<![CDATA[New evidence shows CBT timed after ketamine boosts lasting depression relief; Yale tests digital therapy Rejoyn to scale the neuroplasticity window.]]>

Surveillance of Cannabis Strains Using Online Data: Observational Study

Background: The flower strains of cannabis are an important attribute that determines product appeal and health impacts. However, there is a lack of surveillance of cannabis strains as the marketplace expands in response to the growing legalization of recreational and medical cannabis. Objective: This study aimed to analyze cannabis strains and their growth using existing data from user-generated reviews on the Leafly website. Methods: Using the time stamps of each review, we constructed a dataset of the number of reviews by strain and year over the period of 2010 to 2023. We further conducted trend analyses using Joinpoint regression. Results: As of December 2023, more than 7000 cannabis strains are available for view or purchase on the website, including more than 6000 that have been reviewed by users or customers. The number of strains with reviews experienced a 13-fold increase from 280 strains in 2010 to 3905 strains in 2023. Strains that are hybrid and contain more than 20% tetrahydrocannabinol experienced the highest growth in review numbers. Conclusions: The rapid growth of strain numbers poses challenges to cannabis regulation. Policymakers who would like to base regulations on product features need to consider the variability of strains, along with other features such as potency levels and product forms.
<img src="https://jmir-production.s3.us-east-2.amazonaws.com/thumbs/0a0eb0fa61181f1ac8ac90d4cc83810b" />

Use of the Dynamic Systems Development Method to Inform Technology-Assisted Motivational Interviewing (TAMI) for Tobacco Cessation: Qualitative Study

Background: Smoking continues to be a leading cause of preventable morbidity and mortality, and more than 480,000 Americans die annually due to smoking-related illness attributable to smoking and secondhand smoke. More advanced, responsive, and tailored digital interventions using machine learning and artificial intelligence may be a valuable tool for successful smoking cessation referrals. Objective: This study used the dynamic systems development method to incorporate patient and consumer sources of conversational data to develop a technology-assisted motivational interviewing (TAMI) chatbot, a digital agent using machine learning models to deliver motivational interviewing (MI) for tobacco cessation. Methods: During the functional model iteration phase, user-centered design interviews with smokers (n=3) informed the creation of TAMI. The design and build phase involved the use of existing datasets to guide the incorporation of MI-consistent utterances, language recognition, and topic classification to guide a discussion about smoking, and providing a tailored quit plan if indicated. During the implementation phase, user experience interviews with randomly selected participants (n=9) in a pilot trial discussed their experiences with TAMI. Results: User-centered design interviews indicated a desire for a chatbot that was engaging and adaptable to personal interests in quitting smoking. Inductive analysis of user experience interviews revealed that anonymity, regular reminders, and a humanized experience facilitated engagement with TAMI, but technical glitches, chatbot misunderstandings, and issues with rapport were barriers to engagement. Conclusions: Informed by user input and patient and consumer datasets, TAMI can use MI skills to elicit change talk and/or accurately evaluate readiness for tobacco cessation. Further development will enhance TAMI’s ability to seamlessly engage with users when discussing behavior change and assist underserved populations achieve improvements in a variety of health behavior goals.
<img src="https://jmir-production.s3.us-east-2.amazonaws.com/thumbs/a42048e0fe380701c4eca3d0bc79f43b" />

Pre-Exposure Prophylaxis Adherence and HIV Self-Testing App Among Women in the South Bronx: 12-Month Usability, Acceptability, and Feasibility Study

