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In recent times, Health Professionals (HPs) people may feel a sense of discomfort and nervousness when disconnected from their smartphones, causing the emergence of the new phenomenon of “No Mobile Phone Phobia,” or Nomophobia.
Objectives
We aim to study lifestyle-related factors that influence HPs’ Nomophobia.
Methods
From April- June 2023, a global cross-sectional study was conducted using the modified Nomophobia questionnaire (NMP-Q). The original 20 NMP-Q questions (Qs) were reduced to 14 to avoid repetitive Qs with similar meanings. The Qs were categorized into 4 sections, A- Not Being Able to Access Information; B- Losing Connectedness; C- Not Being Able to Communicate; and D- Giving Up Convenience. A new section, “E- Daily Habits”, and “F- Smartphone Type”, and “Hours Spent Daily” were added. Before the launch, it was internally and externally validated by trained psychiatrists as well as experienced researchers. We utilized social media, WhatsApp, text and emails to share it with HPs of different specialties worldwide. The survey was anonymous and IRB-exempt.
Results
Total 105 countries’ HPs participation led to 12,253 responses. Total 47.3% of HPs agreed/strongly agreed (A/SA) that they prefer to use their smartphone before bedtime. Over half (57.8%) of HPs A/SA checked their notifications immediately after waking up in the morning. Only 19.4 % of HPs A/SA that woke up in the middle of the night to check notifications. Total 40.5% of HPs A/SA, 22% were neutral, and 37.3% of HPs disagreed /strongly disagreed (D/SD) with using smartphones while eating their meals. A total of 52.7% of HPs preferred smartphone usage over exercising as a break, while 454.9% of HPs A/SA that they chose smartphones over exploring other hobbies for relaxation. A total of 44.2% of respondents A/SA with smartphone usage in the restroom, 39.8% D/SD. 37.4% of participants D/SD with getting distracted by notifications and resisted the urge to answer any calls or texts while performing a focused task, whereas 39.6% A/SA and 23% were neutral. A total of 80% of respondents met the modified criteria for moderate-severe nomophobia.
Conclusions
In a large-scale survey-based study on Nomophobia, additional Qs in NMP-Q may help recognize that nomophobia can be a result of daily lifestyle decisions rather than an isolated issue.
Indian foreign policy towards the Gulf has seen a tectonic transformation over the past three decades. From its active pursuit of non-alignment during the Cold War to a steadily growing pragmatism in its approach towards the Middle East, contemporary Indian engagement with its western extended neighbourhood has been progressively expanding. India's unprecedented economic development ever since its economic liberalization during the last decade of the twentieth century has seen its gross domestic product (GDP) rise from USD 458.82 billion in 1999 to USD 2.875 trillion in 2019. Consequently, India's growing economic interlinkages with the rest of the world have gradually increased its stakes as well as their associated vulnerabilities. India of the post–Cold War world seeks to position itself as a leading power on the global stage, seeking to be a rule-maker as opposed to a rule-taker away from the idealism of the past.
Accordingly, India's relationship with the countries in the Gulf has evolved since the end of the Cold War with New Delhi's newfound pragmatism forming the foundation of its new partnerships. This evolving international system, India's transforming perception of its role on the global stage, and the resultant implications on New Delhi's relations with the Gulf have been scrutinized by scholars of Indian foreign policy. Researchers have used a variety of theoretical tools from mainstream, constructivist, and critical international relations (IR) theories to help better explain these changes. However, as Robert Cox states that ‘theory is always for someone and for some purpose’, the question of analysis for this chapter is to understand what the implications of the shifts in global and regional distribution of power are for India's foreign policy in the Gulf. To answer this very question, this analysis primarily relies upon theoretical tools drawn from the mainstream IR school of realism with their positivist ontology.
Putting the last three decades into perspective, this chapter proposes that as India's relative material capabilities have increased, so has its tactful diplomatic engagement with the Gulf intensified, transforming its role in the region.
