Physical Sciences and Mathematics Commons^™

A Smartwatch Step-Counting App For Older Adults: Development And Evaluation Study, George Boateng, Curtis L. Petersen, David Kotz, Karen L. Fortuna, Rebecca Masutani, John A. Batsis

Dartmouth Scholarship

Background: Older adults who engage in physical activity can reduce their risk of mobility impairment and disability. Short amounts of walking can improve quality of life, physical function, and cardiovascular health. Various programs have been implemented to encourage older adults to engage in physical activity, but sustaining their motivation continues to be a challenge. Ubiquitous devices, such as mobile phones and smartwatches, coupled with machine-learning algorithms, can potentially encourage older adults to be more physically active. Current algorithms that are deployed in consumer devices (eg, Fitbit) are proprietary, often are not tailored to the movements of older adults, and have …

The Feasibility And Utility Of Harnessing Digital Health To Understand Clinical Trajectories In Medication Treatment For Opioid Use Disorder: D-Tect Study Design And Methodological Considerations, Lisa A. Marsch, Ching-Hua Chen, Sara R. Adams, Asma Asyyed, Monique B. Does, Saeed Hassanpour, Emily Hichborn, Melanie Jackson-Morris, Nicholas C. Jacobson, Heather K. Jones, David Kotz, Chantal A. Lambert-Harris, Zhiguo Li, Bethany Mcleman, Varun Mishra, Catherine Stanger, Geetha Subramaniam, Weiyi Wu, Cynthia I. Campbell

Dartmouth Scholarship

Introduction: Across the U.S., the prevalence of opioid use disorder (OUD) and the rates of opioid overdoses have risen precipitously in recent years. Several effective medications for OUD (MOUD) exist and have been shown to be life-saving. A large volume of research has identified a confluence of factors that predict attrition and continued substance use during substance use disorder treatment. However, much of this literature has examined a small set of potential moderators or mediators of outcomes in MOUD treatment and may lead to over-simplified accounts of treatment non-adherence. Digital health methodologies offer great promise for capturing intensive, longitudinal ecologically-valid …

Detecting Receptivity For Mhealth Interventions In The Natural Environment, Varun Mishra, Florian Künzler, Jan-Niklas Kramer, Elgar Fleisch, Tobias Kowatsch, David Kotz

Dartmouth Scholarship

Just-In-Time Adaptive Intervention (JITAI) is an emerging technique with great potential to support health behavior by providing the right type and amount of support at the right time. A crucial aspect of JITAIs is properly timing the delivery of interventions, to ensure that a user is receptive and ready to process and use the support provided. Some prior works have explored the association of context and some user-specific traits on receptivity, and have built post-study machine-learning models to detect receptivity. For effective intervention delivery, however, a JITAI system needs to make in-the-moment decisions about a user's receptivity. To this end, …

When Do Drivers Interact With In-Vehicle Well-Being Interventions? An Exploratory Analysis Of A Longitudinal Study On Public Roads, Kevin Koch, Varun Mishra, Shu Liu, Thomas Berger, Elgar Fleisch, David Kotz, Felix Wortmann

Dartmouth Scholarship

Recent developments of novel in-vehicle interventions show the potential to transform the otherwise routine and mundane task of commuting into opportunities to improve the drivers' health and well-being. Prior research has explored the effectiveness of various in-vehicle interventions and has identified moments in which drivers could be interruptible to interventions. All the previous studies, however, were conducted in either simulated or constrained real-world driving scenarios on a pre-determined route. In this paper, we take a step forward and evaluate when drivers interact with in-vehicle interventions in unconstrained free-living conditions.

To this end, we conducted a two-month longitudinal study with 10 …

Evaluating The Reproducibility Of Physiological Stress Detection Models, Varun Mishra, Sougata Sen, Grace Chen, Tian Hao, Jeffrey Rogers, Ching-Hua Chen, David Kotz

Dartmouth Scholarship

Recent advances in wearable sensor technologies have led to a variety of approaches for detecting physiological stress. Even with over a decade of research in the domain, there still exist many significant challenges, including a near-total lack of reproducibility across studies. Researchers often use some physiological sensors (custom-made or off-the-shelf), conduct a study to collect data, and build machine-learning models to detect stress. There is little effort to test the applicability of the model with similar physiological data collected from different devices, or the efficacy of the model on data collected from different studies, populations, or demographics.

