Virtual agents among participants with methamphetamine use disorders: Acceptability and usability study.

INTRODUCTION: While the potential future role of virtual agents (VAs) in treating addiction is promising, participants' attitudes toward the use of VAs in psychotherapy remain insufficiently investigated. This lack of investigation could pose barriers to the adoption of VA-led psychotherapy for people with substance use disorders (SUD). This research aims to explore the acceptability and usability of VAs for people with methamphetamine use disorder. METHODS: Following a single session of psychotherapy led by VAs through the Echo-app, a group of 49 individuals actively seeking treatment for current DSM-V substance dependence (with a mean age of 39.06 ± 8.02) completed self-administered questionnaires and participated in focus group interviews. These questionnaires aimed to investigate participants' preference regarding the type of psychotherapy and their willingness to engage in VA-led psychotherapy, taking into account their diverse psychological needs. RESULTS: Quantitative data were subjected to analysis through both descriptive and inferential statistical methods. Interestingly, participants exhibited a significantly higher acceptability for traditional face-to-face psychotherapy compared to email-based psychotherapy (p = 0.042), but there was no statistically significant difference between their acceptance of traditional psychotherapy and VA-led psychotherapy (p = 0.059). The questionnaire outcomes indicated participants' willingness to engage in VA-led psychotherapy for purposes such as relapse prevention intervention, addressing emotional issues, managing somatic experiences, and facilitating social and family functional recovery. Furthermore, the participants' attitudes toward VA-led psychotherapy were predicted by factors including the need for anxiety-focused psychotherapy (p = 0.027; OR [95%CI] = 0.14[0.03,0.80]), the presence of chronic somatic diseases (p = 0.017; OR [95%CI] = 13.58[1.59,116.03]), and marital status (p = 0.031; OR [95%CI] = 5.02[1.16,21.79]). DISCUSSION: Through the interviews, the study uncovered the factors that either supported or hindered participants' experiences with VA-led psychotherapy, while also gathering suggestions for future improvements. This research highlights the willingness and practicality of individuals with SUD in embracing VA-led psychotherapy. The findings are anticipated to contribute to the refinement of VA-led tools to better align with the preferences and needs of the users.

Multiregional-based magnetic resonance imaging radiomics model for predicting tumor deposits in resectable rectal cancer.

PURPOSE: To establish and validate an integrated model incorporating multiregional magnetic resonance imaging (MRI) radiomics features and clinical factors to predict tumor deposits (TDs) preoperatively in resectable rectal cancer (RC). METHODS: This study retrospectively included 148 resectable RC patients [TDs+ (n = 45); TDs- (n = 103)] from August 2016 to August 2022, who were divided randomly into a testing cohort (n = 45) and a training cohort (n = 103). Radiomics features were extracted from the volume of interest on T2-weighted images (T2WI) and diffusion-weighted images (DWI) from pretreatment MRI. Model construction was performed after feature selection. Finally, five classification models were developed by support vector machine (SVM) algorithm to predict TDs in resectable RC using the selected clinical factor, single-regional radiomics features (extracted from primary tumor), and multiregional radiomics features (extracted from the primary tumor and mesorectal fat). Receiver-operating characteristic (ROC) curve analysis was employed to assess the discrimination performance of the five models. The AUCs of five models were compared by DeLon's test. RESULTS: The training and testing cohorts included 31 (30.1%) and 14 (31.1%) patients with TDs, respectively. The AUCs of multiregional radiomics, single-regional radiomics, and the clinical models for predicting TDs were 0.839, 0.765, and 0.793, respectively. An integrated model incorporating multiregional radiomics features and clinical factors showed good predictive performance for predicting TDs in resectable RC (AUC, 0.931; 95% CI, 0.841-0.988), which demonstrated superiority over clinical model (P = 0.016), the single-regional radiomics model (P = 0.042), and the multiregional radiomics model (P = 0.025). CONCLUSION: An integrated model combining multiregional MRI radiomic features and clinical factors can improve prediction performance for TDs and guide clinicians in implementing treatment plans individually for resectable RC patients.

Feasibility of a Brief Intervention to Decrease Harmful Alcohol Use Among Methadone Maintenance Treatment Clients in Shanghai: A Randomized Controlled Trial.

