Limitations and solutions of low cost virtual reality mirror therapy for post-stroke patients.

Mirror therapy is applied to reduce phantom pain and as a rehabilitation technique in post-stroke patients. Using Virtual Reality and head-mounted displays this therapy can be performed in virtual scenarios. However, for its efficient use in clinical settings, some hardware limitations need to be solved. A new system to perform mirror therapy in virtual scenarios for post-stroke patients is proposed. The system requires the patient a standalone virtual reality headset with hand-tracking features and for the rehabilitator an external computer or tablet device. The system provides functionalities for the rehabilitator to prepare and follow-up rehabilitation sessions and a virtual scenario for the patient to perform rehabilitation. The system has been tested on a real scenario with the support of three experienced rehabilitators and considering ten post-stroke patients in individual sessions focused on upper limb motor rehabilitation. The development team observed all the sessions and took note of detected errors regarding technological aspects. Solutions to solve detected problems will be proposed and evaluated in terms of feasibility, performance cost, additional system cost, number of solved issues, new limitations, or advantages for the patient. Three types of errors were detected and solved. The first error is related to the position of the hands relative to the head-mounted display. To solve it the exercise area can be limited to avoid objectives that require turning the head too far. The second error is related to the interaction between the hands and the virtual objects. It can be solved making the main hand non-interactive. The last type of error is due to patient limitations and can be mitigated by having a virtual hand play out an example motion to bring the patient's attention back to the exercise. Other solutions have been evaluated positively and can be used in addition or instead of the selected ones. For mirror therapy based on virtual reality to be efficient in post-stroke rehabilitation the current head-mounted display-based solutions need to be complemented with specific strategies that avoid or mitigate the limitations of the technology and the patient. Solutions that help with the most common issues have been proposed.

Salmonella assessment along the Spanish food chain: Likelihood of Salmonella occurrence in poultry and pig products is maintained across the food chain stages.

Salmonellosis is one of the most important foodborne diseases worldwide, including the European Union. Despite the One Health approach measures for risk assessment and risk management implemented by the European Union, the occurrence of disease and disease outbreaks remains high (e.g. 694 outbreaks were reported in 2020), highlighting the need of new assessment methods. Herein we applied machine learning using the random forests method to evaluate and identify key points regarding the occurrence of Salmonella sp. along the Spanish food chain during 2015-2020, using data provided by the Spanish Agency for Food Safety and Nutrition. We compared the role of the three categorical variables [product (20 categories), region (18 categories) and stage (11 categories)]. Salmonella presence was influenced by the three explanatory variables considered: first by product, followed by region and stage. The most determinant product for Salmonella probability was 'meat', while the most important stage was 'slaughterhouse'. Specifically, the highest values were found in pig and poultry meats. In these products, the Salmonella probability was high at the early and final stages of the food chain, although not at intermediate stages. The presence of Salmonella in the final stages (retail) of the food chain is of concern, as it can cause human cases of salmonellosis, including outbreaks. This study demonstrates the utility of the random forest method to identify key points and evaluate the control efforts. We recommend improving the surveillance and control measures, especially in the product and stages pointed out by our analysis, and enhancing the data collection harmonization among the different autonomous communities.

Spatio-temporal assessment of soil properties immediately and eight months after a high intensity-controlled burn in the south of Spain.