Background: HIV pre-exposure prophylaxis (PrEP) is underused by cis- and transgender women despite a significant HIV burden. Smartphone technologies are promising tools to support HIV prevention but have yet to be assessed in women. Objective: We conducted a 12-month feasibility study to assess the use and acceptability of a mobile phone app, SmartPrEP, designed to support PrEP adherence and HIV self- and partner-testing among women living in an area of elevated HIV burden in New York City. Methods: Nonpregnant adult cisgender and transgender women who met US PrEP eligibility criteria and were PrEP naïve, reported PrEP use for <3 months, or had inconsistent PrEP use were eligible. Participants received oral PrEP and HIV self-testing kits and downloaded the SmartPrEP app, which sent daily reminders to take PrEP and record adherence through the app. PrEP adherence was assessed based on participants’ self-recorded average doses per week as entered in the app. Sexual behaviors and app acceptability were evaluated quarterly by interviewer-administered questionnaires. Results: From February 2022 to August 2023, 40 participants were enrolled in the study. Median age was 30 (IQR 24-35) years, 70% (28/40) identified as cisgender women, 30% (12/40) as transgender women, 48% (19/40) as Hispanic, and 35% (14/40) as Black. At baseline, the majority, 80% (32/40), had no history of PrEP use, and 65% (26/40) reported that they did not believe they were at risk of HIV. However, 90% (36/40) reported ≥1 and 25% (10/40) reported >4 HIV risk behaviors in the past 6 months, with 58% (23/40) reporting anal or vaginal sex with more than 1 partner. Over the course of the study, although 8 participants withdrew early, and 14 were lost to follow-up, there were 2 pregnancies and 1 HIV seroconversion. PrEP adherence was low, with 80% (32/40) recording <3 doses per week, 17% (7/40) recording 3‐5 doses, and 3% (1/40) recording ≥6 doses per week. PrEP adherence averaged over the second half of study participation was lower than adherence in the first half, with only 10% (4/40) recording >3 doses per week compared to 20% (8/40). In total, 4 participants conducted HIV self- or partner-testing using SmartPrEP during study follow-up. App acceptability assessed at month 12 was moderate to high (median score 3.71 of max 5, IQR 3.47‐4.16). Conclusions: Despite consistently rating the app as acceptable and receiving quarterly HIV testing and counseling, most participants did not achieve optimal PrEP adherence, demonstrating the limitations of this mobile health app among women at elevated risk of HIV. Active navigation and strategies to address gaps in risk perception among women will remain critical, as new, long-acting formulations of PrEP become available. Trial Registration: ClinicalTrials.gov NCT05111119; https://clinicaltrials.gov/study/NCT05111119

Preliminary Evaluation of a Large Language Model–Powered Chatbot for Osteoporosis Self-Management Education: Formative Randomized Controlled Trial

<strong>Background:</strong> With the increasing burden of chronic diseases, self-management education (SME) is crucial. Traditional SME based on face-to-face delivery by clinicians is resource-intensive, and general digital tools such as web-based platforms often provide limited interactivity for patient learning. Although chatbots based on large language models (LLMs) show promise in interactivity, their real-world effectiveness lacks empirical evidence. <strong>Objective:</strong> This study aimed to explore the feasibility and preliminary effectiveness of an LLM-based chatbot specifically designed for osteoporosis SME. <strong>Methods:</strong> A formative randomized controlled trial was conducted in a tertiary hospital from February 2024 to March 2025. Adults aged ≥18 years with osteoporosis were recruited and randomly assigned (1:1) to either the intervention (OPBot) group or a control group receiving traditional health education. The chatbot provided interactive educational content and question-and-answer support, while the control group received face-to-face education and written materials. Osteoporosis knowledge was assessed using the Osteoporosis Knowledge Assessment Tool at baseline and discharge. Nurses’ time spent on health education was self-recorded during each intervention session and aggregated across sessions. Adherence to disease management was assessed at 1, 3, and 6 months after discharge via telephone using Likert-scale questionnaires. The reliability of OPBot responses was evaluated by 2 clinician assessors using a 5-point Likert scale, with interrater agreement calculated using Cohen <i>κ</i>. Group comparisons were conducted using 2-tailed independent <i>t</i> tests, Mann-Whitney <i>U</i> tests, and chi-square tests, and adherence outcomes were analyzed using mixed-effects models. <strong>Results:</strong> A total of 100 participants were randomized; 12% (12/100) were excluded due to loss to follow-up, refusal of the second knowledge assessment, or death, leaving 88% (88/100) participants for analysis (n=45, 51.1% in the OPBot group and n=43, 48.9% in the control group). The OPBot group showed significantly higher postintervention knowledge scores than the control group (median 80.0, IQR 70.0-89.0 vs median 75.0, IQR 65.5-80.0; <i>P</i>=.01). Nurses in the OPBot group spent lesser time on SME than those in the control group (median 5.0, IQR 2.0-17.0 vs median 23.0, IQR 20.0-25.0 minutes; <i>P</i>&lt;.001). For adherence outcomes, a significant group×time interaction was observed for calcium supplement intake (odds ratio 1.49, 95% CI 1.08-2.06; <i>P</i>=.02), indicating differing adherence trajectories over time. The OPBot group also showed higher odds of consuming calcium-rich foods across time points (odds ratio 2.87, 95% CI 1.04-7.89; nominal <i>P</i>=.04), although this association did not remain significant after Holm correction. No significant effects were observed for sun exposure (<i>P</i>=.56), exercise (<i>P</i>=.79), or total adherence scores (<i>P</i>=.33). In the question-and-answer module, most OPBot responses were rated as highly reliable 89.4% (76/85), with high interrater agreement (Cohen <i>κ</i>=0.83). <strong>Conclusions:</strong> LLM-based chatbots specifically designed for osteoporosis SME may improve patient knowledge, supporting adherence behaviors, and reducing healthcare workload. However, further large-scale studies are needed to confirm these findings.