This paper takes …

Barriers And Facilitators In Implementing A Pilot, Pragmatic, Telemedicine-Delivered Healthy Lifestyle Program For Obesity Management In A Rural, Academic Obesity Clinic, John A. Batsis, Auden C. Mcclure, Aaron B. Weintraub, Diane Sette, Sivan Rotenberg, Courtney J. Stevens, Diane Gilbert-Diamond, David Kotz, Stephen Bartels, Summer B. Cook, Richard I. Rothstein

Dartmouth Scholarship

Few evidence-based strategies are specifically tailored for disparity populations such as rural adults. Two-way video-conferencing using telemedicine can potentially surmount geographic barriers that impede participation in high-intensity treatment programs offering frequent visits to clinic facilities. We aimed to understand barriers and facilitators of implementing a telemedicine-delivered tertiary-care, rural academic weight-loss program for the management of obesity.

Using Natural Language Processing And Sentiment Analysis To Augment Traditional User-Centered Design: Development And Usability Study, Curtis L. Petersen, Ryan Halter, David Kotz, Lorie Loeb, Summer B. Cook, Dawna M. Pidgeon, Brock Christensen, John A. Batsis

Dartmouth Scholarship

Background: Sarcopenia, defined as the age-associated loss of muscle mass and strength, can be effectively mitigated through resistance-based physical activity. With compliance at approximately 40% for home-based exercise prescriptions, implementing a remote sensing system would help patients and clinicians to better understand treatment progress and increase compliance. The inclusion of end users in the development of mobile apps for remote-sensing systems can ensure that they are both user friendly and facilitate compliance. With advancements in natural language processing (NLP), there is potential for these methods to be used with data collected through the user-centered design process.

Objective: This study aims …

Automatic Recognition, Segmentation, And Sex Assignment Of Nocturnal Asthmatic Coughs And Cough Epochs In Smartphone Audio Recordings: Observational Field Study, Filipe Barata, Peter Tinschert, Frank Rassouli, Claudia Steurer-Stey, Elgar Fleisch, Milo Puhan, Martin Brutsche, David Kotz, Tobias Kowatsch

Dartmouth Scholarship

Background: Asthma is one of the most prevalent chronic respiratory diseases. Despite increased investment in treatment, little progress has been made in the early recognition and treatment of asthma exacerbations over the last decade. Nocturnal cough monitoring may provide an opportunity to identify patients at risk for imminent exacerbations. Recently developed approaches enable smartphone-based cough monitoring. These approaches, however, have not undergone longitudinal overnight testing nor have they been specifically evaluated in the context of asthma. Also, the problem of distinguishing partner coughs from patient coughs when two or more people are sleeping in the same room using contact-free audio …

The Application Of Digital Health To The Assessment And Treatment Of Substance Use Disorders: The Past, Current, And Future Role Of The National Drug Abuse Treatment Clinical Trials Network, Lisa A. Marsch, Aimee Campbell, Cynthia Campbell, Ching-Hua Chen, Emre Ertin, Udi Ghitza, Chantal Lambert-Harris, Saeed Hassanpour, August F. Holtyn, Yih-Ing Hser, Petra Jacobs, Jeffrey D. Klausner, Shea Lemley, David Kotz, Andrea Meier, Bethany Mcleman, Jennifer Mcneely, Varun Mishra, Larissa Mooney, Edward Nunes, Chrysovalantis Stafylis, Catherine Stanger, Elizabeth Saunders, Geetha Subramaniam, Sean Young

Dartmouth Scholarship

The application of digital technologies to better assess, understand, and treat substance use disorders (SUDs) is a particularly promising and vibrant area of scientific research. The National Drug Abuse Treatment Clinical Trials Network (CTN), launched in 1999 by the U.S. National Institute on Drug Abuse, has supported a growing line of research that leverages digital technologies to glean new insights into SUDs and provide science-based therapeutic tools to a diverse array of persons with SUDs.