In recent years, the use of fire as a means by which to manage forest ecosystems has become more frequent in Europe. Fire has a significant impact on the soil, and it is therefore necessary to understand how controlled burns affect this invaluable resource. The purpose of this study was to evaluate the main alterations in the physical-chemical and biological properties of the soil because of a high intensity-controlled burn in "Los Boquerones" area (Villaviciosa de Córdoba, Spain). Additionally, we assessed the spatial heterogeneity of the alterations of different soil properties. A grid of 12 points was established on a hillside in Sierra Morena (Córdoba). Thermocouples were placed at each point, and soil samples were collected at two depths (0-2 cm and 2-5 cm) before burning, immediately after burning and eight months later. Soil pH, electrical conductivity, nutrient content and/or availability, among others, and their spatio-temporal variations were analysed. Soil pH, increased in the first centimetres of the soil (0-2 cm) immediately after burning up to >2 units, and the increase was maintained eight months following the burn. Additionally, the high-intensity burn had a positive short-term effect on some of the soil properties, such as nutrient availability for plants, which was considerably increased. The magnitude of the alterations in the soil indicators assessed was spatially explained by the behaviour of the fire during the controlled burning. The burn also had both direct and indirect effects on soil microorganisms. In conclusion, the possible immediate and short-term effects of burning on the soil resource should be considered for a more holistic management of fire in forest ecosystems, as its functionality and capacity to provide ecosystem services is largely altered by these events as a function of their intensity.

In vitro safety assessment of reduced graphene oxide in human monocytes and T cells.

Considering the increase in the use of graphene derivatives in different fields, the environmental and human exposure to these materials is likely, and the potential consequences are not fully elucidated. This study is focused on the human immune system, as this plays a key role in the organism's homeostasis. In this sense, the cytotoxicity response of reduced graphene oxide (rGO) was investigated in monocytes (THP-1) and human T cells (Jurkat). A mean effective concentration (EC50-24 h) of 121.45 ± 11.39 µg/mL and 207.51 ± 21.67 µg/mL for cytotoxicity was obtained in THP-1 and Jurkat cells, respectively. rGO decreased THP-1 monocytes differentiation at the highest concentration after 48 h of exposure. Regarding the inflammatory response at genetic level, rGO upregulated IL-6 in THP-1 and all cytokines tested in Jurkat cells after 4 h of exposure. At 24 h, IL-6 upregulation was maintained, and a significant decrease of TNF-α gene expression was observed in THP-1 cells. Moreover, TNF-α, and INF-γ upregulation were maintained in Jurkat cells. With respect to the apoptosis/necrosis, gene expression was not altered in THP-1 cells, but a down regulation of BAX and BCL-2 was observed in Jurkat cells after 4 h of exposure. These genes showed values closer to negative control after 24 h. Finally, rGO did not trigger a significant release of any cytokine at any exposure time assayed. In conclusion, our data contributes to the risk assessment of this material and suggest that rGO has an impact on the immune system whose final consequences should be further investigated.

Potential oestrogenic effects (following the OECD test guideline 440) and thyroid dysfunction induced by pure cyanotoxins (microcystin-LR, cylindrospermopsin) in rats.

Potential endocrine-disrupting properties of cyanotoxins, such as microcystin-LR (MC-LR) and cylindrospermopsin (CYN) are of concern due to their increasing occurrence, the scarcity of reports on the topic (particularly for CYN) and the impact of human's health at different levels. Thus, this work performed for the first time the uterotrophic bioassay in rats, following the Organization for Economic Cooperation and Development (OECD) Test Guideline 440, to explore the oestrogenic properties of CYN and MC-LR (75, 150, 300 µg/kg b.w./day) in ovariectomized (OVX) rats. Results revealed neither changes in the wet and blotted uterus weights nor in the morphometric study of uteri. Moreover, among the steroid hormones analysed in serum, the most remarkable effect was the dose-dependent increase in progesterone (P) levels in rats exposed to MC-LR. Additionally, a histopathology study of thyroids and serum levels of thyroids hormones were determined. Tissue affectation (follicular hypertrophy, exfoliated epithelium, hyperplasia) was observed, as well as increased T3 and T4 levels in rats exposed to both toxins. Taken together, these results point out that CYN and MC-LR are not oestrogenic compounds at the conditions tested in the uterotrophic assay in OVX rats, but, however, thyroid disruption effects cannot be discarded.

Towards highly economical and accurate wastewater sensors by reduced parts of the LED-visible spectrum.

