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The recording of Ecological Momentary Assessments (EMA) can assist people with chronic diseases in monitoring their health state. However, many users quickly lose interest in their respective EMA platforms. Therefore, we studied the adherence of users of the mHealth app T rack Y our T innitus (TYT). The app is used to record EMA in people with tinnitus. 1292 users, who interacted with the app between April 2014 and February 2017, were analyzed in this work. We defined “adherence” based on the dimensions of interaction duration and interaction continuity. We propose methods that are able to predict the (dis)continuation of interaction with the app and identify user segments that are characterized by similar patterns of adherence. For the prediction task we used the data of the questionnaires MiniTF and TSCHQ, which are filled in when the users enter TYT for the first time. Additionally, time series of the eight items of the daily EMA questionnaire were used. The distribution of user activity pertaining to the adherence dimension of interaction duration revealed a very skewed distribution, with most users giving up after only 1 day of interaction. However, many users returned after interrupting for some time. Some of the MiniTF items indicated that the worries of users might have lead to an increased likelihood of returning back to the app. The MiniTF score itself was not predictive, though. The answers to the TSCHQ items, in turn, pointed to user strata (more than 65 years of age at registration), which tended towards higher interaction continuity. As the registration questionnaires predicted adherence only to a limited extent, it is promising to study the activities of the users in the very first days of interaction more deeply. It turned out in this context that the effects of interaction stimulants like personalized and non-personalized tips, pointers to information sources, and mechanisms used in online treatments for tinnitus (e.g., in iCBT) should be further investigated.

Tinnitus is defined as the conscious awareness of a tonal or composite noise in the absence of a corresponding external acoustic source. This international multicentre, parallel-arm, superiority, randomised controlled trial investigated whether combination therapies are superior to single interventions in the treatment of chronic subjective tinnitus. Tinnitus patients were recruited from five clinical sites across the EU and randomly assigned using a web-based system, stratified by their hearing and distress level, to single or combination treatment of 12 weeks. Cognitive-behavioural therapy, hearing aids, app-based structured counselling, or app-based sound therapy were administered either alone or as a combination of two treatments resulting in ten treatment arms. App-based treatments were delivered without direct contact or guidance from clinicians. The primary outcome was the difference in the change from baseline to week 12 in the total score of the Tinnitus Handicap Inventory (THI) between single and combination treatments in the intention-to-treat population. All statistical analysis were performed blinded to treatment allocation. 674 patients of both sexes aged between 18 and 80 years were screened for eligibility. 461 participants (190 females) with chronic subjective tinnitus and at least mild tinnitus handicap were enroled, 230 of which were randomly assigned to single and 231 to combination treatment. Least-squares mean changes from baseline to week 12 were −11.7 for single treatment (95% confidence interval [CI], −14.4 to −9.0) and −14.9 for combination treatments (95% CI, −17.7 to −12.1), with a statistically significant group difference ( p  = 0.034). Cognitive-behavioural therapy and hearing aids alone had large effect sizes, which could not be further increased by combination treatment. No serious adverse events occurred. In this trial involving patients with chronic tinnitus, all treatment arms showed improvement in THI scores from baseline to week 12. Combination treatments showed a stronger clinical effect than single treatment, however, no clear synergistic effect was observed when combining treatments. Instead, we observed a compensatory effect, where a more effective treatment offsets the clinical effects of a less effective treatment. ClinicalTrials.gov Identifier: NCT04663828. Chronic tinnitus is often treated with cognitive-behavioural therapy, hearing aids, counselling, or sound therapy, but their combined benefit is unclear. Here, the authors show, in a multicentre randomised trial, that combination treatments improve tinnitus scores more than single therapies, though benefits appear compensatory rather than synergistic.

Ecological Momentary Assessments (EMA) deliver insights on how patients perceive tinnitus at different times and how they are affected by it. Moving to the next level, an mHealth app can support users more directly by predicting a user's next EMA and recommending personalized services based on these predictions. In this study, we analyzed the data of 21 users who were exposed to an mHealth app with non-personalized recommendations, and we investigate ways of predicting the next vector of EMA answers. We studied the potential of entity-centric predictors that learn for each user separately and of neighborhood-based predictors that learn for each user separately but take also similar users into account, and we compared them to a predictor that learns from all past EMA indiscriminately, without considering which user delivered which data, i.e. to a 'global model'. Since users were exposed to two versions of the non-personalized recommendations app, we employed a Contextual Multi-Armed Bandit (CMAB), which chooses the best predictor for each user at each time point, taking each user's group into account. Our analysis showed that the combination of predictors into a CMAB achieves good performance throughout, since the global model was chosen at early time points and for users with few data, while the entity-centric, i.e. user-specific, predictors were used whenever the user had delivered enough data - the CMAB chose itself when the data were 'enough'. This flexible setting delivered insights on how user behavior can be predicted for personalization, as well as insights on the specific mHealth data. Our main findings are that for EMA prediction the entity-centric predictors should be preferred over a user-insensitive global model and that the choice of EMA items should be further investigated because some items are answered more rarely than others. Albeit our CMAB-based prediction workflow is robust to differences in exposition and interaction intensity, experimentators that design studies with mHealth apps should be prepared to quantify and closely monitor differences in the intensity of user-app interaction, since users with many interactions may have a disproportionate influence on global models.