This manuscript provides an overview of the breadth and impact of research conducted in the realm of digital health within the CTN. This work has …

Workshop On The Development And Evaluation Of Digital Therapeutics For Health Behavior Change: Science, Methods, And Projects, Alan J. Budney, Lisa A. Marsch, Will M. Aklin, Jacob T. Borodovsky, Mary F. Brunette, Andrew T. Campbell, Jesse Dallery, David Kotz, Ashley A. Knapp, Sarah E. Lord, Edward V. Nunes, Emily A. Scherer, Catherine Stanger, William C. Torrey

Dartmouth Scholarship

The health care field has integrated advances into digital technology at an accelerating pace to improve health behavior, health care delivery, and cost-effectiveness of care. The realm of behavioral science has embraced this evolution of digital health, allowing for an exciting roadmap for advancing care by addressing the many challenges to the field via technological innovations. Digital therapeutics offer the potential to extend the reach of effective interventions at reduced cost and patient burden and to increase the potency of existing interventions. Intervention models have included the use of digital tools as supplements to standard care models, as tools that …

Feasibility And Acceptability Of A Rural, Pragmatic, Telemedicine‐ Delivered Healthy Lifestyle Programme, John A. Batsis, Auden C. Mcclure, Aaron B. Weintraub, David F. Kotz, Sivan Rotenberg, Summer B. Cook, Diane Gilbert-Diamond, Kevin Curtis, Courtney J. Stevens, Diane Sette, Richard I. Rothstein

Dartmouth Scholarship

Background: The public health crisis of obesity leads to increasing morbidity that are even more profound in certain populations such as rural adults. Live, two‐way video‐conferencing is a modality that can potentially surmount geographic barriers and staffing shortages. Methods: Patients from the Dartmouth‐Hitchcock Weight and Wellness Center were recruited into a pragmatic, single‐arm, nonrandomized study of a remotely delivered 16‐week evidence‐based healthy lifestyle programme. Patients were provided hardware and appropriate software allowing for remote participation in all sessions, outside of the clinic setting. Our primary outcomes were feasibility and acceptability of the telemedicine intervention, as well as potential effectiveness on …

Exploring The State-Of-Receptivity For Mhealth Interventions, Florian Künzler, Varun Mishra, Jan-Niklas Kramer, David Kotz, Elgar Fleisch, Tobias Kowatsch

Dartmouth Scholarship

Recent advancements in sensing techniques for mHealth applications have led to successful development and deployments of several mHealth intervention designs, including Just-In-Time Adaptive Interventions (JITAI). JITAIs show great potential because they aim to provide the right type and amount of support, at the right time. Timing the delivery of a JITAI such as the user is receptive and available to engage with the intervention is crucial for a JITAI to succeed. Although previous research has extensively explored the role of context in users’ responsiveness towards generic phone notiications, it has not been thoroughly explored for actual mHealth interventions. In this …

Use Of Amulet In Behavioral Change For Geriatric Obesity Management, John A. Batsis, Alexandra B. Zagaria, Ryan J. Halter, George G. Boateng, Patrick Proctor, Stephen J. Bartels, David Kotz

Dartmouth Scholarship

Background: Obesity in older adults is a significant public health concern. Weight-loss interventions are known to improve physical function but risk the development of sarcopenia. Mobile health devices have the potential to augment existing interventions and, if designed accordingly, could improve one’s physical activity and strength in routine physical activity interventions.

Methods and results: We present Amulet, a mobile health device that has the capability of engaging patients in physical activity. The purpose of this article is to discuss the development of applications that are tailored to older adults with obesity, with the intention to engage and improve their health. …

Development And Usability Assessment Of A Connected Resistance Exercise Band Application For Strength-Monitoring, John A. Batsis, George G. Boateng, Lillian M. Seo, Curtis L. Petersen, Karen L. Fortuna, Emily V. Wechsler, Ronald J. Peterson, Summer B. Cook, Dawna Pidgeon, Rachel S. Dokko, Ryan J. Halter, David F. Kotz

Dartmouth Scholarship

Resistance exercise bands are a core component of any physical activity strengthening program. Strength training can mitigate the development of sarcopenia, the loss of muscle mass or strength and function with aging. Yet, the adherence of such behavioral exercise strategies in a home-based setting are fraught with issues of monitoring and compliance. Our group developed a Bluetooth-enabled resistance exercise band capable of transmitting data to an open-source platform. In this work, we developed an application to capture this information in real-time, and conducted three usability studies in two mixed-aged groups of participants (n=6 each) and a group of older adults …

Technology For Behavioral Change In Rural Older Adults With Obesity, John A. Batsis, John A. Naslund, Alexandra B. Zagaria, David Kotz, Rachel Dokko, Stephen J. Bartels, Elizabeth Carpenter-Song

Dartmouth Scholarship

Background: Mobile health (mHealth) technologies comprise a multidisciplinary treatment strategy providing potential solutions for overcoming challenges of successfully delivering health promotion interventions in rural areas. We evaluated the potential of using technology in a high-risk population.