Interest is growing in simple, fast and inexpensive systems to analyze urban wastewater quality in real time. In this research project, a methodology is presented for the characterization of COD, BOD5, TSS, TN, and TP of wastewater samples, without the need to alter the samples or use chemical reagents, from a few wavelengths, belonging to the different color groups that compose the visible spectrum in isolation: (380-700 nm): violet (380-427 nm), blue (427-476 nm), cyan (476-497 nm), green (497-570 nm), yellow (570-581 nm), orange (581-618 nm), and red (618-700 nm). In this study, about 650 raw and treated urban wastewater samples from over 43 WWTPs and a total of 36 estimation models based on genetic algorithms have been calculated. Seven models were calculated for each pollutant parameter; one model for each color group of the visible spectrum, except for TN, which includes an additional model combining the wavelengths of the violet and red region of the spectrum. All the calculated models showed high accuracy, with an R2 between 80 and 85 % for COD, BOD5 and TSS, and 66-74 % for TN and TP. The tests carried out have shown the accuracy of the models of the different color groups to be very close to each other. However, it is noted that the models making use of the wavelengths between 497 and 570 nm (green) were the ones that showed the best performance in all the parameters under study. This research work lays the foundations for the development of cheaper, faster, and simpler wastewater monitoring and characterization equipment.

Six-Month Clinical and Ecological Momentary Assessment Follow-Up of Patients at High Risk of Suicide: A Survival Analysis.

Objective: In this study, we combined ecological momentary assessment (EMA) with traditional clinical follow-up to explore correlates of suicidal relapse in patients with a history of suicidal behavior.Methods: Over 6 months, we followed up with 393 patients who completed baseline and follow-up interviews and were monitored through smartphone-based EMA via the MEmind app. Recruitment was conducted between February 2018 and March 2020. We recorded the occurrence of clinical suicidal events and EMA suicidal events, the latter defined as extreme scores on questions on passive suicide ideation.Results: Fifteen percent of participants had a new clinical suicidal event during follow-up (9.2% suicide attempt [SA]; 5.9% emergency referral for suicidal ideation [SI]). Of the 319 participants who installed the MEmind app, 20.7% presented with EMA suicidal events. EMA suicidal events were statistically significantly associated with clinical suicidal events at 2-month follow-up but not at 6-month follow-up. In the Cox multivariate regression model, 5 factors were independently associated with clinical suicidal events: number of previous SAs, SA in the past year, SA in the past month (risk factors), female gender, and age (protective factors).Conclusions: Our study confirms some of the risk factors classically associated with risk of suicide reattempt, such as history of suicidal behavior, while questioning others, such as female gender. Risk factors associated with EMA events differed from risk factors associated with traditional clinical suicide events, supporting the existence of distinct suicidal phenotypes.

Smartphone-Based Ecological Momentary Assessment for the Measurement of the Performance Status and Health-Related Quality of Life in Cancer Patients Under Systemic Anticancer Therapies: Development and Acceptability of a Mobile App.

Background: We have defined a project to develop a mobile app that continually records smartphone parameters which may help define the Eastern Cooperative Oncology Group performance status (ECOG-PS) and the health-related quality of life (HRQoL), without interaction with patients or professionals. This project is divided into 3 phases. Here we describe phase 1. The objective of this phase was to develop the app and assess its usability concerning patient characteristics, acceptability, and satisfaction. Methods: The app eB2-ECOG was developed and installed in the smartphone of cancer patients who will be followed for six months. Criteria inclusion were: age over 18-year-old; diagnosed with unresectable or metastatic lung cancer, gastrointestinal stromal tumor, sarcoma, or head and neck cancer; under systemic anticancer therapies; and possession of a Smartphone. The app will collect passive and active data from the patients while healthcare professionals will evaluate the ECOG-PS and HRQoL through conventional tools. Acceptability was assessed during the follow-up. Patients answered a satisfaction survey in the app between 3-6 months from their inclusion. Results: The app developed provides a system for continuously collecting, merging, and processing data related to patient's health and physical activity. It provides a transparent capture service based on all the available data of a patient. Currently, 106 patients have been recruited. A total of 36 patients were excluded, most of them (21/36) due to technological reasons. We assessed 69 patients (53 lung cancer, 8 gastrointestinal stromal tumors, 5 sarcomas, and 3 head and neck cancer). Concerning app satisfaction, 70.4% (20/27) of patients found the app intuitive and easy to use, and 51.9% (17/27) of them said that the app helped them to improve and handle their problems better. Overall, 17 out of 27 patients [62.9%] were satisfied with the app, and 14 of them [51.8%] would recommend the app to other patients. Conclusions: We observed that the app's acceptability and satisfaction were good, which is essential for the continuity of the project. In the subsequent phases, we will develop predictive models based on the collected information during this phase. We will validate the method and analyze the sensitivity of the automated results.

