An adaptive design to screen, treat, and retain people with opioid use disorders who use methamphetamine in methadone clinics (STAR-OM): study protocol of a clinical trial.

BACKGROUND: Methamphetamine use could jeopardize the current efforts to address opioid use disorder and HIV infection. Evidence-based behavioral interventions (EBI) are effective in reducing methamphetamine use. However, evidence on optimal combinations of EBI is limited. This protocol presents a type-1 effectiveness-implementation hybrid design to evaluate the effectiveness, cost-effectiveness of adaptive methamphetamine use interventions, and their implementation barriers in Vietnam. METHOD: Design: Participants will be first randomized into two frontline interventions for 12 weeks. They will then be placed or randomized to three adaptive strategies for another 12 weeks. An economic evaluation and an ethnographic evaluation will be conducted alongside the interventions. PARTICIPANTS: We will recruit 600 participants in 20 methadone clinics. ELIGIBILITY CRITERIA: (1) age 16+; (2) Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) scores ≥ 10 for methamphetamine use or confirmed methamphetamine use with urine drug screening; (3) willing to provide three pieces of contact information; and (4) having a cell phone. OUTCOMES: Outcomes are measured at 13, 26, and 49 weeks and throughout the interventions. Primary outcomes include the (1) increase in HIV viral suppression, (2) reduction in HIV risk behaviors, and (3) reduction in methamphetamine use. COVID-19 response: We developed a response plan for interruptions caused by COVID-19 lockdowns to ensure data quality and intervention fidelity. DISCUSSION: This study will provide important evidence for scale-up of EBIs for methamphetamine use among methadone patients in limited-resource settings. As the EBIs will be delivered by methadone providers, they can be readily implemented if the trial demonstrates effectiveness and cost-effectiveness. TRIAL REGISTRATION: ClinicalTrials.gov NCT04706624. Registered on 13 January 2021. https://clinicaltrials.gov/ct2/show/NCT04706624.

Oil Shocks and BRIC Markets: Evidence from Extreme Quantile Approach (preprint)

The present study aims to configure the extreme quantile dependence between oil shocks and BRIC markets from January 2, 1995 to July 27, 2021. Using the cross-quantilogram technique, the current study first decomposed oil shocks pertaining to demand and supply and analyzed their asymmetric impact on BRIC markets. Our findings manifest positive and persistent dependencies between oil demand shocks and BRIC markets. Meanwhile, substantial cross-quantile dependence is demonstrated among shocks in oil supply and the stock returns of Russia. The recursive cross-quantilogram analysis indicates time-varying characteristics reiterating that oil demand shocks are positively and significantly correlated with BRIC stock returns, particularly after the Global Financial Crisis and COVID-19 pandemic. However, weaker dependencies are observed in the normal market conditions in the absence of financial contagion. Finally, after controlling the impact of idiosyncratic risk shocks, our results remain robust. Our findings are of particular prominence for policymakers, investors, and financial market constituents to restructure their current policies and strategies for avoiding uncertainty in the stock returns.

An Adaptive Design To Screen, Treat And Retain People With Opioid Use Disorders Who Use Methamphetamine In Methadone Clinics (STAR-OM) Study Protocol of A Clinical Trial (preprint)

Background: Methamphetamine use could jeopardize the current efforts to address opioid use disorder and HIV infection. Evidence-based behavioral interventions (EBI) are effective in reducing methamphetamine use. However, evidence on optimal combinations of EBI is limited. This protocol presents a Type-1 effectiveness-implementation hybrid design to evaluate the effectiveness, cost-effectiveness of adaptive methamphetamine use interventions and their implementation barriers in Vietnam. Method: Design: Participants will be first randomized into two frontline interventions for 12 weeks. They will then be placed or randomized to three adaptive strategies for another 12 weeks. An economic evaluation and an ethnographic evaluation will be conducted alongside the interventions. Participants: We will recruit 600 participants in 20 methadone clinics. Eligibility criteria: 1) age 16+, 2) Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) scores 10 or more for methamphetamine use or confirmed methamphetamine use with urine drug screening; 3) willing to provide three pieces of contact information; 4) having a cell phone.Outcomes: Outcomes are measured at 13-, 26- and 49-week and throughout the interventions. Primary outcomes include: (1) increase in HIV viral suppression; (2) reduction in HIV risk behaviors; and (3) reduction in methamphetamine use. COVID-19 response: We developed a response plan for interruptions caused by COVID-19 lockdowns to ensure data quality and intervention fidelity. Discussion: This study will provide important evidence for scale-up of EBIs for methamphetamine use among methadone patients in limited-resource settings. As the EBIs will be delivered by methadone providers, they can be readily implemented if the trial demonstrates effectiveness and cost-effectiveness. Trial registration: NCT04706624. Registered 13 January 2021. https://clinicaltrials.gov/ct2/show/NCT04706624

Intra-individual reproducibility as essential determinant of clinical utility of smartphone-based neurological disability tests (preprint)

Technological advances, lack of medical professionals, high cost of face-to face encounters and disasters such as COVID19 pandemic, fuel the telemedicine revolution. Numerous smartphone apps have been developed to measure neurological functions. However, their psychometric properties are seldom determined. Lacking such data, it is unclear which designs underlie’ eventual clinical utility of the smartphone tests. We have developed the smartphone Neu rological Fun ction T ests S uite (NeuFun-TS) and are systematically evaluating their psychometric properties against the gold-standard of complete neurological examination digitalized into NeurEx TM App. This paper examines the fifth, and thus far the most complex NeuFun-TS test, the “Spiral tracing”. We generated 40 features in the training cohort (22 healthy donors [HD] and 105 multiple sclerosis [MS] patients) and compared their intraclass correlation coefficient, fold-change between HD and MS and correlations with relevant clinical and imaging outcomes. We assembled the best features into machine-learning models and examined their performance in the independent validation cohort (56 MS patients). We show that by aggregating multiple neurological functions, complex tests such as spiral tracing are susceptible to intra-individual variations, decreasing their reproducibility and thus, clinical utility. Simple tests, reproducibly measuring single function(s) that can be aggregated to increase sensitivity are preferable in app design.