Methods: We conducted a convergent, parallel mixed-methods study using semi-structured interviews, focus groups, and self-reported questionnaires, using purposive sampling of 29 older adults, 4 community leaders and 7 clinicians in a rural setting. We developed codes informed by thematic analysis and assessed the quantitative data using descriptive statistics.

Results: All groups expressed that mHealth could improve health behaviors. Older adults were optimistic that mHealth …

Workshop On Emerging Technology And Data Analytics For Behavioral Health, David Kotz, Sarah E. Lord, A. James O'Malley, Luke Stark, Lisa Marsch

Dartmouth Scholarship

Wearable and portable digital devices can support self-monitoring for patients with chronic medical conditions, individuals seeking to reduce stress, and people seeking to modify health-related behaviors such as substance use or overeating. The resulting data may be used directly by a consumer, or shared with a clinician for treatment, a caregiver for assistance, or a health coach for support. The data can also be used by researchers to develop and evaluate just-in-time interventions that leverage mobile technology to help individuals manage their symptoms and behavior in real time and as needed. Such wearable systems have huge potential for promoting delivery …

Safety And Immunogenicity Of An Inactivated Whole Cell Tuberculosis Vaccine Booster In Adults Primed With Bcg: A Randomized, Controlled Trial Of Dar-901, C. Fordham Von Reyn, Timothy Lahey, Robert D. Arbeit, Bernard Landry, Leway Kailani, Lisa Adams, Brenda Haynes, Todd Mackenzie, Wendy Wieland-Alter, Ruth Connor, Sue Tvaroha, David Hokey, Ann Ginsberg, Richard Waddell

Dartmouth Scholarship

Development of a tuberculosis vaccine to boost BCG is a major international health priority. SRL172, an inactivated whole cell booster derived from a non-tuberculous mycobacterium, is the only new vaccine against tuberculosis to have demonstrated efficacy in a Phase 3 trial. In the present study we sought to determine if a three-dose series of DAR-901 manufactured from the SRL172 master cell bank by a new, scalable method was safe and immunogenic.

Dueling Biological And Social Contagions, Feng Fu, Nicholas A. Christakis, James H. Fowler

Dartmouth Scholarship

Numerous models explore how a wide variety of biological and social phenomena spread in social networks. However, these models implicitly assume that the spread of one phenomenon is not affected by the spread of another. Here, we develop a model of “dueling contagions”, with a particular illustration of a situation where one is biological (influenza) and the other is social (flu vaccination). We apply the model to unique time series data collected during the 2009 H1N1 epidemic that includes information about vaccination, flu, and face-to-face social networks. The results show that well- connected individuals are more likely to get vaccinated, …

Disability In Long-Term Care Residents Explained By Prevalent Geriatric Syndromes, Not Long-Term Care Home Characteristics: A Cross-Sectional Study, Natasha E. Lane, Walter P. Wodchis, Cynthia M. Boyd, Thérèse A. Stukel

Dartmouth Scholarship

Self-care disability is dependence on others to conduct activities of daily living, such as bathing, eating and dressing. Among long-term care residents, self-care disability lowers quality of life and increases health care costs. Understanding the correlates of self-care disability in this population is critical to guide clinical care and ongoing research in Geriatrics. This study examines which resident geriatric syndromes and chronic conditions are associated with residents’ self-care disability and whether these relationships vary across strata of age, sex and cognitive status. It also describes the proportion of variance in residents’ self-care disability that is explained by residents’ geriatric syndromes …

Implementing An Mhealth System For Substance Use Disorders In Primary Care: A Mixed Methods Study Of Clinicians’ Initial Expectations And First Year Experiences, Marie-Louise Mares, David H. Gustafson, Joseph E. Glass, Andrew Quanbeck, Helene Mcdowell, Fiona Mctavish, Amy Atwood, Lisa Marsch