OBJECTIVES: In this study, we aimed to examine the prevalence of alcohol consumption among methadone maintenance treatment (MMT) clients in Shanghai and to determine whether a brief intervention (BI) affects drinking among them. METHODS: A total of 837 clients from 14 local MMT clinics were invited to complete the Alcohol Use Disorders Identification Test (AUDIT). One hundred one were included in the study and randomly assigned to the BI group or the control group. Clients in the BI group received a BI and general health education, whereas clients in the control group received the general health education only. Baseline and postintervention assessments were conducted by using the AUDIT, the Drinking Attitude Questionnaire, the Depression Module of the Patient Health Questionnaire, the Generalized Anxiety Disorder Scale, and the General Well-Being Schedule. RESULTS: Two hundred fifty-nine (30.9%) reported drinking during the last year, and 103 (12.3%) met the criteria for harmful use. At the 3-month follow-up, the AUDIT scores of the 2 groups were significantly decreased, and the time effect was statistically significant ( F = 6.224, P = 0.018), but there was no group difference in AUDIT scores ( F = 1.953, P = 0.172). Both groups had a main time effect of time on the improvement of depression ( F = 8.044, P = 0.008), anxiety ( F = 9.650, P = 0.004), and general well-being ( F = 5.056, P = 0.033). However, there was no statistical difference between the 2 groups ( P > 0.05), and no statistical difference in the time ( F = 1.738, P = 0.198) and group ( F = 0.658, P = 0.424) effect of drinking attitude. CONCLUSIONS: Alcohol consumption is common among MMT clients in China. Brief intervention, in its current form, could not effectively help them reduce their alcohol consumption.

Virtual Digital Psychotherapist App-Based Treatment in Patients With Methamphetamine Use Disorder (Echo-APP): Single-Arm Pilot Feasibility and Efficacy Study.

BACKGROUND: Substance use disorder is one of the severe public health problems worldwide. Inequitable resources, discrimination, and physical distances limit patients' access to medical help. Automated conversational agents have the potential to provide in-home and remote therapy. However, automatic dialogue agents mostly use text and other methods to interact, which affects the interaction experience, treatment immersion, and clinical efficacy. OBJECTIVE: The aim of this paper is to describe the design and development of Echo-APP, a tablet-based app with the function of a virtual digital psychotherapist, and to conduct a pilot study to explore the feasibility and preliminary efficacy results of Echo-APP for patients with methamphetamine use disorder. METHODS: Echo-APP is an assessment and rehabilitation program developed for substance use disorder (SUD) by a team of clinicians, psychotherapists, and computer experts. The program is available for Android tablets. In terms of assessment, the focus is on the core characteristics of SUD, such as mood, impulsivity, treatment motivation, and craving level. In terms of treatment, Echo-APP provides 10 treatment units, involving awareness of addiction, motivation enhancement, emotion regulation, meditation, etc. A total of 47 patients with methamphetamine dependence were eventually enrolled in the pilot study to receive a single session of the Echo-APP-based motivational enhancement treatment. The outcomes were assessed before and after the patients' treatment, including treatment motivation, craving levels, self-perception on the importance of drug abstinence, and their confidence in stopping the drug use. RESULTS: In the pilot study, scores on the Stages of Change Readiness and Treatment Eagerness Scale and the questionnaire on motivation for abstaining from drugs significantly increased after the Echo-APP-based treatment (P<.001, Cohen d=-0.60), while craving was reduced (P=.01, Cohen d=0.38). Patients' baseline Generalized Anxiety Disorder-7 assessment score (ß=3.57; P<.001; 95% CI 0.80, 2.89) and Barratt Impulsiveness Scale (BIS)-motor impulsiveness score (ß=-2.10; P=.04; 95% CI -0.94, -0.02) were predictive of changes in the patients' treatment motivation during treatment. Moreover, patients' baseline Generalized Anxiety Disorder-7 assessment score (ß=-1.607; P=.03; 95% CI -3.08, -0.14), BIS-attentional impulsivity score (ß=-2.43; P=.004; 95% CI -4.03, -0.83), and BIS-nonplanning impulsivity score (ß=2.54; P=.002; 95% CI 0.98, 4.10) were predictive of changes in craving scores during treatment. CONCLUSIONS: Echo-APP is a practical, accepted, and promising virtual digital psychotherapist program for patients with methamphetamine dependence. The preliminary findings lay a good foundation for further optimization of the program and the promotion of large-scale randomized controlled clinical studies for SUD.