Background: Stroke incidence is rising among younger adults (≤65yrs). Modifiable and behavioural risk factors are linked to stroke; however, limited understanding of knowledge and behaviour exists around preventative/lifestyle medicine (LSM) among this patient population. Study aim was to assess younger adult stroke patients’ lifestyle knowledge, habits, and barriers. Methods: A cross-sectional design was employed. Data were collected through an online, self-reported survey following a routine stroke prevention clinic visit and analyzed using descriptive and inferential statistics. Results: Sample included 103 participants (56.3% women, 60% white, mean age 47.6, 54.5% prior stroke). Majority (63%) understood current healthy lifestyle recommendations around blood pressure, sleep, and alcohol use, but fewer (<24.3%) around exercise and diet. Almost 70% ate processed food weekly, with emotions and social/family situations influencing eating habits. Interestingly, despite not understanding the current recommendations, >80% exercised moderately (3.5d/wk) with work and family responsibilities as main barriers. Over 50% slept <7hrs/night, had moderate to high stress levels, and implemented different coping strategies (food, TV, video games, and exercise). Majority (82.4%) reported willingness to change habits. Conclusions: Our findings provide valuable insight on young adult stroke patients’ preventative/LSM-related knowledge, habits, and barriers and provide new opportunities for the development of brain care-related initiatives.
Changing practice patterns caused by the pandemic have created an urgent need for guidance in prescribing stimulants using telepsychiatry for attention-deficit hyperactivity disorder (ADHD). A notable spike in the prescribing of stimulants accompanied the suspension of the Ryan Haight Act, allowing the prescribing of stimulants without a face-to-face meeting. Competing forces both for and against prescribing ADHD stimulants by telepsychiatry have emerged, requiring guidelines to balance these factors. On the one hand, factors weighing in favor of increasing the availability of treatment for ADHD via telepsychiatry include enhanced access to care, reduction in the large number of untreated cases, and prevention of the known adverse outcomes of untreated ADHD. On the other hand, factors in favor of limiting telepsychiatry for ADHD include mitigating the possibility of exploiting telepsychiatry for profit or for misuse, abuse, and diversion of stimulants. This Expert Consensus Group has developed numerous specific guidelines and advocates for some flexibility in allowing telepsychiatry evaluations and treatment without an in-person evaluation to continue. These guidelines also recognize the need to give greater scrutiny to certain subpopulations, such as young adults without a prior diagnosis or treatment of ADHD who request immediate-release stimulants, which should increase the suspicion of possible medication diversion, misuse, or abuse. In such cases, nonstimulants, controlled-release stimulants, or psychosocial interventions should be prioritized. We encourage the use of outside informants to support the history, the use of rating scales, and having access to a hybrid model of both in-person and remote treatment.
Hot brewed coffee is the most popular hot beverage in the world, and its health properties have been published in the literature(1). Conversely, over the past decade, cold-brewed coffee has gained popularity, but its eventual nutritional properties are unclear. Both hot and cold brewed coffee produces over 6 million tons of spent coffee grounds (SCG) yearly disposed in landfills(1). Interestingly, studies have shown that SCG can improve several metabolic parameters via changes in the gut microbiome in obese and diabetic rats(2), and reduce energy consumption in overweight humans(3). However, studies investigating the nutritional properties of SCG are lacking in the literature. Hence, in this study, we aimed to identify, quantify and compare two main bioactive compounds in hot- and cold-brewed coffee as a beverage, as well as in the SCG. Samples from hot and cold coffee beverages and SCG were obtained from a local coffee shop (n = 3 per group). The coffee beans were composed of Coffea arabica from Papa New Guinea, Brazil, Ethiopia, and Colombia (in order from highest to lowest proportion). All samples were analysed by high-performance liquid chromatography and mass spectrometry (HPLC-MS). The analyses focused on two main bioactive compounds; trigonelline and chlorogenic acid (CGA). Statistical analyses were performed using an unpaired t-test with Welch’s correction and two-way ANOVA with Tukey’s post-hoc test (p<0.05). When compared to hot-brewed coffee beverages, cold-brewed coffee beverages have shown lower (p<0.05) levels of trigonelline (17.26 mg/g + 1.305 vs. 8.46 mg/g + 0.74, respectively) and CGA (9.82 mg/g + 0.93 vs. 5.31 mg/g + 0.48, respectively). In SCG obtained from hot-brewed coffee, a higher concentration of CGA was found (0.12 mg/g + 0.006), when compared to SCG obtained from cold-brewed coffee (0.10 mg/g + 0.03). However, trigonelline in cold-brewed SCG was found in higher (p<0.05) concentration, when compared to hot-brewed SCG (0.11 mg/g + 0.03 vs. 0.09 mg/g + 0.017, respectively). Moreover, hot-brewed coffee beverages showed higher (p<0.05) concentrations of trigonelline and CGA, when compared to hot-brewed SCG. Similarly, cold-brewed coffee beverages showed higher (p<0.05) concentrations of both bioactive compounds, when compared to cold-brewed SCG. Our results indicated that hot brewed coffee beverage contains high concentrations of bioactive compounds (CGA and trigonelline), which possibly explain its health properties. Although SCG obtained from hot and cold-brewed coffee showed lower concentrations of both bioactive compounds than coffee beverages, our results shed light on the possible health benefits of SCG consumption. In a world seeking more sustainable solutions, further studies investigating the potential use of SCG as a functional food are required.
This contribution focuses on the abatement with hydrogen of CO2 and non-CO2 emissions. It is agenda-setting in two respects. Firstly, it challenges the globally accepted hydrocarbon sustainable aviation fuel (SAF) pathway to sustainability and recommends that our industry accelerates along the hydrogen pathway to ‘green’ aviation. Secondly, it reports a philosophical and analytical investigation of appropriate accuracy on abatement strategies for nitrogen oxides and contrails of large hydrogen airliners. For the second contribution, a comparison is made of nitrogen oxide emissions and contrail avoidance options of two hydrogen airliners and a conventional airliner of similar passenger capacity. The hydrogen aircraft are representative of the first and second innovation waves where the main difference is the weight of the hydrogen tanks. Flights of 1000, 2000, 4000 and 8000 nautical miles are explored. Cranfield’s state of the art simulators for propulsion system integration and gas turbine performance (Orion and Turbomatch) were used for this. There are two primary contributions to knowledge. The first is a new set of questions to be asked of SAF and hydrogen decarbonising features. The second is the quantification of the benefits from hydrogen on non-CO2 emissions. For the second generation of long-range hydrogen-fuelled aircraft having gas turbine propulsion, lighter tanks (needing less thrust and lower gas temperatures) are anticipated to reduce NOx emissions by over 20%; in the case of contrails, the preliminary findings indicate that regardless of the fuel, contrails could largely be avoided with fuel-burn penalties of a few per cent. Mitigating action is only needed for a small fraction of flights. For conventional aircraft this penalty results in more CO2, while for hydrogen aircraft the additional emission is water vapour. The conclusion is that our research community should continue to consider hydrogen as the key ‘greening’ option for aviation, notwithstanding the very significant costs of transition.
Dates from recently excavated Gangetic site of Sakas in Bihar, India, place it at ca.1800–1100 BC. The ceramic and lithic chronologies have been interpreted as Early Farming, Transitional and Chalcolithic/Developed Farming in date. However, depending on where in the Ganges Plains is studied, the time frame of Early, Developed and Advanced Farming periods varies widely, from 7th millennium to 2nd millennium BC and beyond, making the chronological framing of absolute dates within a regional scheme highly complex. In this paper we report the new radiocarbon results from Sakas and note how while these are critical for cementing the absolute dating of the site, until such time as a more stable periodization linked not only to relative and absolute dates but also human lifeways within the different zones of the Ganges plains is created, there remains difficulties in understanding how Sakas and other sites of similar date fit into the changing social, cultural and economic systems in this region.