Dartmouth Scholarship

Millions of Americans need but don’t receive treatment for substance use, and evidence suggests that addiction-focused interventions on smart phones could support their recovery. There is little research on implementation of addiction-related interventions in primary care, particularly in Federally Qualified Health Centers (FQHCs) that provide primary care to underserved populations. We used mixed methods to examine three FQHCs’ implementation of Seva, a smart-phone app that offers patients online support/discussion, health-tracking, and tools for coping with cravings, and offers clinicians information about patients’ health tracking and relapses. We examined (a) clinicians' initial perspectives about implementing Seva, and (b) the first year …

Artificial Intelligence And Amikacin Exposures Predictive Of Outcomes In Multidrug-Resistant Tuberculosis Patients, Chawangwa Modongo, Jotam G. Pasipanodya, Shashikant Srivastava, Nicola Zetola, Scott Williams, Giorgio Sirugo, Tawanda Gumbo

Dartmouth Scholarship

Aminoglycosides such as amikacin continue to be part of the backbone of treatment of multidrug-resistant tuberculosis (MDR- TB). We measured amikacin concentrations in 28 MDR-TB patients in Botswana receiving amikacin therapy together with oral levofloxacin, ethionamide, cycloserine, and pyrazinamide and calculated areas under the concentration-time curves from 0 to 24 h (AUC0 –24). The patients were followed monthly for sputum culture conversion based on liquid cultures. The median duration of amikacin therapy was 184 (range, 28 to 866) days, at a median dose of 17.30 (range 11.11 to 19.23) mg/kg. Only 11 (39%) pa- tients had sputum culture conversion during …

Privacy And Security In Mobile Health – A Research Agenda, David Kotz, Carl A. Gunter, Santosh Kumar, Jonathan P. Weiner

Dartmouth Scholarship

Mobile health technology has great potential to increase healthcare quality, expand access to services, reduce costs, and improve personal wellness and public health. However, mHealth also raises significant privacy and security challenges.

Dynapenic Obesity And The Effect On Long-Term Physical Function And Quality Of Life: Data From The Osteoarthritis Initiative, John A. Batsis, Alicia J. Zbehlik, Dawna Pidgeon, Stephen J. Bartels

Dartmouth Scholarship

Obesity is associated with functional impairment, institutionalization, and increased mortality risk in elders. Dynapenia is defined as reduced muscle strength and is a known independent predictor of adverse events and disability. The synergy between dynapenia and obesity leads to worse outcomes than either independently. We identified the impact of dynapenic obesity in a cohort at risk for and with knee osteoarthritis on function.

Validation Of A New Predictive Risk Model: Measuring The Impact Of The Major Modifiable Risks Of Death For Patients And Populations, Stephen S. Lim, Emily Carnahan, Eugene C. Nelson, Catherine W. Gillespie, Ali H. Mokdad, Christopher J. L. Murray, Elliott S. Fisher

Dartmouth Scholarship

Background: Modifiable risks account for a large fraction of disease and death, but clinicians and patients lack tools to identify high risk populations or compare the possible benefit of different interventions.

Methods: We used data on the distribution of exposure to 12 major behavioral and biometric risk factors inthe US population, mortality rates by cause, and estimates of the proportional hazards of risk factor exposure from published systematic reviews to develop a risk prediction model that estimates an adult's 10 year mortality risk compared to a population with optimum risk factors. We compared predicted risk to observed mortality in 8,241 …

Development And Validation Of An Epitope Prediction Tool For Swine (Pigmatrix) Based On The Pocket Profile Method, Andres H. Gutiérrez, William D. Martin, Chris Bailey-Kellogg, Frances Terry, Leonard Moise, Anee S. De Groot

Dartmouth Scholarship

Background: T cell epitope prediction tools and associated vaccine design algorithms have accelerated the development of vaccines for humans. Predictive tools for swine and other food animals are not as well developed, primarily because the data required to develop the tools are lacking. Here, we overcome a lack of T cell epitope data to construct swine epitope predictors by systematically leveraging available human information. Applying the “pocket profile method ”, we use sequence and structural similarities in the binding pockets of human and swine major histocompatibility complex proteins to infer Swine Leukocyte Antigen (SLA) peptide binding preferences. We developed epitope-prediction …