Recommendations for Research and Clinical Implementation of Ambulatory Assessment, Mood Monitoring, Digital Phenotyping, and Remote Measurement Technology in Mood Disorders: Synthesis of Systematic Review Findings

Background: Ambulatory assessment and active and passive monitoring all offer a real-time, flexible approach to assessing mood and behavior in mood disorders. Despite their potential, concerns remain regarding the performance, usability, adherence, and potential safety of these tools. Objective: This study synthesizes the findings from 7 systematic reviews, integrating quantitative and qualitative data from randomized trials, observational studies, and user experience research to evaluate the performance, feasibility, acceptability, and clinical impact of ambulatory assessment and mood monitoring in people with depression and bipolar disorder. We assessed studies over the medium or long term (3 months or more). Methods: A summary of a series of systematic reviews was carried out by the authors—including meta-analyses (for quantitative data) and meta-syntheses (for qualitative data). Eight electronic databases were searched, and mixed methods studies were included. Studies were assessed for risk of bias. The results were checked for coherence, and recommendations were made by individuals with lived experience, methodologists, and psychiatrists. GRADE (Grading of Recommendations Assessment, Development, and Evaluation) was used to assess the quality and strength of the evidence. Results: The 111 included studies included 19,945 participants and used 69 different ambulatory assessment protocols or mood-monitoring interventions. Key barriers to implementation were identified, including performance inconsistency, adverse effects, and user disengagement. Evidence-based recommendations are provided to guide future clinical and research applications. Conclusions: Ambulatory assessment and mood monitoring hold promise in research and clinical practice, yet their implementation requires more rigorous evaluation, greater personalization, and responsible, user-centered design. Crucially, these measures can add granularity and confirmation, but additional context is often required, and none of these measures are robust enough yet to replace current outcomes.
<img src="https://jmir-production.s3.us-east-2.amazonaws.com/thumbs/a83582c454b5b6028210d2cb063318df" />

<![CDATA[APA’s upcoming DSM shifts from “statistical” to “scientific,” adding dimensional, contextual, and biological factors to modernize diagnosis and address past critiques.]]>

AI-Powered Blood Test Detects Early Retinal Damage in Diabetes 

Scientists have developed an AI-assisted prediction tool that can identify patients with type 2 diabetes at high risk of developing diabetic retinal neurodegeneration (DRN) before symptoms appear. Their findings were published today in the journal PLOS Medicine.