Tight focusing with very small f-numbers is necessary to achieve the highest at-focus irradiances. However, tight focusing imposes strong demands on precise target positioning in-focus to achieve the highest on-target irradiance. We describe several near-infrared, visible, ultraviolet and soft and hard X-ray diagnostics employed in a ∼1022 W/cm2 laser–plasma experiment. We used nearly 10 J total energy femtosecond laser pulses focused into an approximately 1.3-μm focal spot on 5–20 μm thick stainless-steel targets. We discuss the applicability of these diagnostics to determine the best in-focus target position with approximately 5 μm accuracy (i.e., around half of the short Rayleigh length) and show that several diagnostics (in particular, 3$\omega$ reflection and on-axis hard X-rays) can ensure this accuracy. We demonstrated target positioning within several micrometers from the focus, ensuring over 80% of the ideal peak laser intensity on-target. Our approach is relatively fast (it requires 10–20 laser shots) and does not rely on the coincidence of low-power and high-power focal planes.
The true characterization of elite germplasm is of utmost importance for accelerating the crop breeding programme. The Indian dolichos bean [Lablab purpureus (L.) var. typicus Prain] has the potential to improve nutritional and food security. In the present investigation, a total of 21 genotypes of dolichos bean, comprising local collections mainly, along with one standard check (Kashi Sheetal) were evaluated in a complete randomized block design with three replications for two consecutive years, 2021–22 to 2022–23 for the perusal of the genetic variability. Analysis of variance revealed significant differences among all the genotypes for all the characters. PCV and GCV estimates revealed very little influence of environment on the expression of traits under study. High heritability (>90%) estimates coupled with high genetic advance as a percent of the mean were observed for flower attributes, pod length, average weight of 10 pods, pod yield and protein content. The principal component analysis revealed that the first two components cumulatively accounted for more than 50% of total variability. The present investigation revealed that the genotypes, RLBDL-S-8, RLBDL-S-14 and RLBDL-S-4-5 were stable across the years and genotype RLBDL-S-8 exhibited the highest yield potential, which can be used effectively in the development of high yielding varieties of dolichos bean in the Bundelkhand region. The study also revealed the presence of wide genetic variability in the studied local accessions which is a prerequisite for the genetic improvement of crop plants. High heritability and genetic advancement indicated the scope of selection in the crop improvement.
Boron adsorption at constant ionic strength [0.09 ± 0.01 moles/liter of KClO4 or Ca(ClO4)2] on 0.2−2 μm clay fraction of pretreated kaolinite was modeled using both phenomenological equations and surface complexation reactions. Phenomenological equations were expressed as linear relationships between the distribution coefficient and adsorption density or equilibrium concentration. The normalized form of the isotherms allowed the distribution coefficient to be predicted over a wide range of adsorption densities or equilibrium concentrations and pH. The Langmuir isotherm revealed a weak two-part linear trend supported by a similar behavior of the van Bemmelen-Freundlich isotherm. Potential adsorption mechanisms were assessed from these isotherms. The bases for the inner-sphere (surface coordination) and outer-sphere (ion-pair) surface reactions were postulated, and equations were developed and incorporated into the generalized triple-layer surface-complexation model [TL(g)-SCM]. Boron adsorption was best modeled using the inner-sphere complexes. The results confirm that the generalized triple-layer surface-complexation model can provide information regarding plausible reactions at the substrate/aqueous interface. Intrinsic constants for postulated surface reactions were derived as fitting parameters over a range of pH and initial boron concentrations.