Recent digitization technologies empower mHealth users to conveniently record their Ecological Momentary Assessments (EMA) through web applications, smartphones, and wearable devices. These recordings can help clinicians understand how the users’ condition changes, but appropriate learning and visualization mechanisms are required for this purpose. We propose a web-based visual analytics tool, which processes clinical data as well as EMAs that were recorded through a mHealth application. The goals we pursue are (1) to predict the condition of the user in the near and the far future, while also identifying the clinical data that mostly contribute to EMA predictions, (2) to identify users with outlier EMA, and (3) to show to what extent the EMAs of a user are in line with or diverge from those users similar to him/her. We report our findings based on a pilot study on patient empowerment, involving tinnitus patients who recorded EMAs with the mHealth app TinnitusTips. To validate our method, we also derived synthetic data from the same pilot study. Based on this setting, results for different use cases are reported.

Chronic tinnitus, the perception of a phantom sound in the absence of corresponding stimulus, is a condition known to affect patients’ quality of life. Recent advances in mHealth have enabled patients to maintain a ‘disease journal’ of ecologically-valid momentary assessments, improving patients’ own awareness of their disease while also providing clinicians valuable data for research. In this study, we investigate the effect of non-personalised tips on patients’ perception of tinnitus, and on their continued use of the application. The data collected from the study involved three groups of patients that used the app for 16 weeks. Groups A & Y were exposed to feedback from the start of the study, while group B only received tips for the second half of the study. Groups A and Y were run by different supervisors and also differed in the number of hospital visits during the study. Users of Group A and B underwent assessment at baseline, mid-study, post-study and follow-up, while users of group Y were only assessed at baseline and post-study. It is seen that the users in group B use the app for longer, and also more often during the day. The answers of the users to the Ecological Momentary Assessments are seen to form clusters where the degree to which the tinnitus distress depends on tinnitus loudness varies. Additionally, cluster-level models were able to predict new unseen data with better accuracy than a single global model. This strengthens the argument that the discovered clusters really do reflect underlying patterns in disease expression.

There is very little knowledge on microplastic pollution in the Western Ghats (WG), a heritage site in southwest India. To address this, we have studied the spatiotemporal variations of sedimentary microplastics (MPs) from the River Sharavathi, a pristine river in the Western Ghats (WG), southern India. The rich biodiversity in the region makes it relevant to analyse the distribution of this emerging pollutant that is causing harm to the biota and the ecosystem. We analysed the sedimentological and carbon content (organic and inorganic) of these sediments and explored their relationship with MPs. Finally, risk assessment indices such as the Pollution Load Index (PLI), the Polymer Hazard Index (PHI), and the Potential Ecological Risk Index (PERI) were calculated to detect the levels of plastic pollution. The concentration of MPs ranged from 2.5 to 57.5 pieces/kg and 0 to 15 pieces/kg during the pre-monsoon and post-monsoon seasons, respectively. The dip in the MPs’ abundance during the post-monsoon season was due to the extremely high rainfall in the river basin during July–August 2019, which would have entrained the sedimentary MPs and transported them to the coast/Arabian Sea. Smaller MPs (0.3–1 mm) were more abundant than the larger MPs (1–5 mm), mainly due to the breakdown of sedimentary plastics by physical processes. Fragments, films, foams, and fibres were the main categories of MPs, and the main polymers were polyethylene, polyethylene terephthalate, and polypropylene. No significant relationship was observed between the sedimentological properties and microplastics, which may be due to the different physical properties of sediments and microplastics. The PLI, PHI, and PERI indices suggest different contamination levels in the river basin. Based on the PLI scores, all the samples belong to the hazardous level I suggesting minor risk category, and the risk of microplastic pollution falls under the high to hazardous risk category based on the PHI values. The PERI value ranged from 160 to 440 and 40 to 2240 during the pre-monsoon and post-monsoon seasons, respectively. The risk assessment in a region known for its rich biodiversity is crucial, as the data can be used by the district administration to mitigate plastic pollution.