Use of Ecological Momentary Assessment Through a Passive Smartphone-Based App (eB2) by Patients With Schizophrenia: Acceptability Study.

BACKGROUND: Ecological momentary assessment (EMA) tools appear to be useful interventions for collecting real-time data on patients' behavior and functioning. However, concerns have been voiced regarding the acceptability of EMA among patients with schizophrenia and the factors influencing EMA acceptability. OBJECTIVE: The aim of this study was to investigate the acceptability of a passive smartphone-based EMA app, evidence-based behavior (eB2), among patients with schizophrenia spectrum disorders and the putative variables underlying their acceptance. METHODS: The participants in this study were from an ongoing randomized controlled trial (RCT) of metacognitive training, consisting of outpatients with schizophrenia spectrum disorders (F20-29 of 10th revision of the International Statistical Classification of Diseases and Related Health Problems), aged 18-64 years, none of whom received any financial compensation. Those who consented to installation of the eB2 app (users) were compared with those who did not (nonusers) in sociodemographic, clinical, premorbid adjustment, neurocognitive, psychopathological, insight, and metacognitive variables. A multivariable binary logistic regression tested the influence of the above (independent) variables on "being user versus nonuser" (acceptability), which was the main outcome measure. RESULTS: Out of the 77 RCT participants, 24 (31%) consented to installing eB2, which remained installed till the end of the study (median follow-up 14.50 weeks) in 14 participants (70%). Users were younger and had a higher education level, better premorbid adjustment, better executive function (according to the Trail Making Test), and higher cognitive insight levels (measured with the Beck Cognitive Insight Scale) than nonusers (univariate analyses) although only age (OR 0.93, 95% CI 0.86-0.99; P=.048) and early adolescence premorbid adjustment (OR 0.75, 95% CI 0.61-0.93; P=.01) survived the multivariable regression model, thus predicting eB2 acceptability. CONCLUSIONS: Acceptability of a passive smartphone-based EMA app among participants with schizophrenia spectrum disorders in this RCT where no participant received financial compensation was, as expected, relatively low, and linked with being young and good premorbid adjustment. Further research should examine how to increase EMA acceptability in patients with schizophrenia spectrum disorders, in particular, older participants and those with poor premorbid adjustment. TRIAL REGISTRATION: ClinicalTrials.gov NCT04104347; https://clinicaltrials.gov/ct2/show/NCT04104347.

Patients at high risk of suicide before and during a COVID-19 lockdown: ecological momentary assessment study.

The coronavirus disease 2019 (COVID-19) outbreak may have affected the mental health of patients at high risk of suicide. In this study we explored the wish to die and other suicide risk factors using smartphone-based ecological momentary assessment (EMA) in patients with a history of suicidal thoughts and behaviour. Contrary to our expectations we found a decrease in the wish to die during lockdown. This is consistent with previous studies showing that suicide rates decrease during periods of social emergency. Smartphone-based EMA can allow us to remotely assess patients and overcome the physical barriers imposed by lockdown.

Ecological Momentary Assessment for Monitoring Risk of Suicide Behavior.

