Tailored psychological intervention for anxiety or depression in COPD (TANDEM): a randomised controlled trial.

BACKGROUND: The TANDEM multicentre, pragmatic, randomised controlled trial evaluated whether a tailored psychological intervention based on a cognitive behavioural approach for people with COPD and symptoms of anxiety and/or depression improved anxiety or depression compared with usual care (control). METHODS: People with COPD and moderate to very severe airways obstruction and Hospital Anxiety and Depression Scale subscale scores indicating mild to moderate anxiety (HADS-A) and/or depression (HADS-D) were randomised 1.25:1 (242 intervention and 181 control). Respiratory health professionals delivered the intervention face-to-face over 6-8 weeks. Co-primary outcomes were HADS-A and HADS-D measured 6 months post-randomisation. Secondary outcomes at 6 and 12 months included: HADS-A and HADS-D (12 months), Beck Depression Inventory II, Beck Anxiety Inventory, St George's Respiratory Questionnaire, social engagement, the EuroQol instrument five-level version (EQ-5D-5L), smoking status, completion of pulmonary rehabilitation, and health and social care resource use. RESULTS: The intervention did not improve anxiety (HADS-A mean difference -0.60, 95% CI -1.40-0.21) or depression (HADS-D mean difference -0.66, 95% CI -1.39-0.07) at 6 months. The intervention did not improve any secondary outcomes at either time-point, nor did it influence completion of pulmonary rehabilitation or healthcare resource use. Deaths in the intervention arm (13/242; 5%) exceeded those in the control arm (3/181; 2%), but none were associated with the intervention. Health economic analysis found the intervention highly unlikely to be cost-effective. CONCLUSION: This trial has shown, beyond reasonable doubt, that this cognitive behavioural intervention delivered by trained and supervised respiratory health professionals does not improve psychological comorbidity in people with advanced COPD and depression or anxiety.

Evaluating Explainable Artificial Intelligence (XAI) techniques in chest radiology imaging through a human-centered Lens.

The field of radiology imaging has experienced a remarkable increase in using of deep learning (DL) algorithms to support diagnostic and treatment decisions. This rise has led to the development of Explainable AI (XAI) system to improve the transparency and trust of complex DL methods. However, XAI systems face challenges in gaining acceptance within the healthcare sector, mainly due to technical hurdles in utilizing these systems in practice and the lack of human-centered evaluation/validation. In this study, we focus on visual XAI systems applied to DL-enabled diagnostic system in chest radiography. In particular, we conduct a user study to evaluate two prominent visual XAI techniques from the human perspective. To this end, we created two clinical scenarios for diagnosing pneumonia and COVID-19 using DL techniques applied to chest X-ray and CT scans. The achieved accuracy rates were 90% for pneumonia and 98% for COVID-19. Subsequently, we employed two well-known XAI methods, Grad-CAM (Gradient-weighted Class Activation Mapping) and LIME (Local Interpretable Model-agnostic Explanations), to generate visual explanations elucidating the AI decision-making process. The visual explainability results were shared through a user study, undergoing evaluation by medical professionals in terms of clinical relevance, coherency, and user trust. In general, participants expressed a positive perception of the use of XAI systems in chest radiography. However, there was a noticeable lack of awareness regarding their value and practical aspects. Regarding preferences, Grad-CAM showed superior performance over LIME in terms of coherency and trust, although concerns were raised about its clinical usability. Our findings highlight key user-driven explainability requirements, emphasizing the importance of multi-modal explainability and the necessity to increase awareness of XAI systems among medical practitioners. Inclusive design was also identified as a crucial need to ensure better alignment of these systems with user needs.

Father Involvement in Early Childhood Care: Insights From a MEL System in a Behavior Change Intervention Among Rural Indian Parents.

Introduction: Fathers' involvement in care and early initiation of cognitive development activities have a positive impact on a child's social-behavioral, cognitive-academic and emotional-psychological development. This research study, conducted in Tamil Nadu in south India (2017-19), employed a Cluster Randomized Trial to test the impact of techno-social innovations in improving the involvement of fathers in child-care on child development outcomes. Qualitative studies were used to inform the trial and provide insights into pathways of change. Objective: This paper discusses the design, implementation and results of the study through the monitoring, evaluation and learning (MEL) framework to provide an understanding of the perceptions among parents and service providers surrounding early child development, the adaptations and learnings through the intervention period, and changes that were brought about through the intervention. Methods: The study was at a Proof of Concept stage, and the primary learning objective was to keep the learning process going through the period of the study, as well as obtain evidence to inform future model development. The measurement for change process in the study occurred in three distinct yet interconnected stages. In the first stage, the program was planned, and the design was refined for both the implementation and evaluation of the project. The next stage was the actual implementation: with a learning loop during the execution of the main intervention. The third stage was intended to reflect on the adaptations and pathways to change through the project period and collate evidence for model refinement. Results and Discussion: The data collected from the formative research was used to design, develop and implement the intervention. Lessons in coordination with the government program not only brought policy visibility, access to secondary data, and enabled field research, but also provided access to a workforce with immense field knowledge and presence in the rural underserved population. In order to continuously inform the implementation process of the intervention, the feedback loops allowed for adaptions to be made at each stage. The findings provide insights for programming early childhood development interventions, especially interventions regarding improving father's involvement in child-care, and ways to leverage evidence in these interventions.

Interstitial lung disease in patients with rheumatoid arthritis: comparison with cryptogenic fibrosing alveolitis over 5 years.

OBJECTIVE: There is little information on the natural history of patients with rheumatoid arthritis (RA) and associated interstitial lung disease (ILD). Cryptogenic fibrosing alveolitis (CFA) is known to have a poor longterm prognosis, and we compared the 2 conditions through a longitudinal prospective study. METHODS: We previously compared baseline clinical, physiological, and radiological characteristics in 18 RA-ILD patients with 18 case controls with CFA. Clinical, physiological, and radiological assessment was repeated in all survivors at 5 years, and data on treatment and mortality were collected. RESULTS: The median age in each group was 77 years and 10 patients in each group were male. More patients with RA-ILD survived to 5 years (8 RA-ILD vs 2 CFA; p = 0.03), and median survival was significantly longer for patients with RA-ILD (60 mo) compared to CFA (27 mo; p