IntroductionSirāgranthi results from vitiated vāta in sirās, leading to granthi due to Vātaprakopaka nidānas. Ācārya Vagbhata recommends sirāvyadha for treating sirāgranthi. The role of inflammation in vascular diseases is explored, with a focus on Interleukin-6 as a key biomarker. The absence of studies on sirāvyadha’s impact on inflammatory biomarkers, particularly Interleukin-6, underscores the study’s relevance, aiming to observe changes in inflammatory response in varicose veins post-sirāvyadha within a 15-day period.ObjectiveTo observe changes in IL-6 values before and after sirāvyadha within a 15-day period in individuals with varicose veins. Materials and Methods: After excluding deep vein thrombosis (DVT) through lower limb color doppler, five subjects who satisfied the inclusion criteria were selected. Assessments included BT, CT, Hb screening, and parameters like AVVQ, pain, edema, tortuosity, skin pigmentation, and itching. Sirāvyadha was performed over the tortuous vein with an 18G needle, and sample was collected from drained blood for IL-6 testing. After a 15-day follow-up, Sirāvyadha was repeated, and assessment of all parameters were done.ResultsStatistically significant differences (p<0.05) were observed after treatment in Interleukin-6, AVVQ, pain, edema, tortuosity, and skin pigmentation. However, itching showed no statistically significant difference after treatment (p > 0.05).ConclusionIn all 5 cases, a reduction in the rate of IL-6 was observed. Remarkably, three patients with initially high values showed a statistically significant reduction (p < 0.05) after sirāvyadha treatment, indicating a reduction in inflammation. Clinical and statistical significance (p < 0.05) were also observed in subjective parameters such as pain, edema, tortuosity, and skin pigmentation. Although itching decreased in patients, it did not reach statistical significance, possibly due to some patients not experiencing itching before the procedure. The study demonstrates that sirāvyadha effectively reduces the inflammatory response and subjective symptoms of varicose veins. Furthermore, the improvement in the quality of life after sirāvyadha was highly significant (p < 0.05). Overall, the study supports sirāvyadha’s efficacy in reducing inflammatory biomarker IL-6 and subjective symptoms in varicose veins.

Emerging spectrum trends require a higher integration of 5G New Radio Frequency Range 1 (FR1) and Frequency Range 2 (FR2) bands to enhance the availability of spectrum and spectrum-sharing opportunities. To enable the reception of both FR1 and FR2 bands in a seamless hardware entity, we propose combining homodyne and heterodyne architectures. This necessitates the incorporation of a down-converter module that transfers the incoming signals from FR2 bands down to FR1, ensuring compatibility with an FR1 direct-conversion receiver (DCR) for the final signal reception. The primary focus of this paper is the design and implementation of the required integrated down-converter. The module includes an integrated balun, a low-noise amplifier (LNA) with a bypass mode, a dual-mode mixer, and an intermediate frequency (IF) amplifier. The introduced bypass mode helps to further elevate the linearity performance compared to the nominal mode. The bypass mode is designed for joint communication and sensing operation to avoid the compression of the receiver. This work also incorporates a local oscillator (LO) signal distribution network with phase tuning elements using a mixed-signal approach. The circuit is implemented in a 22-nm CMOS process, and the active die area is 0.6  mm 2 . The measurements demonstrate that the implemented chip can efficiently perform the required frequency conversion over a wide frequency range of 18–28 GHz. Conversion gain of 4.5–7.5 dB, noise figure of 15–19.7 dB, 1 dB compression point (IP1dB) of − 16 to − 10 dBm, and input third-order intercept point (IIP3) of − 5 to 0 dBm are achieved. The measured IP1 dB and IIP3 for the bypass mode are +0.5 to +4.5 dBm and +8.5 to +10 dBm, respectively.

Background: Children residing in orphanages often have accumulated oral health needs as they are unaware of the importance of maintaining good oral hygiene. Due to financial constraints, the provision of oral health care is often neglected. Aims and Objectives: This study attempts to assess the perception of oral health and practices among children residing in orphanages in Bengaluru. Materials and Methods: A cross-sectional survey was conducted among 269 inmates, which assessed their perception and practices concerning oral health. Results: The self-assessment and practices of the study participants varied significantly. The proportion of substance abuse was very low, and the oral hygiene practices of the majority of participants were good. Conclusion: Interventions need to be undertaken to improve and reinforce oral health awareness among the study participants.

Background: Tinnitus is a heterogeneous condition. The aim of this study as to compare the online and hospital responses to the Spanish version of European School for Interdisciplinary Tinnitus Research screening-questionnaire (ESIT-SQ) in tinnitus individuals by an unsupervised age clustering. Methods: A cross-sectional study was performed including 434 white Spanish patients with chronic tinnitus to assess the demographic and clinical profile through the ESIT-SQ, with 204 outpatients and 230 individuals from an online survey; a K-means clustering algorithm was used to classify both responses according to age. Results: Online survey showed a high proportion of Meniere’s disease (MD) patients compared to both the general population and the outpatient cohort. The responses showed statistically significant differences between groups regarding education level, tinnitus-related hearing disorders (MD, hyperacusis), sleep difficulties, dyslipidemia, and other tinnitus characteristics, including duration, type of onset, the report of mitigating factors and the use of treatments. However, these differences were partially confirmed after adjusting for age. Conclusions: Self-reported tinnitus surveys are a low confidence source for tinnitus phenotyping. Additional clinical evaluation is needed for tinnitus research to reach the diagnosis. Age-based cluster analysis might help to better define clinical profiles and to compare responses in ESIT-SQ among subgroups of patients with tinnitus.