Medial meniscus posterior root tears and partial meniscectomy significantly increase stress in the knee joint during dynamic gait.

PURPOSE: As a simple and invasive treatment, arthroscopic medial meniscal posterior horn resections (MMPHRs) can relieve the obstructive symptoms of medial meniscus posterior root tears (MMPRTs) but with the risk of aggravating biomechanical changes of the joint. The aim of this study was to analyze dynamic simulation of the knee joint after medial meniscus posterior root tear and posterior horn resection. METHODS: This study established static and dynamic models of MMPRTs and MMPHRs on the basis of the intact medial meniscus model (IMM). In the finite element analysis, the three models were subjected to 1000 N axial static load and the human walking gait load defined by the ISO14243-1 standard to evaluate the influence of MMPRTs and MMPHRs on knee joint mechanics during static standing and dynamic walking. RESULTS: In the static state, the load ratio of the medial and lateral compartments remained nearly constant (2:1), while in the dynamic state, the load ratio varied with the gait cycle. After MMPHRs, at 30% of the gait cycle, compared with the MMPRTs condition, the maximum von Mises stress of the lateral meniscus (LM) and the lateral tibial cartilage (LTC) were increased by 166.0% and 50.0%, respectively, while they changed by less than 5% during static analysis. The maximum von Mises stress of the medial meniscus (MM) decreased by 55.7%, and that of the medial femoral cartilage (MFC) increased by 53.5%. CONCLUSION: After MMPHRs, compared with MMPRTs, there was no significant stress increase in articular cartilage in static analysis, but there was a stress increase and concentration in both medial and lateral compartments in dynamic analysis, which may aggravate joint degeneration. Therefore, in clinical treatments, restoring the natural structure of MMPRTs is first recommended, especially for physically active patients.

Preoperative Ki-67 proliferation index prediction with a radiomics nomogram in stage T1a-b lung adenocarcinoma.

OBJECTIVES: To establish a radiomics nomogram for preoperative prediction of Ki-67 proliferation index in stage T1a-b lung adenocarcinoma. METHODS: A total of 206 patients with pathologically confirmed lung adenocarcinoma who underwent CT scans within 2 weeks preoperatively from January 2016 to June 2020 were retrospectively included. Ki-67 index ≤ 10% was considered low expression, and Ki-67 index > 10% was considered high expression. The primary cohort was randomized with a 7:3 ratio into a training cohort (n = 145) and a validation cohort (n = 61). The minimum redundancy maximum relevance (mRMR) and the least absolute shrinkage and selection operator (LASSO) were used for feature selection, and radiomics signature was constructed. Univariate and multivariate logistic regression analyses were used to identify clinically important risk factors and radiomics signature associated with Ki-67 proliferation index, which were then combined into radiomics nomogram. RESULTS: Tumor maximum diameter (P = 0.005), lobulation (P = 0.002), absent of vacuole (P < 0.001), and Radscore (P < 0.001) were independent risk predictors of high Ki-67 proliferation index expression. The radiomics nomogram showed good predictive efficacy. The AUC, sensitivity, specificity and accuracy of radiomics nomogram in the training and validation cohorts were 0.91 (95% CI: 0.86-0.96), 87.9%, 80.5%, 83.4% and 0.85 (95% CI: 0.75-0.94), 71.9%, 82.8% and 77.0%. Decision curve analysis further demonstrated the clinical utility of the nomogram. CONCLUSIONS: Radiomics nomogram provide a non-invasive method to predict Ki-67 proliferation index preoperatively in stage T1a-b lung adenocarcinoma, which might be the supplementary information for clinicians to choose the appropriate treatment program.

A Nomogram Combined Radiomics and Clinical Features as Imaging Biomarkers for Prediction of Visceral Pleural Invasion in Lung Adenocarcinoma.

