Recovery Progress Research Articles

Revision Reverse Total Shoulder Arthroplasty Using an Augmented Glenoid Baseplate: A Review of Current Glenoid Baseplate Options and a Case Report

Introduction: Total and hemi-shoulder arthroplasty have proved to be a safe and effective option for patients with symptomatic osteoarthritis. In some cases, glenoid implant failures or erosion can lead to acquired glenoid bone loss, complicating potential revision surgery. This paper presents a review of glenoid implant options for total shoulder arthroplasty and a case study which discusses a new augmented reverse baseplate for the revision of a failed hemi-shoulder arthroplasty. The patient was fully informed and gave written consent to submit the details of this case for publication in a peer-reviewed journal. Case Description: An 80-year-old retired professor with a prior history of right shoulder hemiarthroplasty presented with worsening right shoulder pain. She failed conservative care and wanted a conversion to a reverse total shoulder arthroplasty. The erosion on the patient's glenoid was severe enough for the surgeon to elect for the use of a metal augmented baseplate to fill the acquired defect and correct version and inclination. After an uneventful postoperative and recovery progression, at her one-year follow-up visit, she was pain-free and active, with significant improvements in her visual analogue scale (VAS) score, American Shoulder and Elbow Surgeons (ASES) score, and active range of motion (ROM). Discussion: The advent of metal augmentation with advanced glenoid preparation instruments allows shoulder specialists the ability to address implant-associated acquired glenoid bone loss and soft tissue deficiencies with ease and confidence and reduce additional clinical challenges.

Still in there—citizens’ well-being and PTSD after Seoul Halloween crowd crush in Korea: a cross-sectional study

The October 29, 2022, Seoul Halloween Crowd Crush (SHCC) caused the loss of 159 lives, making it the deadliest global mass-gathering disaster between 2018 and 2022. Despite the fact that years have passed since the incident, there remains a significant gap in research addressing the mental health of citizens to evaluate their recovery progress. Therefore, in this study, a survey was conducted to assess citizens’ anxiety, depression, post-traumatic stress disorder (PTSD), and well-being after the SHCC. The data were analyzed using t-tests, analysis of variance (ANOVA), correlations, a Kruskal–Wallis test, and post hoc tests. The citizens' well-being differed significantly by victimization status, with direct victims showing languishing well-being (p = .036). PTSD severity level was higher in victims and direct witnesses (p < .001). Victims and direct witnesses exhibited worse outcomes in subjective, social, and psychological well-being as well as in PTSD (p < .001). Well-being exhibited a significant negative correlation with PTSD (r = − .247, p < .001). The results of the analysis suggest the SHCC’s psychological impact has endured not only for victims and direct witnesses but also for media-exposed citizens. Offering continuous psychological support and fostering positive self-perceptions and social interactions are crucial for their recovery and well-being enhancement.

An All-in-One Array of Pressure Sensors and sEMG Electrodes for Scoliosis Monitoring.

Scoliosis often occurs in adolescents and seriously affects physical development and health. Traditionally, medical imaging is the most common means of evaluating the corrective effect of bracing during treatment. However, the imaging approach falls short in providing real-time feedback, and the optimal corrective force remains unclear, potentially slowing the patient's recovery progress. To tackle these challenges, an all-in-one integrated array of pressure sensors and sEMG electrodes based on hierarchical MXene/chitosan/polydimethylsiloxane (PDMS)/polyurethane sponge and MXene/polyimide (PI) is developed. Benefiting from the microstructured electrodes and the modulus enhancement of PDMS, the sensor demonstrates a high sensitivity of 444.3 kPa-1 and a broad linear detection range (up to 81.6kPa). With the help of electrostatic attraction of chitosan and interface locking of PDMS, the pressure sensor achieves remarkable stability of over 100000 cycles. Simultaneously, the sEMG electrodes offer exceptional stretchability and flexibility, functioning effectively at 60% strain, which ensures precise signal capture for various human motions. After integrating the developed all-in-one arrays into a commercial scoliosis brace, the system can accurately categorize human motion and predict Cobb angles aided by deep learning. This study provides real-time insights into brace effectiveness and patient progress, offering new ideas for improving the efficiency of scoliosis treatment.

