Subjective data, objective data and the role of bias in predictive modelling: Lessons from a dispositional learning analytics application

Human slip perception while walking on ice: Can we rely on self-reported slip counts for winter footwear evaluations?

Fall-related injuries on icy surfaces are a major public health concern. Slip-resistant winter boots that incorporate the latest composite outsole technologies have demonstrated the potential to prevent falls in winter weather in lab-based testing. However, the real-world benefits of this composite footwear remain difficult to measure because of a lack of accurate evaluation methods. In particular, existing methods rely on comparing self-reported slip counts to identify differences in slip resistance performance between different footwear models. However, prior research has primarily focused on slip detection on soapy and oily surfaces, revealing that small slips (≤30 mm) often go undetected, with humans correctly identifying them only 50% of the time. No studies have yet examined slip perception on icy surfaces, which possess significantly lower coefficients of friction compared to soapy and oily environments. The objective of this study was to investigate the agreement between self-reported slip counts and motion capture detected slips while walking on ice with winter footwear. Twenty-five healthy participants were asked to walk on ice surfaces (melting ice 0.5 ± 1.0 °C and cold ice -3.5 ± 1.0 °C) while wearing three models of winter boots with varying slip resistance performance (poor, moderate, good) and were asked to report any slips they experienced. Ground truth slip identification and slip length measurement was done using an 8-camera Vicon motion capture system. Slips were categorized as small slips (≤30 mm), moderate slips (30-100 mm), or large slips (>100 mm) for each boot and the proportion detected by participants was calculated. A total of 7743 slips were identified from 53,944 steps captured by the motion capture system with 4395, 1999 and 1349 slips recorded from the boots with poor, moderate and good slip resistance, respectively. These included 1658 small slips, 2521 moderate slips, and 3564 large slips. Overall, participants only reported 38.3% of these slips including 375 small slips (22.6% reported), 823 moderate slips (32.6% reported) and 1767 large slips (49.6% reported). These findings showed a strong positive correlation between self-reported slips and slip length (ρ = 0.573, p<0.001) demonstrating that participants were significantly more likely to report larger slips. The findings of this study demonstrate the need to develop more objective methods of recording slip events for real-world winter footwear evaluations.

Technology Readiness Drives Digital Adoption in Dentistry: Insights from a Cross-Sectional Study

Background/Objectives: Digital transformation is reshaping dentistry by improving clinical efficiency, diagnostic accuracy, and patient care. However, the adoption of digital technologies in dental clinics varies widely, influenced by multiple factors, including technology readiness. This study aimed to assess the relationship between technology readiness and digital technology adoption among German dentists, focusing on the impact of clinic characteristics and professional development. Methods: A cross-sectional survey was conducted among 200 licensed German dentists. Technology readiness was measured using the validated Technology Readiness Index (TRI 2.0), encompassing four dimensions: optimism, innovativeness, discomfort, and insecurity. Data on the current use of digital technologies were collected, including digital radiography, CAD/CAM systems, AI-supported tools, and patient management solutions. Statistical analyses included correlation and quartile-based comparisons to identify patterns and significant associations. Results: Clinics with higher TRI scores demonstrated significantly greater adoption of digital technologies. Larger clinics (MVZs) showed higher levels of digital integration compared to solo practices. Younger dentists and those engaged in continuous professional development exhibited higher technology readiness and usage of advanced digital tools. No significant gender-based differences were identified in technology readiness or digital adoption. While basic technologies like digital radiography and CAD/CAM systems were widely used, AI-based diagnostics and 3D printing remained underutilized. Key barriers included financial constraints and limited training opportunities. Conclusions: Technology readiness plays a critical role in shaping digital adoption in dental clinics. The findings highlight the need for targeted support, especially for smaller clinics, through professional training and investment in digital infrastructure. This study contributes to a better understanding of digital transformation in dentistry and supports strategies aligned with global health goals to improve access to digital care.

Is age an effect modifier of the association between body mass index and physical function in patients with obesity?