In recent years the involvement of technology in psychiatric treatment and its usefulness is increasing. The main advantages of its use lie in the possibility of collecting passively data with greater temporal granularity from each patient individually, since these devices are in direct contact almost every minute of the day with them. The variety of data collected by the all the smartphone sensors allows for a better understanding of the patient behavior through what is called the digital phenotype. So the use of a continuous monitoring system for patients at risk of suicide becomes a very useful tool for improving the quality of life of patients and for the early detection of suicide attempts.

Smartphone-based ecological momentary assessment (EMA) in psychiatric patients and student controls: A real-world feasibility study.

BACKGROUND: Smartphone-based ecological momentary assessment (EMA) is a promising methodology for mental health research. The objective of this study is to determine the feasibility of smartphone-based active and passive EMA in psychiatric outpatients and student controls. METHODS: Two smartphone applications -MEmind and eB2- were developed for behavioral active and passive monitoring. The applications were tested in psychiatric patients with a history of suicidal thoughts and/or behaviors (STB), psychiatric patients without a history of STB, and student controls. Main outcome was feasibility, measured as response to recruitment, retention, and EMA compliance. Secondary outcomes were patterns of smartphone usage. RESULTS: Response rate was 87.3% in patients with a history of STB, 85.1% in patients without a history of STB, and 75.0% in student controls. 457 participants installed the MEmind app (120 patients with a history of STB and 337 controls) and 1,708 installed the eB2 app (139 patients with a history of STB, 1,224 patients with no history of STB and 346 controls). For the MEmind app, participants were followed-up for a median of 49.5, resulting in 22,622 person-days. For the eB2 application, participants were followed-up for a median of 48.9 days, resulting in 83,521 person-days. EMA compliance rate was 65.00% in suicidal patients and 75.21% in student controls. At the end of the follow-up, over 60% of participants remained in the study. LIMITATIONS: Cases and controls were not matched by age and sex. Cases were patients who were receiving adequate psychopharmacological treatment and attending their appointments, which may result in an overstatement of clinical compliance. CONCLUSIONS: Smartphone-based active and passive monitoring are feasible methods in psychiatric patients in real-world settings. The development of applications with friendly interfaces and directly useful features can help increase engagement without using incentives. The MEmind and eB2 applications are promising clinical tools that could contribute to the management of mental disorders. In the near future, these applications could serve as risk monitoring devices in the clinical practice.

How Does Positive Work-Related Stress Affect the Degree of Innovation Development?

Many studies sustain that work-related stress exerts pervasive consequences on the employees' levels of performance, productivity, and wellbeing. However, it remains unclear whether certain levels of stress might lead to positive outcomes regarding employees' innovativeness. Hence, this paper examines how the five dimensions of work-related stress impact on the employees' levels of innovation performance. To this aim, this study focused on a sample of 1487 employees from six Italian companies. To test the research hypotheses under assessment, we relied on the use of the partial least squares (PLS) technique. Our results reveal that, in summary, the stressors job autonomy, job demands, and role ambiguity exert a positive and significant impact on the employees' levels of innovativeness. However, this study failed to find evidence that the supervisors' support-innovation and colleagues' support-innovation links are not statistically significant.

The Genetic Architecture of Parkinson Disease in Spain: Characterizing Population-Specific Risk, Differential Haplotype Structures, and Providing Etiologic Insight.