Objectives: To develop and validate a nomogram model based on radiomics features for preoperative prediction of visceral pleural invasion (VPI) in patients with lung adenocarcinoma. Methods: A total of 659 patients with surgically pathologically confirmed lung adenocarcinoma underwent CT examination. All cases were divided into a training cohort (n = 466) and a validation cohort (n = 193). CT features were analyzed by two chest radiologists. CT radiomics features were extracted from CT images. LASSO regression analysis was applied to determine the most useful radiomics features and construct radiomics score (radscore). A nomogram model was developed by combining the optimal clinical and CT features and the radscore. The model performance was evaluated using ROC analysis, calibration curve and decision curve analysis (DCA). Results: A total of 1316 radiomics features were extracted. A radiomics signature model with a selection of the six optimal features was developed to identify patients with or without VPI. There was a significant difference in the radscore between the two groups of patients. Five clinical features were retained and contributed as clinical feature models. The nomogram combining clinical features and radiomics features showed improved accuracy, specificity, positive predictive value, and AUC for predicting VPI, compared to the radiomics model alone (specificity: training cohort: 0.89, validation cohort: 0.88, accuracy: training cohort: 0.84, validation cohort: 0.83, AUC: training cohort: 0.89, validation cohort: 0.89). The calibration curve and decision curve analyses suggested that the nomogram with clinical features is beyond the traditional clinical and radiomics features. Conclusion: A nomogram model combining radiomics and clinical features is effective in non-invasively prediction of VPI in patients with lung adenocarcinoma.

A Combination of Radiomic Features, Imaging Characteristics, and Serum Tumor Biomarkers to Predict the Possibility of the High-Grade Subtypes of Lung Adenocarcinoma.

RATIONALE AND OBJECTIVES: Lung adenocarcinomas (LADC) containing high-grade subtypes have a poorer prognosis. And some studies have shown that high-grade subtypes have been identified as an independent predictor of local recurrence in patients treated with limited resection. The aim of this study was to construct a combined model based on radiomic features, imaging characteristics and serum tumor biomarkers to predict the possibility of preoperative high-grade subtypes. MATERIALS AND METHODS: 156 patients with LADC were retrospectively recruited in this study. These patients were randomly divided into training and validation cohorts. Radiomics features and imaging characteristics were extracted from plain CT images. A nomogram was developed in a training cohort by univariate and multivariate logistic analysis, and its performance was evaluated by receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA) in the training and validation cohorts. RESULTS: A total of 1316 radiomic features were extracted from the lesions in plain chest CT images. After applying the mRMR algorithm and the LASSO regression, 4 features were retained. Based on these radiomic features, Radiomic score (Radscore) was calculated for each patient. Spiculation, air bronchogram sign, CYFRA 21-1 and Radscore had been used in the construction of the combined model. The AUC of the combined model was respectively 0.88 (95% CI, 0.82-0.95) and 0.94 (95% CI, 0.86-1.00) in the training and validation cohorts. CONCLUSION: The combined model based on CT images and serum tumor biomarkers, can predict the high-grade subtypes of LADC in a non-invasive manner, which may influence individual treatment planning, such as the choice of surgical approach and postoperative adjuvant therapy.

Comfort Evaluation of Slow-Recovery Ejection Seat Cushions Based on Sitting Pressure Distribution.

Sitting discomfort not only affects the health of pilots carrying out long-endurance missions but also affects operational performance. The experimental objects included four ejection seat cushions: N1 was a fast-recovery foam as the comparison group, and the experimental groups were slow-recovery foams with different indentation force deflection (IFD), named N2 (hard), N3 (mid), and N4 (soft). The sitting comfort of 20 participants was tested on the four cushions by using subjective rating and sitting pressure distribution analysis. The results showed that compared with fast-recovery cushion N3 and N4 slow-recovery cushions have lower contact pressure and more uniform pressure distribution. Slow-recovery cushions that were too soft or too hard would reduce the comfort. No matter from the subjective rating or the analysis of the contact pressure data, the N3 cushion with a thickness of 3 cm and 65% IFD of 280 N had the highest comfort. In addition, the seat pressure distribution (SPD%) has a significant correlation with the subjective rating (p = 0.019, R = -0.98), which is more suitable for evaluating the comfort of the cushions. However, the slow-recovery cushions would show a decrease in support after a period of sitting, while the fast-recovery cushion could always maintain constant support.