OBJECTIVES

Amid hesitancy to pursue interventions, such as metabolic and bariatric surgery for obesity within some age groups, the impact of age on the relationship between body mass index (BMI) and perceived bodily function is fundamental to understand. Our objective was thus to determine whether this relationship was affected by older age such that it might alter how we consider interventions in different age groups.

METHODS

Patient data (N = 1921) were obtained prospectively and assessed to determine if age decile influenced the association between BMI and BODY-Q Physical Function scores; BODY-Q PF is a validated instrument which assesses perceived physical function in patients who are being managed for weight loss. Normative BODY-Q PF scores were defined according to the previously published threshold. Stratified analyses, receiver operator characteristic curves, and logistic regression were utilized to assess for effect modification by age.

RESULTS

Among 1921 adults (80% female) seeking weight management interventions at an academic hospital consortium, the strongest association between normal BODY-Q PF and lower BMI was seen in patients 61-70 years of age, whether assessed through receiver operator characteristic curves, bivariable odds ratios, or multivariable logistic regression. Age was an effect modifier of the association between BODY-Q PF and BMI. When both age 61-70 years and BMI < 30 occurred concurrently, the odds of normal BODY-Q PF scores increased (OR 3.275, 95% CI 1.994-5.379). In contrast, age 61-70 years alone was associated with lower odds of a normal BODY-Q PF score (OR 0.434, 95% CI 0.298-0.603).

CONCLUSION

When BMI is improved in older patients, it is more closely associated with better physical function. Age is thus an effect modifier of the association between BMI and BODY-Q PF scores. Older patients may then experience at least as many physical function benefits from weight loss interventions as their younger counterparts.

Health in Spanish older people: Dietary habits, lifestyles and related socioeconomic factors

Objective

To measure diet quality in the population aged over 65 years in Spain and its autonomous communities and to identify sociodemographic, health and lifestyle factors related to diet quality based on 2017 Spanish National Health Survey.

Methods

To estimate diet quality, we used the Healthy Eating Index for Spanish Population (IASE). A multiple linear regression analysis (regression coefficients and 95 % CIs) was used to determine the relationship between socio-demographic, health and lifestyle factors and IASE. This index was our dependent variable and as independent variables: sex, chronic diseases, age, level of education, engagement in physical activity, marital status and Body Mass Index.

Results

A total of 6325 participants were included in the sample. The diet quality rating in Spain revealed that 0.46 % of our population had an unhealthy diet, 87 % needed to make changes, and 12.3 % were following a healthy diet. Being female (Regression coefficient = 1.6, 95 % CI = 1.14;-1.97), being physically active several times a month (Regression coefficient = 1.6, 95 % CI =0.63-2.48) and several times a week (Regression coefficient = 2.2, 95 % CI =1.36-3.10), having chronic disease (Regression coefficients =0.7, 95 % CI =0.08-1.29), being overweight (Regression coefficient = 0.5, 95 % CI =0.06-0.95) and being aged between 70 and 74 (Regression coefficient = 0.5, 95 % CI =0.01-1.07) and 75-79 (Regression coefficient = 0.9, 95 % CI =0.33-1.50) were associated with higher IASE scores.

Conclusion and implications

These results help to identify risk groups or situations and to design health prevention programs.

Online profiling of volunteers in public health emergencies: insights from COVID-19 in China

BACKGROUND

During public health emergencies, the diverse backgrounds of volunteers pose numerous management challenges. This study aims to develop an online profiling model of volunteers using social media data to achieve a more comprehensive and objective understanding of them.

METHODS

In the proposed model, the study designed five profiling tags: basic information, sentiment, topic features, interest preferences, and online social engagement. K-Modes clustering was employed to implement the profiling. To validate the feasibility of the model, an empirical study was conducted using Weibo data from 1,070 volunteers during the COVID-19 pandemic in China, resulting in the online profiling of these volunteers.

RESULTS

Four categories of volunteers could be identified: Public Affairs Pioneers (32.4%), Diary Record Lurkers (32.8%), Social Topic Sharers (20.9%), and Fashion and Entertainment Influencers (13.9%). Overall, volunteers were predominantly female, generally interested in entertainment, relatively satisfied with their volunteer work, and possessed a sense of social responsibility. The four categories of volunteers exhibited distinct characteristics in terms of interests, online social behavior, and influence.