Iarc Monographs: 40 Years Of Evaluating Carcinogenic Hazards To Humans, Neil E. Pearce, Aaron Blair, Paolo Vineis, Wolfgang Ahrens, Aage Andersom, Josep M. Anto, Bruce K. Armstrong, Andrea A. Baccarelli, Frederick A. Beland, Amy Berrington, Pier Alberto Bertazzi, Linda S. Birnbaum, Ross C. Brownson, John R. Bucher, Kenneth P. Cantor, Elisabeth Cardis, John W. Cherrie, David C. Christiani, Pierluigi Cocco, David Coggon, Pietro Comba, Paul A. Demers, John M. Dement, Jeroen Douwes, Ellen A. Eisen, Lawrence S. Engel, Richard A. Fenske, Lora E. Fleming, Tony Fletcher, Elizabeth Fontham, Francesco Forastiere, Rainer Frentzel-Beyme, Lin Fritschi, Michel Gerin, Marcel Goldberg, Philippe Grandjean, Tom K. Grimsrud, Per Gustavsson, Andy Haines, Patricia Hartge, Johnni Hansen, Michael Hauptmann, Dick Heederik, Kari Hemminki, Denis Hemon, Irva Hertz-Picciotto, Jane A. Hoppin, James Huff, Bengt Jarvholm, Daehee Kang, Margaret R. Karagas

Dartmouth Scholarship

Background: Recently, the International Agency for Research on Cancer (IARC) Programme for the Evaluation of Carcinogenic Risks to Humans has been criticized for several of its evaluations, and also for the approach used to perform these evaluations. Some critics have claimed that failures of IARC Working Groups to recognize study weaknesses and biases of Working Group members have led to inappropriate classification of a number of agents as carcinogenic to humans.

Objectives: The authors of this Commentary are scientists from various disciplines relevant to the identification and hazard evaluation of human carcinogens. We examined criticisms of the IARC classification process …

Spectral Gene Set Enrichment (Sgse), H Robert Frost, Zhigang Li, Jason H. Moore

Dartmouth Scholarship

Gene set testing is typically performed in a supervised context to quantify the association between groups of genes and a clinical phenotype. In many cases, however, a gene set-based interpretation of genomic data is desired in the absence of a phenotype variable. Although methods exist for unsupervised gene set testing, they predominantly compute enrichment relative to clusters of the genomic variables with performance strongly dependent on the clustering algorithm and number of clusters. We propose a novel method, spectral gene set enrichment (SGSE), for unsupervised competitive testing of the association between gene sets and empirical data sources. SGSE first computes …

Gene Expression Changes Reflect Clinical Response In A Placebo-Controlled Randomized Trial Of Abatacept In Patients With Diffuse Cutaneous Systemic Sclerosis, Eliza F. Chakravarty, Viktor Martyanov, David Fiorentino, Tammara A. Wood, David J. Haddon, Justin A. Jarrell, Paul Utz, Mark Genovese, Michael Whitfield, Lorinda Chung

Dartmouth Scholarship

Systemic sclerosis is an autoimmune disease characterized by inflammation and fibrosis of the skin and internal organs. We sought to assess the clinical and molecular effects associated with response to intravenous abatacept in patients with diffuse cutaneous systemic.

Wordless Intervention For Epilepsy In Learning Disabilities (Wield): Study Protocol For A Randomized Controlled Feasibility Trial, Marie-Anne Durand, Bob Gates, Georgina Parkes, Asif Zia

Dartmouth Scholarship

Epilepsy is the most common neurological problem that affects people with learning disabilities. The high seizure frequency, resistance to treatments, associated skills deficit and co-morbidities make the management of epilepsy particularly challenging for people with learning disabilities. The Books Beyond Words booklet for epilepsy uses images to help people with learning disabilities manage their condition and improve quality of life. Our aim is to conduct a randomized controlled feasibility trial exploring key methodological, design and acceptability issues, in order to subsequently undertake a large-scale randomized controlled trial of the Books Beyond Words booklet for epilepsy.

Successful Mdr-Tb Treatment Regimens Including Amikacin Are Associated With High Rates Of Hearing Loss, Chawangwa Modongo, Rafal S. Sobota, Boikobo Kesenogile, Ronald Ncube

Dartmouth Scholarship

Aminoglycosides are a critical component of multidrug-resistant tuberculosis (MDR-TB) treatment but data on their efficacy and adverse effects in Botswana is scarce. We determined the effect of amikacin on treatment outcomes and development of hearing loss in MDR-TB patients. Patients started on MDR-TB treatment between 2006 and 2012 were included. Multivariate analysis was used to determine the effect of amikacin on treatment outcomes and development of hearing loss.