The North-Eastern region (NER) of India falls under the Eastern Himalayan region and it is a bio-diversity hub. Diverse maize landraces with wide adaptability to extreme climatic and soil scenario like heavy rainfall, drought and acidic soil conditions have been grown in NER since time immemorial. However, maize diversity in NER region has drastically reduced due to introduction of high yielding varieties and hybrids. Modern maize breeding programmes are focused on high yield but other unique traits like stay green trait, prolificacy (more than one fertile ear per plant), self-fertilizing ability are also important and the local germplasm of the NER region can contribute with these unique traits. Prior to the selection of any lines in several breeding programmes, assessment of genetic diversity and population structure are basic requirements. Hence, in the present study assessment of genetic diversity and population structure study in 30 maize inbreds developed from different germplasm of NER was undertaken using SSR markers, selected for their broad distribution throughout the genome, in order to assess the extent of allelic diversity among the lines and whether any population structure could be established. In addition to assessing molecular diversity, the study aims to evaluate the potential for yield and other beneficial and unique alleles that have high potential to contribute in the genetic enhancement programme of maize.
Indigofera oblongifolia Forssk. locally known as ‘Goilia or Jhil’, is an important underutilized leguminous browse shrub for small ruminants in hot arid region of India and traditionally utilized for its medicinal value. Its irregular patchy distribution was observed in depression of rocky areas, bunds of farmer fields and along the depression on the road sides in Jaisalmer and Pali district during collection. Soil samples collected from Pali district have high level of pH and electrical conductivity as compared to Jaisalmer which indicates its suitability to saline areas. It exhibited good plant growth under Jodhpur conditions with respect to plant height (171.5 cm), number of branches (47.9) and canopy diameter (100–210 and 115–180 cm in north-south and east-west direction, respectively) after 12 months of planting in fields under protected condition. Morphological characterization showed the presence of high coefficient of variation (%) in the number of raceme per branch (27.3) followed by raceme length (22.9), pod length (21.0) and least in pod width (8.1). Phytochemical results revealed that leaves of I. oblongifolia contained considerable amounts of total phenols (31.44 mg g−1), flavonoids (29.73 mg g−1) and antioxidant capacity (6.26 FRU g−1) which make its suitability as a browse species to ruminants in rangelands. Along with these finding, its traditional knowledge and utilization are detailed in this paper as to hasten further research on its various aspects for its sustainable utilization in rangelands or in alternate land use systems in the Indian hot arid region.
Kerala, a humid tropical southern state, is the third largest producer of Tamarind (Tamarindus indica L.) in India. This tree spice is an important livelihood option for the rural society, especially in Palakkad district which is the lead producer of tamarind in the state with a few accepted primitive cultivars, viz. ‘valanpuli’, ‘madhurapuli’ and ‘thenpuli’. A survey was conducted to identify the fruit variability and document the sweet tamarind types of Palakkad. This study revealed the variability and weight of 30 fruits was seen to be the most indicative variable of tamarind in Kerala. The pod length varied from 5.28 to 23.41 cm and fruit weight from 4.83 to 43.40 g. Hierarchical clustering on principal component analysis resulted in six clusters. The clusters I, IV and V represented collections with fruit weight more than 20 g. Box plot diagrams revealed the high real pulp value in sample KTJ 162 (9.57) and high fruit length in KTJ 44 (21.68 cm). Among 113 collections, 18 samples were collected as perceived sweet types based on local enquiry. In the scatter plot between total soluble solids and ratio between total soluble solids and total titrable acidity, two samples were spotted as sweet types with acidity below 8%. Further molecular characterization and systematic crop improvement programmes are required for conserving the eroding gene pool of tamarind in Kerala and to develop sweet types for commercial production.