Wearable-Based Kinematic Analysis of Upper-Limb Movements During Daily Activities Could Provide Insights into Stroke Survivors’ Motor Ability

Background Frequent and objective monitoring of motor recovery progression holds significant importance in stroke rehabilitation. Despite extensive studies on wearable solutions in this context, the focus has been predominantly on evaluating limb activity. This study aims to address this limitation by delving into a novel measure of wrist kinematics more intricately related to patients’ motor capacity. Objective To explore a new wearable-based approach for objectively and reliably assessing upper-limb motor ability in stroke survivors using a single inertial sensor placed on the stroke-affected wrist. Methods Seventeen stroke survivors performed a series of daily activities within a simulated home setting while wearing a six-axis inertial measurement unit on the wrist affected by stroke. Inertial data during point-to-point upper-limb movements were decomposed into movement segments, from which various kinematic variables were derived. A data-driven approach was then employed to identify a kinematic variable demonstrating robust internal reliability, construct validity, and convergent validity. Results We have identified a key kinematic variable, namely the 90th percentile of movement segment distance during point-to-point movements. This variable exhibited robust reliability (intra-class correlation coefficient of .93) and strong correlations with established clinical measures of motor capacity (Pearson’s correlation coefficients of .81 with the Fugl-Meyer Assessment for Upper-Extremity; .77 with the Functional Ability component of the Wolf Motor Function Test; and −.68 with the Performance Time component of the Wolf Motor Function Test). Conclusions The findings underscore the potential for continuous, objective, and convenient monitoring of stroke survivors’ motor progression throughout rehabilitation.

Physical Activity and Epigenetic Aging in Breast Cancer Treatment.

Biological age, reflecting the cumulative damage in the body over a lifespan, is a dynamic measure more indicative of individual health than chronological age. Accelerated aging, when biological age surpasses chronological age, is implicated in poorer clinical outcomes, especially for breast cancer (BC) survivors undergoing treatments. This preliminary study investigates the impact of a 16-week online supervised physical activity (PA) intervention on biological age in post-surgery female BC patients. Telomere length was measured using qPCR, and the ELOVL2-based epigenetic clock was assessed via DNA methylation pyrosequencing of the ELOVL2 promoter region. Telomere length remained unchanged, but the ELOVL2 epigenetic clock indicated a significant decrease in biological age in the PA group, suggesting the potential of PA interventions to reverse accelerated aging processes in BC survivors. The exercise group showed improved cardiovascular fitness, highlighting PA's health impact. Finally, the reduction in biological age, as measured by the ELOVL2 epigenetic clock, was significantly associated with improvements in cardiovascular fitness and handgrip strength, supporting improved recovery. Epigenetic clocks can potentially assess health status and recovery progress in BC patients, identifying at-risk individuals in clinical practice. This study provides potential and valuable insights into how PA benefits BC survivors' health, supporting the immediate benefits of a 16-week exercise intervention in mitigating accelerated aging. The findings could suggest a holistic approach to improving the health and recovery of post-surgery BC patients.

Application of biomechanics in sports rehabilitation

The application of biomechanical methods and techniques in rehabilitation treatment has been explored to deepen understanding of the health recovery of injured athletes, thereby improving their efficacy and quality. There are various methods for using biomechanics, which can help people understand the patient’s movement characteristics and mechanical changes, evaluate the patient’s recovery progress, and optimize the plan. Therefore, this article mainly conducted research and analysis on the application of biomechanics in sports rehabilitation, and explained the specific role of biomechanics in it by comparing before and after sports rehabilitation in different situations. The results showed that after treatment with biomechanical methods, the patient’s muscle strength increased by 9.4%–20.93% compared to the original, and the power value increased by 0.8–4.56 watts. The effect was good for achieving 71.28% muscle activity, and there was also a significant improvement in its sports mechanics indicators. After receiving biomechanical treatment, the quality of motor skills in patients was over 60%, which showed significant improvement compared to before treatment. Therefore, when conducting sports rehabilitation, biomechanical treatment plans should be used to achieve better therapeutic effects.

