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Substance use disorders (SUD) are common in adolescents and young adults, though few youth with SUD receive treatment, and rates of medication for substance use disorder treatment are much lower in youth compared to adults. Pediatric primary care could present an opportunity for youth with SUD to access medication, though pediatric providers may need support. Massachusetts has provided a substance use consultation line for pediatric providers since 2018. One large network of independent primary care practices within the state has been further supported by access to resources provided through a grant from the Substance Abuse and Mental Health Services Administration. In this paper, we describe the services provided in Massachusetts and examine whether additional resources are associated with increased use of the consultation line as a marker of provider engagement in SUD treatment.

Abstract Background Wearable-generated data yield objective information on physical activity and sleep variables, which, are in turn, related to the phenomenology of depression. There is a dearth of wearable-generated data regarding physical activity and sleep variables among youth with clinical depression. Methods Longitudinal (up to 24 months) quarterly collections of wearable-generated variables among adolescents diagnosed with current/past major depression. Latent class analysis was employed to classify participants on the basis of wearable-generated: Activity, Sleep Duration, and Sleep efficiency. The Patient Health Questionnaire adapted for adolescents (PHQ-9-A), and the Ruminative Response Scale (RRS) at study intake were employed to predict class membership. Results Seventy-two adolescents (72.5% girls) were recruited over 31 months. Activity, Sleep Duration, and Sleep efficiency were reciprocally correlated, and wearable-generated data were reducible into a finite number (3 to 4) of classes of individuals. A PHQ-A score in the clinical range (14 and above) at study intake predicted a class of low physical activity (Acceleration) and a class of shorter Sleep Duration. Limitations Limited power related to the sample size and the interim nature of this study. Conclusions This study of wearable-generated variables among adolescents diagnosed with clinical depression shows that a large amount of longitudinal data is amenable to reduction into a finite number of classes of individuals. Interfacing wearable-generated data with clinical measures can yield insights on the relationships between objective psychobiological measures and symptoms of adolescent depression, and may improve clinical management of depression.

Livestock agriculture must change to meet demand for food production while building soil, reducing flooding, retaining nutrients, enhancing biodiversity, and supporting thriving communities. Technological innovations, including those in digital and precision agriculture, are unlikely by themselves to create the magnitude and directionality of transformation of livestock production systems that are needed. We begin by comparing technological, ecological and social innovations in feedlot-finished and pasture-finished cattle production and propose that what is required is a more integrative ‘agroecological innovation’ process that intentionally weaves these three forms of innovation to transition livestock agriculture to be genuinely regenerative and multifunctional. This integrated system emphasizes social innovations as essential components of the innovation system because of their capacity to address and influence the social context into which technological and ecological innovations occur. In particular, regional place-making can be especially useful as an interactive process of designing regional identities as people engage with one another and their environments to define landscape futures and the related social standards that normalize particular land management practices. Intentionally developing innovations can help communities engage in relational place-making processes to define desired outcomes for agricultural landscapes and develop ways to collaborate towards achieving them, including the creation of novel supply chains that support regenerative livestock systems. As social norms evolve through place-making they influence individual behaviors and agricultural practices on the ground and offer a pathway for more rapid scaling of regenerative practices in livestock agriculture. Regional place-making also can influence the ‘meta’ context of agricultural systems by engaging with public and private institutions responsible for management of natural resources, food systems, and the public good, further accelerating the scaling process. Emerging agroecological innovation systems for livestock agriculture must be designed and governed in ways that ensure responsible and diverse outcomes compatible with their social and ecological contexts, and with management approaches and technologies consistent with the values and goals of communities in a region.

Abstract Background To co‐ordinate a multidisciplinary team in the delivery of guideline recommendations using a measurement‐based care framework, our group previously developed a care pathway for the treatment of depression in adolescents. Core components of the pathway were: assessment, education, cognitive‐behavioural therapy, a caregiver intervention group, a medication algorithm, and monthly measurement‐based care “team reviews” with the adolescent present. The aim of this study was to test the feasibility of conducting a controlled clinical trial of the pathway. Method We conducted a 20‐week pilot controlled clinical trial of the care pathway relative to treatment as usual. Participants were adolescents (age 14–18) with a primary diagnosis of Major Depressive Disorder recruited from one of two outpatient psychiatric clinics at academic hospitals. Site of presentation was the method of allocation. Thirty‐five youth were allocated to the pathway and 31 were allocated to treatment as usual. As this is a pilot study, trial feasibility outcomes were of primary interest, including clinician fidelity to the care pathway. Results Our target sample size was recruited over a 15‐month time interval. Clinician fidelity and adolescent engagement in the care pathway components on a priori checklists were high (95% and 80%, respectively). We collected baseline and 20‐week endpoint data for our primary outcome of the Children's Depression Rating Scale – Revised (CDRS‐R) for 83% of the sample. On linear mixed effects modelling, we observed a linear decrease in CDRS‐R across 4‐week intervals up to the 20‐week endpoint in both groups (β = −2.07; 95% CI −3.14 to −1.01). Conclusion A controlled clinical trial of a complex, multi‐component intervention for the treatment of depression in adolescents is feasible. Given the need to find optimal strategies to deliver effective care for adolescents with depression, a definitive randomized controlled trial of the pathway is warranted. Trial is registered at Clinicaltrials.gov: NCT03428555

