimensional Lennard-Jones system. Results show clearly how the strain due to the lattice-mismatched interface acts as a driving force for migration of dislocations in the substrate and the overlayer and nucleation of dislocations in the overlayer edges. Moreover, we observe dislocation reactions in which the gliding planes of dislocations change such that they can migrate to the interface.
Skull morphology and histology in the heterozygous offspring
of a transgenic founder mouse Del1, harbouring 6 copies of deletion
mutation in Col2a1 gene, were compared with those in normal siblings.
On visual observation and roentgenocephalometric examination the heads
of heterozygous Del1 mice were smaller than normal. Histologically the
sizes of cartilaginous structures of the cranial base were reduced.
Severe defects were seen in the temporomandibular joint as progressive
osteoarthritic lesions. These observations elucidate the relationship
between the genotype and phenotype and demonstrate that heterozygous
Del1 mice are a useful model for studies on a genetic disturbance
where ‘clinical’ manifestations are not evident until
EVERY POLITICAL SYSTEM, WHETHER IT IS PREDEMOCRATIC, DEMOcratic, or postdemocratic totalitarian, has both leaders and followers. All those who are leaders – in other words, all those who exercise power over followers – can be grouped together under the category of the ruling class. Any ruling class, to be such, obviously must be accepted by those who are ruled. Human beings are followers only if they choose to follow. Leaders must have recognition and at least some degree of consent from followers to be leaders. This is the necessary condition for possession of power by the ruling class. If the ruling class does not provide those elements which are necessary for the survival of the political system, both its power and that system are in peril. In return for the security which it provides its followers, the ruling class gives the tone to politics. It does not, however, have to occupy the actual administrative posts to be the ruling class, but it must possess a prestige position.