CONCLUSIONS

The proposed online profiling model objectively captures the characteristics of volunteers during public health emergencies. The four volunteer categories identified through the empirical results provide a multidimensional and comprehensive understanding of volunteers. For different volunteer categories, official agencies can tailor their recruitment, management, and training strategies to better suit the specific needs and strengths of the volunteers, thereby enhancing the effectiveness and efficiency of volunteer engagement and ensuring volunteers are well-prepared and supported in their roles.

Parent's acceptance of advanced behavior management techniques on children during dental treatment

AIM

This study explores the acceptance of Advanced Behavior Management Techniques (ABMTs) by parents during their children's dental treatments, comparing the opinion of parents of neurotypical children with that of parents of children with autism spectrum disorders (ASDs).

METHODS

An observational cross-sectional study was conducted involving 440 parents, divided into two groups: 236 parents of neurotypical children and 204 parents of children with ASDs, recruited from pediatricians' centers and centers for ASDs children in Northern and Southern Italy. A survey assessed their familiarity and acceptance of ABMTs, including protective stabilization, conscious sedation, and deep sedation/general anesthesia. Discrete variables were expressed as absolute and relative frequencies (%) and compared with Pearson's chi-squared or Fisher's exact test. Continue variables were expressed as mean ± SD and compared with the one-way ANOVA test. Heatmap and PCA analysis were used to determine possible correlations between items.

RESULTS

Parents of children with ASDs showed a higher acceptance rate of ABMTs compared to parents of neurotypical children. Overall, only 30.68% of parents knew ABMTs before the survey. Differences between the two groups of parents in acceptance of Active Stabilization in emergency settings, Passive Stabilization in routine settings, and Deep sedation/general anesthesia in both settings were observed (p < 0.01). Only 6.82% of parents ever used at least one ABMT on their children. Heatmap analysis revealed that parents who have accepted one of the ABMTs tend to accept the others as well.

CONCLUSION

Differences in parental acceptance of different ABMTs was noted among the two groups of parents, with greater acceptance of ABMTs observed in the group of parents of children with ASDs. Parents of both groups have significant gaps in their knowledge of ABMTs. Therefore, increased awareness and personalized communication strategies are needed to increase acceptance of the studied techniques and, thus, facilitate access to dental care for uncooperative pediatric patients. Patient-centered behavior management strategies that meet children's needs and parents' preferences can contribute to the achievement of good oral health.

A mixed methods approach to describe the efficacy of lift assist device use to reduce low back musculoskeletal disorder risk factors during three common patient extrication scenarios

This mixed-method study evaluated the efficacy of lift assist device use (Binder®, Eagle®, Maxi Air®) relative to manual lifting/care-as-usual in reducing low back muscle activity and perceived exertion during simulated patient extrication tasks. User feedback was recorded to identify factors that might influence use. Twenty paramedics performed a floor to stretcher lift, lateral transfer, and confined space extrication care-as-usual and with lift assist devices. Use of a lift assist reduced low back muscle activity during floor to stretcher and confined space tasks by 34-47%. Paramedics perceived exertion decreased from 'somewhat hard' to 'light' or 'very light' when using an assistive device. Paramedics noted that ease of use, patient comfort, task time, patient acuity, among other considerations would influence use decisions. Lift assist devices were efficacious at reducing low back muscle activity and perceived exertion during floor to stretcher and patient extrication tasks.