Establishing a Cutoff Score for the Healing after Gender-based Violence Scale (GBV-Heal): A Brief Report

Abstract Purpose To evaluate a cutoff score for the Healing after Gender-based Violence Scale (GBV-Heal)—an instrument to assess recovery progress for survivors of GBV. Methods We surveyed 321 women-identifying GBV survivors living in the Midwestern United States from April to December 2022 to evaluate their mental health symptom burden, trauma coping self-efficacy, sense of meaning, healing progress, and recovery stage. We used Receiver Operating Characteristic (ROC) analysis to determine the best cutoff score for the GBV-Heal. Results We found a cutoff point of 64 for the GBV-Heal. Those above this cutoff point were found to have significantly lower PTSD and depression symptoms and significantly higher trauma coping self-efficacy and sense of meaning compared to those below the cutoff point. Conclusions The GBV-Heal cutoff score can help practitioners recognize survivors needing additional support or resources as they navigate their healing journey. The use of this scale can promote tailored care for survivors seeking healing support in a variety of public health sectors.

Phased post-disaster recovery challenges: 2016–2017 floods and landslides in Colombo and Kalutara, Sri Lanka

This paper aims to understand the challenges arising in individual post-disaster recovery (PDR) phases and how they contribute to overall recovery progress. It further investigates the transition of recovery from one phase to the subsequent phases of PDR. The 2016 and 2017 floods and landslides in Sri Lanka were used as the case study focusing on the two affected districts, Colombo and Kalutara. An in-depth study was conducted to explore the PDR phases from response to long-term reconstruction and development following the disaster events.A mixed methods approach was adopted where, under a qualitative approach, twenty-two semi-structured interviews with disaster management stakeholders were conducted. Moreover, on quantitative analysis, a survey questionnaire was conducted. The case study field data was supplemented with an extensive document review.The study found several factors in different PDR phases hindering long-term recovery. They include: a lack of communication and coordination mechanisms among key stakeholders in the response phase, and limited capacity and resources of local authorities in the rehabilitation phase. The challenges in recovery and long-term reconstruction and development phases were to disaster governance, collection and management of data and information, and low level of inter-agency collaboration. Some factors were recurring and continually hindered the PDR process and had a larger impact in Kalutara than in the Colombo district. Regarding the transition of recovery, there was only one transition from response and rehabilitation to the recovery phase occurred. No evidence was found for the second recovery transition from recovery to the long-term reconstruction and development phase.These findings will assist in planning future post-disaster recoveries in the region to ensure issues are anticipated, and proper planning is done ahead of time. The goal is to tackle the issues impeding long-term recovery in each PDR phase to allow a smooth and successful transition into the long-term phase.The findings of this research make an original contribution to the limited scholarship on the implications of individual PDR phases on long-term recovery.

Green finance as a driver for environmental and economic resilience post-COVID-19: A focus on China's strategy

This study investigates the critical role of green finance in enhancing environmental and economic resilience during China's post-COVID-19 recovery. Employing sophisticated econometric techniques, including the Vector Error Correction Model (VECM) and Nonlinear Autoregressive Distributed Lag (NARDL) model, the effectiveness of green finance policies and instruments is rigorously assessed during the years 1986–2022. The findings reveal that green finance initiatives significantly fund sustainable projects and drive economic revitalization, marking substantial progress in China's eco-friendly recovery. Essential areas for improvement identified include robust policy support, technological innovation, and stronger international collaboration. Specifically, leveraging green finance effectively necessitates coordinated efforts across various sectors, ensuring it underpins China's sustainable development and resilience amid global economic challenges. The study recommends enhancing green finance mechanisms through comprehensive policy frameworks, fostering green technology innovation, and developing global partnerships to address environmental sustainability and economic recovery synergistically.