BACKGROUND: The Iberian Peninsula stands out as having variable levels of population admixture and isolation, making Spain an interesting setting for studying the genetic architecture of neurodegenerative diseases. OBJECTIVES: To perform the largest PD genome-wide association study restricted to a single country. METHODS: We performed a GWAS for both risk of PD and age at onset in 7,849 Spanish individuals. Further analyses included population-specific risk haplotype assessments, polygenic risk scoring through machine learning, Mendelian randomization of expression, and methylation data to gain insight into disease-associated loci, heritability estimates, genetic correlations, and burden analyses. RESULTS: We identified a novel population-specific genome-wide association study signal at PARK2 associated with age at onset, which was likely dependent on the c.155delA mutation. We replicated four genome-wide independent signals associated with PD risk, including SNCA, LRRK2, KANSL1/MAPT, and HLA-DQB1. A significant trend for smaller risk haplotypes at known loci was found compared to similar studies of non-Spanish origin. Seventeen PD-related genes showed functional consequence by two-sample Mendelian randomization in expression and methylation data sets. Long runs of homozygosity at 28 known genes/loci were found to be enriched in cases versus controls. CONCLUSIONS: Our data demonstrate the utility of the Spanish risk haplotype substructure for future fine-mapping efforts, showing how leveraging unique and diverse population histories can benefit genetic studies of complex diseases. The present study points to PARK2 as a major hallmark of PD etiology in Spain. © 2019 International Parkinson and Movement Disorder Society.

The Subjective Well-Being Challenge in the Accounting Profession: The Role of Job Resources.

The main activity of the accountant is the preparation and audit of the financial information of a company. The subjective well-being of the accountant is important to ensure a balanced professional judgment and to offer a positive image of the profession in the face of the incorporation and retention of talent. However, accountants are subjected to intense pressures that affect their well-being in the performance of their tasks. In this paper, the job demands-resources theoretical framework is adopted to analyze the relationships between job demands, job resources, and the subjective well-being of a large sample of 739 accounting experts at the European level. Applying a structural equations model, the results confirm, on the one hand, the direct effects provided in the theoretical framework and, on the other, a new mediating role of job demands-subjective well-being relationship resources.

Assessment of e-Social Activity in Psychiatric Patients.

This paper introduces a novel method to assess the social activity maintained by psychiatric patients using information and communication technologies. In particular, we model the daily usage patterns of phone calls and social and communication apps using point processes. We propose a novel nonhomogeneous Poisson process model with periodic (circadian) intensity function using a truncated Fourier series expansion, which is inferred using a trust-region algorithm. We also extend the model using a mixture of periodic intensity functions to cope with the different daily patterns of a person. The analysis of the usage of phone calls and social and communication apps of a cohort of 259 patients reveals common patterns shared among patients with relatively high homogeneity and differences among patient pathologies.

Clinical-economic impact of the change of protocol for use of basiliximab in liver transplant.

OBJECTIVE: Evaluation of the clinical and economic impact after the protocol  change of basiliximab use in orthohepatic transplant. METHOD: Retrospective study in which all liver transplant patients were included  during the years 2013, 2014 and until February 15, 2015. The study was divided into two stages according to the protocol used: 1) administration of basiliximab  only if factors of previous risk, and 2) administration of the first dose of  basiliximab to all transplant patients and the second dose if it had risk factors. RESULTS: 83 patients were included, 34 according to protocol 1 and 49 according  to protocol 2. No significant differences were found in the clinical  variables evaluated or in the variables related to health outcomes. Considering  that the percentage of patients without risk factors who received basiliximab was 43% and without differences in the stays, we could estimate an additional cost  for the universal use of basiliximab in orthohepatic transplant of € 21,400.00. CONCLUSIONS: In our population, the protocol change making universal the first  dose of basiliximab has not shown the expected benefits, but an increase in  costs, so the suitability of the new protocol in consensus with the medical team  must be reconsidered. The evidence regarding the use of basiliximab in  orthohepatic transplant remains limited and although its benefit seems clear in  patients with risk factors, especially renal failure, recommendations about its use universally remains controversial.