Psychometric benefits of self-chosen rating scales over given rating scales

Rating scales are susceptible to response styles that undermine the scale quality. Optimizing a rating scale can tailor it to individuals' cognitive abilities, thereby preventing the occurrence of response styles related to a suboptimal response format. However, the discrimination ability of individuals in a sample may vary, suggesting that different rating scales may be appropriate for different individuals. This study aims to examine (1) whether response styles can be avoided when individuals are allowed to choose a rating scale and (2) whether the psychometric properties of self-chosen rating scales improve compared to given rating scales. To address these objectives, data from the flourishing scale were used as an illustrative example. MTurk workers from Amazon's Mechanical Turk platform (N = 7042) completed an eight-item flourishing scale twice: (1) using a randomly assigned four-, six-, or 11-point rating scale, and (2) using a self-chosen rating scale. Applying the restrictive mixed generalized partial credit model (rmGPCM) allowed examination of category use across the conditions. Correlations with external variables were calculated to assess the effects of the rating scales on criterion validity. The results revealed consistent use of self-chosen rating scales, with approximately equal proportions of the three response styles. Ordinary response behavior was observed in 55-58% of individuals, which was an increase of 12-15% compared to assigned rating scales. The self-chosen rating scales also exhibited superior psychometric properties. The implications of these findings are discussed.

Wearable network for multilevel physical fatigue prediction in manufacturing workers

Manufacturing workers face prolonged strenuous physical activities, impacting both financial aspects and their health due to work-related fatigue. Continuously monitoring physical fatigue and providing meaningful feedback is crucial to mitigating human and monetary losses in manufacturing workplaces. This study introduces a novel application of multimodal wearable sensors and machine learning techniques to quantify physical fatigue and tackle the challenges of real-time monitoring on the factory floor. Unlike past studies that view fatigue as a dichotomous variable, our central formulation revolves around the ability to predict multilevel fatigue, providing a more nuanced understanding of the subject's physical state. Our multimodal sensing framework is designed for continuous monitoring of vital signs, including heart rate, heart rate variability, skin temperature, and more, as well as locomotive signs by employing inertial motion units strategically placed at six locations on the upper body. This comprehensive sensor placement allows us to capture detailed data from both the torso and arms, surpassing the capabilities of single-point data collection methods. We developed an innovative asymmetric loss function for our machine learning model, which enhances prediction accuracy for numerical fatigue levels and supports real-time inference. We collected data on 43 subjects following an authentic manufacturing protocol and logged their self-reported fatigue. Based on the analysis, we provide insights into our multilevel fatigue monitoring system and discuss results from an in-the-wild evaluation of actual operators on the factory floor. This study demonstrates our system's practical applicability and contributes a valuable open-access database for future research.

Knowledge, attitudes, and barriers: Palliative Care services for women with HIV in resource-limited settings

BACKGROUND

Women living with HIV (WLWH) in low- middle-income countries (LMICs) face increased mortality risks from comorbidities despite progress in antiretroviral therapy. Palliative care (PC) is vital for these patients, yet its integration in LMICs, such as Nigeria, is suboptimal due to unique challenges.

OBJECTIVE

This study investigated the knowledge, perceived barriers, and facilitators influencing PC integration into routine HIV care within healthcare (HC) settings.

METHODOLOGY

A cross-sectional survey was conducted among WLWH in twelve HC facilities throughout Nigeria. Data collection involved surveys focused on PC knowledge, attitudes, facilitators, and barriers. Logistic regression analyses were employed to examine the data.

RESULTS

This study revealed significant gaps in knowledge and attitudes towards PC among HIV + women at NISA-MIRCs. Over 90% were unaware of PC services, but many saw its potential to offer hope (55%) and improve quality of life (56.5%). The key predictors of PC knowledge included education, occupation, religion, having fewer children, urban residence, type of residence, and having a high income (p < .05). Despite the willingness to access PC, barriers such as negative HC worker attitudes, perceived high cost, and limited decision autonomy could hinder integration. Facilitators included low-cost services, positive HCW attitudes, physician recommendations, and perceived necessity for personal well-being.

CONCLUSION

Knowledge gaps, diverse attitudes, and significant barriers highlight the need for targeted PC interventions for WLWH. Tailoring educational programs, addressing cost barriers, and improving healthcare infrastructure are crucial to enhancing PC accessibility and quality. These findings can guide policymakers and HC practitioners toward more effective and inclusive care strategies.

Assessing methodological quality in dental education research using MERSQI: Analysis of publications from two journals

PURPOSE

The Medical Education Research Study Quality Instrument (MERSQI) has been used frequently to assess the methodological quality of medical education but not for dental education. The present study aimed to assess the methodological quality using MERSQI scores of articles published in the Journal of Dental Education (JDE) and the European Journal of Dental Education (EJDE).