Sustainability of maize production systems is threatened by poor economic returns and resource intensiveness. Therefore, an experiment was conducted at the ICAR-Indian Agricultural Research Institute, New Delhi during 2016–17 to 2017–18 to assess the effect of tillage and microbial inoculantsintegrated phosphorus (P) management on productivity, quality, economic outcome and energy dynamics of maize. Three tillage practices viz., CT–R (conventional tillage with no residue), ZT–R (zero tillage with no residue) and ZT + R (zero tillage with wheat crop residue at 2.5 Mg/ha) were assigned in main plots and five P management practices viz., P1 (control–NK as per recommendation, but no P), P2 (17.2 kg P/ha), P3 (17.2 kg P/ha + PSB), P4 (17.2 kg P/ha + compost inoculants) and P5 (34.4 kg P/ha) were allocated in subplots in three times replicated split-plot design. The maximum grain yield (5.96 Mg/ha), protein content (9.13%), protein yield (546 kg/ha) and gross energy returns (209 × 103 MJ/ha) were recorded under ZT + R while higher benefit: cost ratio (B: C ratio – the amount of economic gain per unit investment) (1.53) and energy efficiency (12.5) was noticed under ZT–R. Among the P management practices, the application of 34.4 kg P/ha recorded the highest grain yield (6.45 Mg/ha), protein content (9.34%), protein yield (603 kg/ha), B: C ratio (1.65) and energy efficiency (10.1). The results suggested that the application of P at the rate of 34.4 kg/ha under ZT + R is an economically robust approach for the quality maize production in semi-arid region.
We present new theoretical period–luminosity (PL) and period–radius (PR) relations at multiple wavelengths (Johnson–Cousins–Glass and Gaia passbands) for a fine grid of BL Herculis models computed using mesa-rsp. The non-linear models were computed for periods typical of BL Her stars, i.e. 1 ≤ P(days) ≤ 4, covering a wide range of input parameters: metallicity (−2.0 dex ≤ [Fe/H] ≤ 0.0 dex), stellar mass (0.5–0.8 ), luminosity (50–300 ) and effective temperature (full extent of the instability strip; in steps of 50K). We investigate the impact of four sets of convection parameters on multi-wavelength properties. Most empirical relations match well with theoretical relations from the BL Her models computed using the four sets of convection parameters. No significant metallicity effects are seen in the PR relations. Another important result from our grid of BL Her models is that it supports combining PL relations of RR Lyrae and Type II Cepheids together as an alternative to classical Cepheids for the extragalactic distance scale calibration.
We summarize what we assess as the past year's most important findings within climate change research: limits to adaptation, vulnerability hotspots, new threats coming from the climate–health nexus, climate (im)mobility and security, sustainable practices for land use and finance, losses and damages, inclusive societal climate decisions and ways to overcome structural barriers to accelerate mitigation and limit global warming to below 2°C.
Technical summary
We synthesize 10 topics within climate research where there have been significant advances or emerging scientific consensus since January 2021. The selection of these insights was based on input from an international open call with broad disciplinary scope. Findings concern: (1) new aspects of soft and hard limits to adaptation; (2) the emergence of regional vulnerability hotspots from climate impacts and human vulnerability; (3) new threats on the climate–health horizon – some involving plants and animals; (4) climate (im)mobility and the need for anticipatory action; (5) security and climate; (6) sustainable land management as a prerequisite to land-based solutions; (7) sustainable finance practices in the private sector and the need for political guidance; (8) the urgent planetary imperative for addressing losses and damages; (9) inclusive societal choices for climate-resilient development and (10) how to overcome barriers to accelerate mitigation and limit global warming to below 2°C.
Social media summary
Science has evidence on barriers to mitigation and how to overcome them to avoid limits to adaptation across multiple fields.
Background: Chordomas are rare malignant skull-base/spine cancers with devastating neurological morbidities and mortality. Unfortunately, no reliable prognostic factors exist to guide treatment decisions. This work identifies DNA methylation-based prognostic chordoma subtypes that are detectable non-invasively in plasma. Methods: Sixty-eight tissue samples underwent DNA methylation profiling and plasma methylomes were obtained for available paired samples. Immunohistochemical staining and publicly available methylation and gene expression data were utilized for validation. Results: Unsupervised clustering identified two prognostic tissue clusters (log-rank p=0.0062) predicting disease-specific survival independent of clinical factors (Multivariable Cox: HR=16.5, 95%CI: 2.8-96, p=0.0018). The poorer-performing cluster showed immune-related pathway promoter hypermethylation and higher immune cell abundance within tumours, which was validated with external RNA-seq data and immunohistochemical staining. The better-performing cluster showed higher tumour cellularity. Similar clusters were seen in external DNA methylation data. Plasma methylome-based models distinguished chordomas from differential diagnoses in independent testing sets (AUROC=0.84, 95%CI: 0.52-1.00). Plasma methylomes were highly correlated with tissue-based signals for both clusters (r=0.69 & 0.67) and leave-one-out models identified the correct cluster in all plasma cases. Conclusions: Prognostic molecular chordoma subgroups are for the first time identified, characterized, and validated. Plasma methylomes can detect and subtype chordomas which may transform chordoma treatment with personalized approaches tailored to prognosis.