“Our study suggests that early retinal nerve damage in diabetes leaves measurable signals in the blood,” write the authors of the study, led by Wei Wang, MD, PhD, associate professor at the Guangdong Provincial Clinical Research Center for Ocular Diseases. “These findings suggest that a simple blood test analyzed with artificial intelligence may help identify people with diabetes who are at highest risk of early retinal nerve damage, well before visible damage appears on the retina.”

Type 2 diabetes affects more than half a billion people worldwide, carrying with it an increased risk of long-term complications including progressive neurodegeneration. Retinal nerves are among the earliest tissues to be damaged, which can eventually lead to severe visual impairment and vision loss. However, current diagnostic methods can only detect DRN once the retina has already suffered irreversible damage. 

Wang and colleagues developed a machine learning algorithm called Pro-DRN using data from 1,218 participants in the Guangzhou Diabetic Eye Study, all of whom were diagnosed with type 2 diabetes but had not yet developed DRN at the time of enrollment. The AI model integrated proteomics data from blood samples with yearly retinal images collected over a six-year follow-up period. 

This led to the identification of 71 proteins associated with the development of DRN. Among them, the proteins most consistently driving accurate predictions were ACTA2, COL6A3, and HSPG2, which are key structural components involved in maintaining the integrity of the nerve and muscle tissue in the eyes. These results were then validated in an independent cohort of 502 patients from UK Biobank, where the core effects and protein signals were reproduced. 

Pro-DRN has been deployed as an interactive, web-based risk assessment tool that doctors can use to support early DRN screening and monitor patient evolution over time. Individuals identified as being at high risk of DRN could benefit from more frequent checkups and early interventions aimed at preventing or slowing down progressive neurodegeneration. 

Because DRN is one of the first symptoms of nerve degeneration induced by diabetes, early detection could also signal the onset of nerve injury elsewhere in the body. Such damage can contribute to cognitive impairment, dementia, and peripheral neuropathy, which can cause loss of sensation and motor control in the hands, feet, and other extremities. A single eye test could therefore provide valuable insights into the overall health of the nervous system. 

In addition, the proteins identified to be involved in DRN progression could be investigated as potential targets for the development of novel therapies. Furthermore, the AI-based tool could also prove valuable for the selection and stratification of participants in clinical trials evaluating neuroprotective strategies designed to prevent or delay nerve damage. 

“Pro-DRN may help move diabetic eye care from detecting established damage toward earlier, molecularly informed risk stratification, so that closer monitoring and future neuroprotective interventions can be directed to the people most likely to benefit,” Wang and colleagues write. 

The post AI-Powered Blood Test Detects Early Retinal Damage in Diabetes  appeared first on Inside Precision Medicine.

Disease Detection Gets Boost from Keck’s New Brain Reference Map

Investigators at the USC Mark and Mary Stevens Neuroimaging and Informatics Institute (Stevens INI) at the Keck School of Medicine say they have created one of the largest reference models ever developed for the human brain, using diffusion MRI scans from more than 54,000 people to chart how the brain’s communication pathways develop, mature, and decline across the lifespan.

Published in Nature Communications, the study “Lifespan normative modeling of brain microstructure” provides the equivalent of growth charts for the brain’s white matter, the vast network of neural wiring that allows brain regions to communicate, according to the Keck team, which adds that the novel tool offers researchers a new way to detect subtle patterns linked to aging, Alzheimer’s disease, schizophrenia risk, and other neurological and psychiatric conditions.

“Just as pediatric growth charts help clinicians determine whether a child’s height or weight is developing as expected, these brain charts provide a reference for how the brain’s neural pathways typically change over the lifespan,” said Julio E. Villalón-Reina, MD, PhD, a postdoctoral researcher at the Stevens INI and the study’s first author. “That gives us a powerful new way to identify when an individual’s brain wiring falls outside the expected range.”

To study white matter, the team used diffusion MRI, an imaging method that tracks how water moves through brain tissue. Because water movement is shaped by microscopic features such as nerve fibers and myelin, diffusion MRI can reveal subtle changes in tissue organization not visible on standard brain scans.

After compiling diffusion MRI data from 54,583 individuals across 19 international datasets, the researchers built statistical growth and decline charts for the brain’s neural pathways.