METHODS

A cross-sectional assessment of the quality of manuscripts published in 2012, 2017, and 2022 JDE and EJDE was conducted. MERSQI data, numbers of authors, first and corresponding author degrees, geographic origins, and funding information were also extracted for each included study. Descriptive and analytical statistics were conducted, and significance level was set at α < 0.05.

RESULTS

Four hundred ninety-five articles met the inclusion criteria. The most common study design was a single-group cross-sectional or single-group posttest and conducted in one institution for all studied years. In all journals and years, studies were assessed mainly by participants. The study outcome was mostly satisfaction, attitudes, perceptions, opinions, and general facts. The total mean MERSQI score for each journal and year varied. Year and geographic origin significantly affected the total MERSQI score. Papers originating from Asia had the highest score, followed by South America, Europe, North America, Oceania, and Africa.

CONCLUSION

MERSQI score is applicable to the assessment of the methodological quality of dental educational research. The MERSQI score for most of the domains was similar for both journals. The MERSQI score was affected by publication years and geographic origins.

Exploring the Interrelationships Between Physical Function, Functional Exercise Capacity, and Exercise Self-Efficacy in Persons Living with HIV

PURPOSE

To determine if there were differences between the subjective and objective assessments of physical activity while controlling for sociodemographic, anthropometric, and clinical characteristics.

SETTING/SAMPLE

A total of 810 participants across eight sites located in three countries.

MEASURES

Subjective instruments were the two subscales of Self-efficacy for Exercise Behaviors Scale: Making Time for Exercise and Resisting Relapse and Patient-Reported Outcomes Measurement Information System, which measured physical function. The objective measure of functional exercise capacity was the 6-minute Walk Test.

ANALYSIS

Both univariate and multivariant analyses were used.

RESULTS

Physical function was significantly associated with Making Time for Exercise (β = 1.76, p = .039) but not with Resisting Relapse (β = 1.16, p = .168). Age (β = -1.88, p = .001), being employed (β = 16.19, p < .001) and race (βs = 13.84-31.98, p < .001), hip-waist ratio (β = -2.18, p < .001), and comorbidities (β = 7.31, p < .001) were significant predictors of physical functioning. The model predicting physical function accounted for a large amount of variance (adjusted R2 = .938). The patterns of results predicting functional exercise capacity were similar. Making Time for Exercise self-efficacy scores significantly predicted functional exercise capacity (β = 0.14, p = .029), and Resisting Relapse scores again did not (β = -0.10, p = .120). Among the covariates, age (β = -0.16, p < .001), gender (β = -0.43, p < .001), education (β = 0.08, p = .026), and hip-waist ratio (β = 0.09, p = .034) were significant. This model did not account for much of the overall variance in the data (adjusted R2 = .081). We found a modest significant relationship between physical function and functional exercise capacity (r = 0.27).

CONCLUSIONS

Making Time for Exercise Self-efficacy was more significant than Resisting Relapse for both physical function and functional exercise capacity. Interventions to promote achievement of physical activity need to use multiple measurement strategies.

The middle-aged and older Chinese adults' health using actigraphy in Taiwan (MOCHA-T): protocol for a multidimensional dataset of health and lifestyle

BACKGROUND AND OBJECTIVES

Older adults keep transforming with Baby Boomers and Gen Xers being the leading older population. Their lifestyle, however, is not well understood. The middle-aged and older Chinese adults' health using actigraphy in Taiwan (MOCHA-T) collected both objective and subjective data to depict the health and lifestyle of this population. The objectives, design, and measures of the MOCHA-T study are introduced, and the caveats and future directions related to the use of the data are presented.

METHODS

People aged 50 and over were recruited from the community, with a subset of women aged 45-49 invited to supplement data on menopause and aging. Four instruments (i.e., self-reported questionnaires, diary, wrist actigraphy recorder, and GPS) were used to collect measures of sociodemographic, health, psychosocial, behavioral, temporal, and spatial data.