The sustainability of rigid packaging can be increased by using biocomposites in packaging. Existing frameworks have some limitations such as are made to assess a few aspects, conventional packaging parameters are considered, etc. Biocomposite has a slightly different scenario at various life cycle stages, like the end-of-life cycle process. To assess the sustainability of biocomposite rigid packaging, we must consider parameters related to the biocomposite-based rigid packaging materials life cycle. These are categorised into different aspects of sustainability and life cycle phases.
Ketamine, an N-methyl-d-aspartate receptor antagonist, has been “repurposed” as a rapid-acting antidepressant for treatment-resistant depression (TRD). The s-enantiomer of ketamine, “esketamine,” was FDA approved for TRD and depressive symptoms in adults with major depressive disorder with suicidal ideations/behaviors. Intravenous (IV) ketamine, although financially less expensive, is often not covered by insurance and intranasal (IN) esketamine, although covered by insurance can be expensive. There is a paucity of literature on efficacy data comparing subanesthetic IV ketamine and IN esketamine for TRD in a real-world scenario. Thus, we conducted this study comparing the efficacy and the number of treatments required to achieve remission/response with repeated use of subanesthetic IV ketamine/IN esketamine among TRD patients.
Methods
This was an observational study where we included adults (≥18 years) with TRD who provided consent and had received up to 6 IV ketamine infusions (0.5 mg/kg, infused over 40 minutes) or up to 8 intranasal (IN) esketamine (56/84 mg) treatments for TRD at the Mayo Clinic Depression Center. Depression symptoms were measured utilizing the self-report 16-Item Quick Inventory of Depressive Symptomatology (QIDS-SR) scale before and 24 hours after ketamine/esketamine treatment. Remission and response were defined as QIDS-SR 16 score ≤5 and ≥50% change in QIDS-SR 16, respectively. Continuous variables are reported as means ± SD and categorical variables as counts and percentages. The Wilcoxon rank-sum test was used to compare continuous variables. Chi-square and Fisher’s exact tests were used to compare categorical variables. The number of treatments to remission/response was calculated.
Results
Sixty-three adults with TRD, middle-aged (47.0 ± 12.1 years), predominantly female (65%), of which 76% (n = 48) and 24% (n = 15) received IV ketamine and IN esketamine, respectively. Mean (SE) change in QIDS-SR 16 score was −8.7 ± 0.7 (P < .001), a significant reduction (improvement) from baseline (mean ± SD = 17.6 ± 3.7). Overall remission and response rates were 36.5% and 55.6%, respectively in the acute phase. Response (56.3% vs 53.3%) and remission rates (39.6% vs 26.7%) were similar among patients who received IV ketamine or IN esketamine, respectively (P > .05). The mean number of treatments received to achieve response (2.5 ± 1.6 vs 4.6 ± 2.1) and remission (2.4 ± 1.3 vs 6.3 ± 2.4) were significantly lower among patients who received IV ketamine compared to IN esketamine (P < .005). Most patients tolerated both treatments well.
Conclusion
Intravenous ketamine and intranasal esketamine showed similar response/remission in TRD patients but the number of treatments required to achieve response/remission was significantly lower with IV ketamine compared to IN esketamine. These findings need to be investigated in a randomized control trial comparing these two treatment interventions.