A new metric for conducting 5‐year reviews to evaluate recovery progress under the Endangered Species Act

AbstractThe Endangered Species Act (ESA) provides legal protection to imperiled populations and their associated habitats. As a part of this process, listed species must undergo a general status review (also called 5‐Year Review) to assess the progress toward recovery every 5 years. However, almost all 5‐year reviews result in a status of “no change,” prompting scientists to question if the review process is robust enough to detect changes in recovery. The U.S. Fish and Wildlife Service (USFWS) was therefore interested in developing a standardized metric for monitoring more nuanced recovery progress as part of the status review. In collaboration with the USFWS, over 75 biologists from five different organizations developed and tested a set of novel metrics to summarize recovery progress of listed species by considering current and future conditions, threats, and conservation measures. We found that, although the majority of species had reviews with a recommendation of no change, scorers were able to use the metrics to interpret more nuanced changes in the 3Rs (resiliency, redundancy, and representation), threats, and conservation measures than in the status review. Our results suggest that these metrics could illuminate more nuanced areas of recovery and decline in species' conditions, but consistency among scorers and status reports should be a focus of future development. Our approach offers a rigorous set of metrics to systematically track the recovery progress of all ESA species.

An Observational Study of a Digital Substance Use and Recovery Program.

Digital substance use treatment programs present an opportunity to provide nonresidential care for people with problematic substance use. In June 2021, the provincial government in Ontario provided free access to Breaking Free Online (BFO), a digital behavioral change program for people with substance use disorders. An observational study was conducted with retrospective data to characterize clients' use and engagement patterns in BFO and examine changes in self-reported outcomes. In total, 6,370 individuals registered for BFO between June 2021 and October 2022, of whom 3,650 completed the intake assessment. Most of these clients were self-referred (64%), with 37% having been referred by health service providers. More than one-half of the clients (52%) resided in Ontario West or East regions. Support for addressing problematic alcohol use was the most requested program (40%). By October 2022, about 44% of the clients had completed between one and four of 12 program strategies. Analysis revealed significant changes in pre-post scores across four validated scales (p<0.001), indicating a decrease in anxiety and depression, an increase in quality of life, an improvement in recovery progression, and a decrease in severity of symptoms associated with substance use disorders. BFO clients with higher completion rates had the most improvement across the scales used; however, clients with lower and medium completion rates also had improvements. Because of the shame and stigma associated with substance use, digital supports with low barriers to entry can help support the autonomy, privacy, and preferences of individuals seeking help for problematic substance use.

Adolescents' Participation in Drug Addiction Interventions, Individual Perceptions, and Attitudes towards Recovery: A Scoping Review

Introduction: Adolescents recovering from substance use problems face significant psycho-social challenges. These challenges can affect their recovery progress, overall well-being, and integration into the society. Due to paucity studies, this study aimed to identify the perceptions and attitude towards recovery among adolescents participating in drug addiction interventions. Methods: This systematic review study applied a complete search of relevant databases, including Scopus, Embase, Cinahl, and PubMed/Medline using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search was limited to articles published in English language, between 2013 and 2023, and focused on adolescents drug addiction. Twelve articles were critically appraised using Critical Appraisal Skills Programme (CASP) for qualitative studies and Joanna Briggs Institute (JBI) tools. The results were synthesised using a thematic analysis. Results: The findings identify that adolescents in addiction recovery face several challenges, including stigmatisation, social isolation, self-doubt, and difficulties accessing and maintaining treatment. The findings also point out that supportive relationships, culturally sensitive treatment approaches and interventions to combat self-stigma can play a critical role in promoting resilience and recovery for adolescents in recovery. Conclusion: The comprehensive review brings us up to speed on the challenging experiences young people recovering from addiction in different addiction intervention go through, it underscores the importance of supportive relationships and encourages strengthening of interventions that mitigate against stigmatization.