The researchers focused on four widely used measures of white matter microstructure across 21 major brain regions. By modeling how these measures vary by age and sex, they generated lifespan curves and percentile ranges that show what is typical at different stages of life.

Statistical charts compiled from a large population allow brain abnormalities to be detected in new individuals. [Stevens INI]
Statistical charts compiled from a large population allow brain abnormalities to be detected in new individuals. [Stevens INI]

The results revealed that white matter follows distinct developmental and aging trajectories, with some measures reaching peak maturity in early adulthood and others later in midlife.

“Brain development and brain aging are not uniform processes,” continued Villalón-Reina. “The brain’s neural pathways mature on distinct timelines, and some are more vulnerable to decline than others. Our model reveals this structure by merging data on a truly global scale.”

The scientists also discovered evidence for a longstanding theory of brain aging, sometimes described as last in, first out. According to this theory, brain pathways that develop last in childhood and adolescence tend to be more susceptible to decline in older age. The researchers observed that white matter regions that mature later did indeed decline faster in old age, offering new insight linking brain development and aging.

To demonstrate the model’s practical value, the researchers applied it to clinical datasets from people with mild cognitive impairment, dementia, and 22q11.2 deletion syndrome, a genetic condition that increases risk of schizophrenia.

In each case, the model identified alterations in the brain’s circuitry that deviated from age-expected norms. Importantly, these deviations were not identical across individuals with the same diagnosis, highlighting the value of a person-specific approach.

Paul M. Thompson, PhD, associate director of the Stevens INI and senior author of the study
Paul M. Thompson, PhD, associate director of the Stevens INI and senior author of the study

“This monumental study took seven years to complete,” explained Paul M. Thompson, PhD, associate director of the Stevens INI and senior author of the study. “The vast scale of the data and the fine scale of the brain features assessed means we can now evaluate your neural pathways relative to other people of the same age, sex, and demographics. We can see how your brain differs from what we would expect for a person of your age and sex, giving us a tool to use in clinical trials of treatments for dozens of brain diseases.”

When applied to people with dementia and mild cognitive impairment, the model detected atypical white matter patterns in brain regions involved in memory and interregional communication. In people with 22q11.2 deletion syndrome, it identified deviations in multiple key neural pathways, helping researchers discover which brain systems develop differently.

The reference charts may also help researchers evaluate treatments by tracking whether a person’s white matter measures move closer to the expected range, or whether a treatment slows the shift away from healthy patterns over time. The charts will now be used to compare more than 30 brain diseases and conditions, offering a common framework for studying how different disorders emerge, progress, and respond to intervention.

The models are also a publicly available resource that can be extended as additional brain imaging data become available. The methods are now being used to study neurological, psychiatric, and neurodevelopmental disorders by providing a common reference standard for white matter microstructure across the lifespan.

“This study demonstrates the power of large-scale, international data sharing to create tools the entire research community can use,” pointed out Arthur W. Toga, PhD, director of the Stevens INI and provost professor at USC. “By establishing a lifespan framework for the brain’s communication pathways, this work opens new opportunities to detect subtle disease-related changes, compare conditions more rigorously, and move toward a more individualized understanding of brain health.”

 

 

 

 

The post Disease Detection Gets Boost from Keck’s New Brain Reference Map appeared first on GEN – Genetic Engineering and Biotechnology News.

Mature Intestinal Cells Revert to Stem-Like State to Sustain Colorectal Cancer

Researchers at the Stevens Institute of Technology have identified a mechanism that helps explain how colorectal cancer (CRC) develops, persists, and resists treatment. The research, published in the journal Cell Death & Disease, shows that mature intestinal cells that revert to a stem cell-like state can sustain tumor growth more effectively than mutated intestinal stem cells, a finding that could inform new drug development strategies focused on preventing CRC recurrence.