Objetivo: Evaluación del impacto clínico y económico tras el cambio de protocolo de uso de basiliximab en el trasplante ortohepático. Método: Estudio retrospectivo en el que se incluyó a todos los pacientes trasplantados de hígado durante los años 2013, 2014 y hasta el 15 de  febrero de 2015. El estudio se dividió en dos etapas según el protocolo  empleado: 1) administración de basiliximab solo si existían factores de riesgo  previos, y 2) administración de la primera dosis de basiliximab a todos los  pacientes trasplantados y de una segunda dosis si existían factores de riesgo. Resultados: Se incluyeron 83 pacientes, 34 según el protocolo 1 y 49 según el  protocolo 2. No se encontraron diferencias significativas en las variables clínicas  evaluadas ni en las variables relacionadas con los resultados en salud.  Considerando que el porcentaje de pacientes sin factores de riesgo que recibieron basiliximab fue del 43% y sin diferencias en las estancias,  podríamos estimar un coste adicional por el empleo universal de basiliximab en  el trasplante ortohepático de 21.400 €.Conclusiones: En nuestra población, el cambio de protocolo haciendo universal  la primera dosis de basiliximab no ha mostrado los beneficios esperados, pero sí  un aumento de los costes, por lo que debe replantearse la idoneidad del nuevo  protocolo en consenso con el equipo médico. La evidencia en relación con el  empleo de basiliximab en el trasplante ortohepático sigue siendo limitada y  aunque parece claro su beneficio en pacientes con factores de riesgo,  especialmente fallo renal, las recomendaciones acerca de su uso de forma  universal sigue siendo controvertido.

Treatment persistence during therapeutic sequences with adalimumab and infliximab in the treatment of Crohn's disease.

BACKGROUND AND AIM: Tumor necrosis factor (TNF) inhibitors have demonstrated efficacy and safety in the treatment Crohn's disease (CD). However, the loss of response over time means that they are usually used sequentially. The aim of this study was to compare treatment persistence with different sequences of TNF inhibitors in patients with active luminal CD. METHODS: A Markov model (3-month cycles) was developed to simulate the therapeutic sequences of beginning biological treatment with infliximab or adalimumab, with a time horizon of three years. Each state of the model represented treatment (induction, standard dose or escalated dose) with each TNF inhibitor or the state without biological treatment. The transition probabilities between states were determined by the clinical response to TNF inhibitors obtained from the literature. The likelihood of discontinuation due to adverse effects was also considered. RESULTS: After three years, the percentage of CD patients receiving infliximab and adalimumab as a first TNF inhibitor that remained in treatment was 52.8% and 59.3% (p = 0.1) respectively. Median time to discontinuation of the standard dose was 26.26 months in patients who started with adalimumab and 24.39 months in patients who started with infliximab. CONCLUSION: In the model, there were no significant differences in persistence after three years with the initial drug among patients with active luminal CD starting treatment with infliximab or adalimumab.

User profiles of an electronic mental health tool for ecological momentary assessment: MEmind.

Ecological momentary assessment (EMA) is gaining importance in psychiatry. This article assesses the characteristics of patients who used a new electronic EMA tool: the MEmind Wellness Tracker. Over one year, 13811 adult outpatients in our Psychiatry Department were asked to use MEmind. We collected information about socio-demographic data, psychiatric diagnoses, illness severity, stressful life events and suicidal thoughts/behavior. We compared active users (N = 2838) and non-active users (N = 10,973) of MEmind and performed a Random Forest analysis to assess which variables could predict its use. Univariate analyses revealed that MEmind-users were younger (42.2 ± 13.5 years versus 48.5 ± 16.3 years; χ2  = 18.85; P < 0.001) and more frequently diagnosed with anxiety related disorders (57.9% versus 46.7%; χ2  = 105.92; P = 0.000) than non-active users. They were more likely to report thoughts about death and suicide (up to 24% of active users expressed wish for death) and had experienced more stressful life events than non-active users (57% versus 48.5%; χ2  = 64.65; P < 0.001). In the Random Forest analysis, 31 variables showed mean decrease accuracy values higher than zero with a 95% confidence interval (CI), including sex, age, suicidal thoughts, life threatening events and several diagnoses. In the light of these results, strategies to improve EMA and e-Mental Health adherence are discussed.