Optimization of rare earth magnet recovery processes using oxalic acid in precipitation stripping: Insights from experimental investigation and statistical analysis

Recycling the valuable metals found in spent permanent magnets (REPMs) poses a significant global challenge for the future. This study examines the efficiency of back extraction of rare earth elements (REEs) by oxalic acid solution from di-(2-ethylhexyl) phosphoric acid (D2EHPA) in recycling REPMs. To evaluate the efficiency of this process, several experiments were carried out using designed BOX-Behnken methodology to investigate the effects of various operational and chemical parameters, including stripping solution to loaded organic phase volume ratio (in the range of 1.0–2.0), oxalic acid concentration (ranging from 0.25 to 0.75 M), the stirring rate (ranged between 150 and 350 rpm), and stripping time (ranging from 15 to 45 min) on the REEs recovery and the purity of final production. Analysis of variance was applied to rigorously examine the results statistically. The results showed that more than 85 % of light and 80 % of heavy REEs can be recovered under optimal conditions. Moreover, the final product contained 43.5 % REEs and approximately 0.1 % iron. The stripping experiment using phosphoric acid as the reagent demonstrated ∼57 % light and ∼4 % heavy REEs recovery. Additionally, the recyclability of the organic phase showed its effective reuse for up to four cycles. This study underscores significant progress in the selective recovery of rare earth elements through a relatively straightforward process consuming mild reagents.

Galectin-8 counteracts folic acid-induced acute kidney injury and prevents its transition to fibrosis

Acute kidney injury (AKI), characterized by a sudden decline in kidney function involving tubular damage and epithelial cell death, can lead to progressive tissue fibrosis and chronic kidney disease due to interstitial fibroblast activation and tissue repair failures that lack direct treatments. After an AKI episode, surviving renal tubular cells undergo cycles of dedifferentiation, proliferation and redifferentiation while fibroblast activity increases and then declines to avoid an exaggerated extracellular matrix deposition. Appropriate tissue recovery versus pathogenic fibrotic progression depends on fine-tuning all these processes. Identifying endogenous factors able to affect any of them may offer new therapeutic opportunities to improve AKI outcomes. Galectin-8 (Gal-8) is an endogenous carbohydrate-binding protein that is secreted through an unconventional mechanism, binds to glycosylated proteins at the cell surface and modifies various cellular activities, including cell proliferation and survival against stress conditions. Here, using a mouse model of AKI induced by folic acid, we show that pre-treatment with Gal-8 protects against cell death, promotes epithelial cell redifferentiation and improves renal function. In addition, Gal-8 decreases fibroblast activation, resulting in less expression of fibrotic genes. Gal-8 added after AKI induction is also effective in maintaining renal function against damage, improving epithelial cell survival. The ability to protect kidneys from injury during both pre- and post-treatments, coupled with its anti-fibrotic effect, highlights Gal-8 as an endogenous factor to be considered in therapeutic strategies aimed at improving renal function and mitigating chronic pathogenic progression.

Reassembly of ground-dwelling ant communities in reforestation plots in SW Costa Rica

Due to agriculture and logging, Costa Rica has lost many primary forests, making reforestation an important task. To judge the progress of reforestation, it is important to follow the reassembly of organismal communities within restored habitats. The COBIGA project near La Gamba, in the Golfo Dulce region of Costa Rica, aims at reforestation of lowland sites with native tree species. Ants, as ubiquitous and highly abundant terrestrial organisms, have a substantial influence on tropical ecosystems. The multiple roles include scavenging, predation, herbivory, and mutualistic interactions. We examined ant community responses to reveal the status of community regeneration and functional integrity. We compared the composition and diversity of the ant assemblages at three different age reforestation sites (2, 8, and 10 years old) with those at an old-growth forest as a reference site. By offering canned tuna fish at ground level along replicated transects, we observed 43 ant species representing six functional groups during the 2 months of sampling. Most of the observed ant species were omnivorous, but old-growth forests harbored a substantial number of other functional groups, such as generalized predators, arboreal predators, and arboreal omnivores. In contrast, the youngest reforestation site harbored a severely impoverished ant assemblage comprising mostly generalized polygynous and polydomous ant species from lower trophic levels. The within-site heterogeneity of the ant assemblages increased from the youngest to the oldest forest. In addition, our results show the importance of monitoring the progress of forest recovery to avoid the spread of invasive species into primary habitats.