Effect of lighting illuminance and colour temperature on mental workload in an office setting.

The mental workload of subjects was tested under different lighting conditions, with colour temperatures ranging from 3000 to 6500 K and illuminance ranging from 300 to 1000 lx. We used both psychological and physiological responses for evaluation. The former was based on NASA Task Load Index (NASA-TLX, NASA), and the latter was based on the electroencephalogram (EEG) P3b analysis of event-related potentials using the "oddball" paradigm experimental task. The results show that as illuminance increases, and the response time becomes longer with a colour temperature of 3000 K (P < 0.01). However, when the colour temperature is set at 6500 K, the response time becomes shorter as the illuminance increases (P < 0.01). P3b amplitudes were significantly affected by colour temperature (P = 0.009) and illuminance (P = 0.038) levels. The highest amplitudes occurred at 3000 K and 750 lx, which is consistent with the trend shown by the subjective scale. The data analysis of error rates is not significant. These results suggest that an office environment with a colour temperature of 3000 K and illumination of 750 lx, which exerts the lowest mental workload, is the most suitable for working. However, the interaction between colour temperature and illuminance in affecting the mental workload of participants is not clear. This work provides more appropriate lighting choices with colour temperature and illuminance to reduce people's mental workload in office settings.

Effectiveness of music therapy on improving treatment motivation and emotion in female patients with methamphetamine use disorder: A randomized controlled trial.

OBJECTIVES: The purpose of the study was to investigate whether Group Music Therapy (GMT) could enhance the treatment motivation and change the negative emotion among female patients with methamphetamine use disorder in a randomized clinical trial. Methods: Participants (N = 60) were randomized to the group of GMT combined with treatment as usual (TAU) or the group with TAU only. Questionnaire of Motivation for Abstaining from Drugs was used to measure the motivation for abstaining from drugs of the female patients. And Self-Rating Depression Scale and Self-Rating Anxiety Scale were used to measure negative emotion of participants. The measurements were conducted at T0 (baseline), T1 (post 13 sessions of intervention) and T2 (3-month follow-up after T1) by the independent trained researcher. Results: The postintervention and 3-month follow-up results according to the intention-to-treat principle indicated that GMT + TAU intervention showed significantly positive group-by-time effect on the scores of the subscale-tending to rehabilitation-internal motivation (p = 0.01) and avoiding abuse-external motivation (p = 0.04). In 3-month follow-up, total scores of the questionnaire of motivation for abstaining from drugs (p = 0.02), scores of avoiding abuse-internal motivation subscale (p = 0.05), and scores of confidence of abstaining from drugs subscale (p = 0.01) in GMT + TAU were also presented with significantly positive group x time effect. The changes of total score of Questionnaire of Motivation for Abstaining from Drugs (from baseline to 3-month follow-up) was significantly positive association with the changes of scores of SAS in GMT + TAU group (r = -0.55, p = 0.00). Conclusions: The present study suggests that GMT could be used as an effective treatment strategy to enhance treatment motivation of female patients with methamphetamine use disorder.

Strengths, weaknesses, opportunities and threats (SWOT) analysis of reinitiation into methamphetamine abusers: qualitative findings from an exploration of methamphetamine abusers in Shanghai, China.

BACKGROUND: Despite high relapse rate among methamphetamine (MA) abusers, there still have been little empirical data to date detecting the risk factors related to craving and relapse from the perspective of MA abusers. Therefore, the aim of this study was to use qualitative research methods exploring the strengths, weaknesses, opportunities and threat factors that could facilitate or impede individuals' abstinence in a real-life context from the perspectives of MA abusers. AIM: To use qualitative research methods exploring the strengths, weaknesses, opportunities and threat factors relating to individuals' abstinence in a real-life context. METHOD: Semistructured interviews were conducted with 32 MA abusers recruited in Shanghai guided by open-ended questions on narrating the real-life catalysts and inhibitors related to craving, initiation, relapse and abstinence. All data were transcribed verbatim and analysed using a strengths, weaknesses, opportunities and threats (SWOT) analysis. RESULTS: The results of the SWOT analysis revealed that contextual factors including peer influence, prevalence and availability of MA, familiar venue of MA use, discrimination, sexual behaviours, alcohol, emotional states and their attitudes towards smoking MA were important factors that contribute to reinitiation and relapse. Surveillance systems, antidrug social workers, vocational skills trainings, moving to another city and family responsibility might serve as counter measures targeting those mentioned weaknesses and threats above. CONCLUSION: This SWOT analysis highlights the complex nature of relapse. Comprehensive interventions strengthening coping skills such as virtual reality techniques are desperately needed to facilitate individuals' sustained abstinence.