“Our study suggests that intestinal cancers can arise not just from damaged stem cells, but also from cells that revert into stem-like cancer cells,” said senior author Ansu Perekatt, PhD, an assistant professor of chemistry and chemical biology at Stevens Institute of Technology, “and they may contribute to why colorectal cancer can be diverse and resistant to treatment.”

Colorectal cancer is the second leading cause of cancer-related death worldwide. Cancer stem cells are known to play a role in tumor growth, metastasis, treatment resistance, and relapse. The new study focused on understanding how these cancer-driving stem cell populations emerge within the intestinal epithelium.

Two different models have been proposed for how colorectal cancer can develop. The most widely held belief is the “bottom-up” model which suggests that mutations in stem cells initiate tumor formation. By comparison, the “top-down” model suggests that mature epithelial cells acquire mutations, dedifferentiate into stem-like cells, and then drive tumor growth. Histological features observed in many human colorectal tumors have suggested a luminal, or top-down, origin.

Under normal conditions, Lgr5-positive stem cells reside in intestinal crypts and their role is to replenish the intestinal lining. As their progeny migrate from the crypts toward the villi in the intestine walls, they stop dividing and become specialized mature cells. However, previous research has shown that the intestinal epithelium is highly plastic and that differentiated cells can regain stem cell characteristics under certain conditions.

To better understand the biology of these pathways, the Stevens employed mouse model carrying Smad4 loss-of-function and β-catenin gain-of-function mutations, to mimic two common drivers of human colorectal cancer. They then tracked the behavior of both stem cells and differentiated epithelial cells.

The researchers also performed single-cell RNA sequencing to characterize the cellular populations that emerged during tumor initiation and progression allowing them to compare mutant stem cells residing in the crypts with dedifferentiation-derived stem-like cells arising in the villi.

The data showed that mutant Lgr5-positive stem cells in the crypts were at a competitive disadvantage. While they carried cancer-associated mutations, many were displaced and ultimately replaced by normal stem cells. At the same time, a subset of progenitor and epithelial cells underwent dedifferentiation and reacquired stem-cell properties making them capable of sustaining tumor growth.

“We don’t know why they change and why only a subset changes,” Perekatt said. “It’s very random, very sporadic. But when they change, they develop tumors.”

According to the study, dedifferentiating epithelial cells showed early expression of both CD44 and Lgr5, markers associated with stemness and tumor initiation. The Stevens team also found abnormal activation of Notch signaling in villus epithelial cells before the formation of tumor-associated crypt structures, suggesting that this pathway may contribute to the acquisition of stem-like properties.

The dedifferentiation-derived cells showed growth-factor independence, which allows them to proliferate without relying on the supportive niche environment normally required by stem cells. They also exhibited metabolic adaptations associated with tumor survival.

The study also found evidence of stem-cell heterogeneity within tumors. Single-cell analysis identified populations with distinct proliferative, signaling, and metabolic states. One mutant stem-cell cluster exhibited cancer-associated and embryonic stem cell-like gene signatures, while other clusters appeared more quiescent.

“Our findings suggest that metabolic adaptations and dedifferentiation-driven stem cell heterogeneity may enhance adaptability and confer a selective advantage driving top-down tumorigenesis,” the researchers wrote.

The findings have implications for current and future treatment strategies. Many therapies focus on eliminating actively growing cancer cells, but the study suggests that stem-like cells generated through dedifferentiation may remain capable of regenerating tumors after treatment. Targeting the mechanisms that enable mature epithelial cells to revert to a stem-like state could prove an effective method for preventing cancer recurrence.

“If you are only treating the cells that become cancerous without targeting the cells that acquired the de novo stemness, the cancer will likely come back,” Perekatt said. “So it’s really important to understand what causes this reversion to stemness, in order to develop new and effective therapies for colorectal cancers.”

Future research will focus on unanswered questions raised by the study, including the source of the Notch signals that trigger dedifferentiation, the transcriptional programs activated during this process, and the metabolic vulnerabilities of the resulting stem-like tumor cells.

The post Mature Intestinal Cells Revert to Stem-Like State to Sustain Colorectal Cancer appeared first on Inside Precision Medicine.