Recovery of the baroreflex and autonomic modulation after anesthesia with MS-222 in bullfrogs

The time course for recovery after anesthesia is poorly described for tricaine methanesulfonate (MS-222). We suggest that the baroreflex and the heart rate variability (HRV) could be used to index the recovery of the autonomic modulation after anesthesia. We analyzed the recovery profile of behavioral and physiological parameters over time to analyze the progression of recovery after anesthesia of American bullfrogs with MS-222. Mean heart rate stabilized after 17 h, whereas the baroreflex efficiency index took 23 h and the baroreflex operating gain, 29 h. Mean arterial pressure recovered after 26 h. Power spectral density peaked at 23 h and again after 40 h. Baroreflex was a relevant component of the first phase of HRV, while autonomic modulation for resting may take longer than 40 h. We suggest that physiological recovery is a complex phenomenon with multiple progressive phases, and the baroreflex may be a useful tool to observe the first substantial recovery of post-instrumentation capacity for autonomic modulation.

The Role of Family Dynamics and Social Support in Substance Use Recovery within the Naga Society

While previous researchers have explored the impact of family and social support networks in the process of substance use recovery, there is a lack of research on the same for the Naga Community from North-East, India. A sample of 150 participants aged 18-35 from the Naga Community of Nagaland currently in the process of substance use recovery was surveyed. Data was collected through self-report measures including FACES III - Family Version Scale to assess the family dynamics, the Social Support Questionnaire (SSQ6) to assess an individual’s perceived social support, the Substance Use Recovery Evaluator Scale (SURE) to assess the individual’s progress in substance use recovery. The study revealed a statistically significant correlation between substance use recovery and the family cohesion aspect of family dynamics, as well as between substance use recovery and social support. However, no correlation significant correlation was found between substance use recovery and the family adaptability aspect of family dynamics. The significant correlation observed between Substance Use Recovery and family cohesion indicates that strong family support and unity positively influence an individual’s ability to overcome substance use and addiction. Similarly, the association between Substance Use Recovery and Social Support emphasizes the role of social networks in helping individuals overcome their addiction. These results contribute to a deeper understanding of how family dynamics and social support have an impact on the recovery process of individuals dealing with substance use.

The role of leaf superoxide dismutase and proline on intra-specific photosynthesis recovery of Schima superba following drought

Understanding the physiological and biochemical responses of tree seedlings under extreme drought stress, along with recovery during rewatering, and potential intra-species differences, will allow us to more accurately predict forest responses under future climate change. Here, we selected seedlings from four provenances (AH (Anhui), JX (Jiangxi), HN (Hunan) and GX (Guangxi)) of Schima superba and carried out a simulated drought-rewatering experiment in a field-based rain-out shelter. Seedlings were progressively dried until they reached 50% and 88% loss of xylem hydraulic conductivity (PLC) (i.e. P50 and P88), respectively, before they were rehydrated and maintained at field capacity for 30 days. Leaf photosynthesis (Asat), water status, activity of superoxide dismutase (SOD), and proline (Pro) concentration were monitored and their associations were determined. Increasing drought significantly reduced Asat, relative water content (RWC) and SOD activity in all provenances, and Pro concentration was increased to improve water retention; all four provenances exhibited similar response patterns, associated with similar leaf ultrastructure at pre-drought. Upon rewatering, physiological and biochemical traits were restored to well-watered control values in P50-stressed seedlings. In P88-stressed seedlings, Pro was restored to control values, while SOD was not fully recovered. The recovery pattern differed partially among provenances. There was a progression of recovery following watering, with RWC firstly recovered, followed by SOD and Pro, and then Asat, but with significant associations among these traits. Collectively, the intra-specific differences of S. superba seedlings in recovery of physiology and biochemistry following rewatering highlight the need to consider variations within a given tree species coping with future more frequent drought stress.

Contributing to 'a sense of purpose' - Evaluating consumer recovery progress after attending a therapeutic-recreation intervention programme: A quantitative analysis.