Anxiety disorders (AD) are the most common mental conditions affecting an estimated 40 million adults in the United States. Amiloride, a diuretic agent, has shown efficacy in reducing anxious responses in preclinical models by inhibiting the acid-sensing ion channels (ASIC). By delivering amiloride via nasal route, rapid onset of action can be achieved due to direct "nose-to-brain" access. Therefore, this study reports the formulation, physical, chemical, and microbiological stability of an extemporaneously prepared amiloride 2 mg/mL nasal spray. The amiloride nasal spray was prepared by adding 100 mg of amiloride hydrochloride to 50 mL of sterile water for injection in a sterile reagent bottle. A stability-indicating high-performance liquid chromatography (HPLC) method was developed and validated. Forced-degradation studies were performed to confirm the ability of the HPLC method to identify the degradation products from amiloride distinctively. The physical stability of the amiloride nasal spray was assessed by pH, clarity, and viscosity assessments. For chemical stability studies, samples of nasal sprays stored at room temperature were collected at time-points 0, 3 hr., 24 hr., and 7 days and were assayed in triplicate using the stability-indicating HPLC method. Microbiological stability of the nasal spray solution was evaluated for up to 7 days based on the sterility test outlined in United States Pharmacopoeia (USP) chapter 71. The stability-indicating HPLC method identified the degradation products of amiloride without interference from amiloride. All tested solutions retained over 90% of the initial amiloride concentration for the 7-day study period. There were no changes in color, pH, and viscosity in any sample. The nasal spray solutions were sterile for up to 7 days in all samples tested. An extemporaneously prepared nasal spray solution of amiloride hydrochloride (2 mg/mL) was physically, chemically, and microbiologically stable for 7 days when stored at room temperature.

Abstract Objective The purpose of this paper is to extend a previous study by evaluating the use of a speech recognition software in a clinical psychiatry milieu. Physicians (n = 55) at a psychiatric hospital participated in a limited implementation and were provided with training, licenses, and relevant devices. Post-implementation usage data was collected via the software. Additionally, a post-implementation survey was distributed 5 months after the technology was introduced. Results In the first month, 45 out of 51 (88%) physicians were active users of the technology; however, after the full evaluation period only 53% were still active. The average active user minutes and the average active user lines dictated per month remained consistent throughout the evaluation. The use of speech recognition software within a psychiatric setting is of value to some physicians. Our results indicate a post-implementation reduction in adoption, with stable usage for physicians who remained active users. Future studies to identify characteristics of users and/or technology that contribute to ongoing use would be of value.

Theory of mind-the ability to decode and reason about others' mental states-is a universal human skill and forms the basis of social cognition. Theory of mind accuracy is impaired in clinical conditions evidencing social impairment, including major depressive disorder. The current study is a preliminary investigation of the association of polymorphisms of the serotonin transporter (SLC6A4), dopamine transporter (DAT1), dopamine receptor D4 (DRD4), and catechol-O-methyl transferase (COMT) genes with theory of mind decoding in a sample of adults with major depression. Ninety-six young adults (38 depressed, 58 non-depressed) completed the 'Reading the Mind in the Eyes task' and a non-mentalistic control task. Genetic associations were only found for the depressed group. Specifically, superior accuracy in decoding mental states of a positive valence was seen in those homozygous for the long allele of the serotonin transporter gene, 9-allele carriers of DAT1, and long-allele carriers of DRD4. In contrast, superior accuracy in decoding mental states of a negative valence was seen in short-allele carriers of the serotonin transporter gene and 10/10 homozygotes of DAT1. Results are discussed in terms of their implications for integrating social cognitive and neurobiological models of etiology in major depression.