Mixed methods to explore factors associated with the decline of patients in the methadone maintenance treatment program in Shanghai, China.

BACKGROUND: This study was to characterize the Methadone Maintenance Treatment (MMT) in Shanghai, China, and to explore factors associated with the decline of patients in MMT during 2005-2016. METHODS: Both qualitative and quantitative methods were used in this study. Based on the data from Shanghai Centers for Disease Control (CDC), we described the changes in the number of patients who received MMT, and new enrollment each year from 2005 to 2016. Focus groups were conducted with 22 patients, and in-depth interviews were conducted with 9 service providers. RESULTS: Quantitative data demonstrate that the number of new enrollment began to decline in 2009, and the number of patients receiving MMT began to decline in 2012. The main reasons for dropout include (1) discontinuing medication due to unknown reasons (25%), (2) criminal activities other than drug-related crimes (20%), (3) relapse to heroin use (16%), and (4) physical disease (10%). Qualitative assessment results indicate that the major reasons for the decline of patients in MMT are as follows: (1) the increase of Amphetamine-type stimulants (ATS) use in recent years, (2) limited knowledge about MMT in both patients and MMT staff, (3) complicated enrollment criteria, and (4) discrimination against drug use. CONCLUSION: Various reasons to explain the decline of patients in MMT in Shanghai, China, were identified. Government agencies, service providers, and other stakeholders need to work together and overcome identified barriers to support MMT programs in China.

Status Investigation of Outpatients Receiving Methadone Maintenance Treatment (MMT) in Shanghai from 2005 to 2016.

BACKGROUND: Methadone maintenance treatment (MMT) is an effective measure to control drug abuse, prevent AIDS, and improve family and social functions among those with heroin addiction. Relevant surveys in recent years show that the number of outpatients receiving MMT has a downward trend. AIMS: To understand variation in maintenance treatment rates and causes of withdrawal for outpatients receiving MMT in Shanghai since initiation of this program. METHOD: This study was a retrospective investigation, with data from the AIDS Comprehensive Prevention and Control Data Information Management System of the China AIDS Prevention and Control Center. Descriptive statistics were used to describe demographic data, treatment maintenance rate, and number of new outpatients receiving MMT in Shanghai From May 2005 to June 2016. The causes of withdrawal were summarized and analyzed. RESULTS: From May 2005 to June 2016, there were a total of 7181 outpatients receiving MMT in Shanghai. These patients were primarily male (male to female ratio around 3:1), young adults (more than 90% of these patients were 25 to 54 years old), with junior high school education level and below (65.4%), single (total of unmarried, divorced and widowed: 63.1%), and unemployed or underemployed (81.5%). The daily dose of methadone in MMT patients showed an upward trend since 2008, and gradually declined after reaching its peak in 2013. The mean (sd) dose of methadone taken in the years studied was 56 (2.75) ml/d. The number of new outpatients increased sharply in 2007 and 2008 (more than 1500), and then decreased year by year. The number of outpatients had increased continuously from 2005 to 2011, with the peak in 2011 (3840 patients), and then decreased gradually. The maintenance rate was stable at over 80% since 2010. The main causes of withdrawal: 1) arrested due to unrelated criminal causes (19.89%), 2) sent to compulsory isolated rehabilitation center due to occasional drug use, and 3) physical reasons (disease/pregnancy/death, 11.80%). CONCLUSION: The maintenance rate has been kept at a relatively good level since the initiation of the MMT outpatient clinic service in Shanghai. The number of patients receiving treatment showed an increase-then-decrease trend. The main causes of patients' withdrawal were mainly related to "crime" and "relapse". In order to make MMT outpatient service better, subsequent studies need to carry out related investigations to understand the causes of these changes and patients reasons for withdrawal.