The recommended objective for mental health plans and policies is the adoption of recovery approaches to mental healthcare. Mental health recovery is no longer defined by symptom resolution but as a journey towards a meaningful life from the consumer's own perspective. Recovery approaches focus on consumers' strengths, feelings of well-being and the achievement of personal goals. Designing recovery-oriented interventions is crucial for supporting people in their personal recovery journey. This study sought to evaluate how attending a recovery-oriented intervention impacts the recovery of attending people living with serious mental illness. A quasi-experimental approach was utilised to examine changes in self-reported recovery progress in a purposive sample of consumers living with enduring mental illness (N = 105). Recovery progress was evaluated via the Recovery Assessment Scale - Domains and Stages (RAS-DS). Data were collected at entry and exit to a therapeutic recreation programme grounded in principles of recovery-oriented care and social contact theory. Pre-post scores were analysed via a repeated-measures multivariate analysis of variance (RM-MANOVA) per the four RAS-DS recovery domains. After attending the therapeutic recreation programme, consumer recovery scores significantly increased in the functional, personal, and social recovery RAS-DS domains as measured by 'Doing Things I Value', 'Looking Forward', and 'Connecting and Belonging' (respectively). No changes were observed to consumers' clinical recovery progress, as assessed via the recovery domain 'Mastering my Illness'. The results of this study demonstrate that therapeutic recreation camps can provide a recovery-based approach to mental healthcare, with positive effects on the three areas of: a purposeful life; connection and belonging; and optimism and hope. Recovery Camp has been previously identified by the Productivity Commission as having potential person-centred recovery benefits for mental health consumers. The results of this study now establish these benefits as evidence based and can be used to guide mental health practice and policy for the implementation of therapeutic recreation camps for mental health recovery.

Development and Evaluation of a Digital App for Patient Self-Management of Opioid Use Disorder: Usability, Acceptability, and Utility Study.

Self-management of opioid use disorder (OUD) is an important component of treatment. Many patients receiving opioid agonist treatment in methadone maintenance treatment settings benefit from counseling treatments to help them improve their recovery skills but have insufficient access to these treatments between clinic appointments. In addition, many addiction medicine clinicians treating patients with OUD in a general medical clinic setting do not have consistent access to counseling referrals for their patients. This can lead to decreases in both treatment retention and overall progress in the patient's recovery from substance misuse. Digital apps may help to bridge this gap by coaching, supporting, and reinforcing behavioral change that is initiated and directed by their psychosocial and medical providers. This study aimed to conduct an acceptability, usability, and utility pilot study of the KIOS app to address these clinical needs. We developed a unique, patient-centered computational software system (KIOS; Biomedical Development Corporation) to assist in managing OUD in an outpatient, methadone maintenance clinic setting. KIOS tracks interacting self-reported symptoms (craving, depressed mood, anxiety, irritability, pain, agitation or restlessness, difficulty sleeping, absenteeism, difficulty with usual activities, and conflicts with others) to determine changes in both the trajectory and severity of symptom patterns over time. KIOS then applies a proprietary algorithm to assess the individual's patterns of symptom interaction in accordance with models previously established by OUD experts. After this analysis, KIOS provides specific behavioral advice addressing the individual's changing trajectory of symptoms to help the person self-manage their symptoms. The KIOS software also provides analytics on the self-reported data that can be used by patients, clinicians, and researchers to track outcomes. In a 4-week acceptability, usability (mean System Usability Scale-Modified score 89.5, SD 9.2, maximum of 10.0), and utility (mean KIOS utility questionnaire score 6.32, SD 0.25, maximum of 7.0) pilot study of 15 methadone-maintained participants with OUD, user experience, usability, and software-generated advice received high and positive assessment scores. The KIOS clinical variables closely correlated with craving self-report measures. Therefore, managing these variables with advice generated by the KIOS software could have an impact on craving and ultimately substance use. KIOS tracks key clinical variables and generates advice specifically relevant to the patient's current and changing clinical state. Patients in this pilot study assigned high positive values to the KIOS user experience, ease of use, and the appropriateness, relevance, and usefulness of the specific behavioral guidance they received to match their evolving experiences. KIOS may therefore be useful to augment in-person treatment of opioid agonist patients and help fill treatment gaps that currently exist in the continuum of care. A National Institute on Drug Abuse-funded randomized controlled trial of KIOS to augment in-person treatment of patients with OUD is currently being conducted.