RESULTS

A total of 242 participants who returned the informed consent and questionnaires were recruited in the MOCHA-T study. Among them, 94.6%, 95.0%, and 25.2% also completed the diary, actigraphy, and GPS data, respectively. There was almost no difference in sociodemographic characteristics between those with and without a completed diary, actigraphy, and GPS data, except for age group and educational level for those who returned completed actigraphy data.

CONCLUSION

The MOCHA-T study is a multidimensional dataset that allows researchers to describe the health, behaviors, and lifestyle patterns, and their interactions with the environment of the newer generation of middle-aged and older adults in Taiwan. It can be compared with other countries with actigraphy and GPS-based lifestyle data of middle-aged and older adults in the future.

Webcam-based eye-tracking to measure visual expertise of medical students during online histology training

Objectives

Visual expertise is essential for image-based tasks that rely on visual cues, such as in radiology or histology. Studies suggest that eye movements are related to visual expertise and can be measured by near-infrared eye-tracking. With the popularity of device-embedded webcam eye-tracking technology, cost-effective use in educational contexts has recently become amenable. This study investigated the feasibility of such methodology in a curricular online-only histology course during the 2021 summer term.

Methods

At two timepoints (t1 and t2), third-semester medical students were asked to diagnose a series of histological slides while their eye movements were recorded. Students' eye metrics, performance and behavioral measures were analyzed using variance analyses and multiple regression models.

Results

First, webcam-eye tracking provided eye movement data with satisfactory quality (mean accuracy=115.7 px±31.1). Second, the eye movement metrics reflected the students' proficiency in finding relevant image sections (fixation count on relevant areas=6.96±1.56 vs. irrelevant areas=4.50±1.25). Third, students' eye movement metrics successfully predicted their performance (R2adj=0.39, p<0.001).

Conclusion

This study supports the use of webcam-eye-tracking expanding the range of educational tools available in the (digital) classroom. As the students' interest in using the webcam eye-tracking was high, possible areas of implementation will be discussed.

Understanding mental fatigue and its detection: a comparative analysis of assessments and tools

Mental fatigue has shown to be one of the root causes of decreased productivity and overall cognitive performance, by decreasing an individual's ability to inhibit responses, process information and concentrate. The effects of mental fatigue have led to occupational errors and motorway accidents. Early detection of mental fatigue can prevent the escalation of symptoms that may lead to chronic fatigue syndrome and other disorders. To date, in clinical settings, the assessment of mental fatigue and stress is done through self-reported questionnaires. The validity of these questionnaires is questionable, as they are highly subjective measurement tools and are not immune to response biases. This review examines the wider presence of mental fatigue in the general population and critically compares its various detection techniques (i.e., self-reporting questionnaires, heart rate variability, salivary cortisol levels, electroencephalogram, and saccadic eye movements). The ability of these detection tools to assess inhibition responses (which are sensitive enough to be manifested in a fatigue state) is specifically evaluated for a reliable marker in identifying mentally fatigued individuals. In laboratory settings, antisaccade tasks have been long used to assess inhibitory control and this technique can potentially serve as the most promising assessment tool to objectively detect mental fatigue. However, more studies need to be conducted in the future to validate and correlate this assessment with other existing measures of mental fatigue detection. This review is intended for, but not limited to, mental health professionals, digital health scientists, vision researchers, and behavioral scientists.

Academic boredom(s): a person-centered investigation

Should we refer to boredom or boredoms? Research on the emotion of boredom sets itself apart from studies on other emotions by posing the question: is boredom a singular concept or does it have multiple facets? In this manuscript presenting empirical research on academic boredom, our aim is to demonstrate the justification for claiming a distinct position. Person-centered models examining university students' achievement emotions reveal the existence of multiple types of boredom, in contrast to other learning emotions that are typically represented as singular constructs. Using data generated by dispositional learning analytics applications, we further investigate the progression of learning boredom over time, exploring the impact of the pandemic and analyzing how various student learning aptitudes, such as mindsets, epistemological beliefs, epistemic emotions, learning motivation, engagement, as well as demographic factors like gender and culture, can be considered as potential antecedents or triggers of boredom. Consistent with the control-value theory of achievement emotions, we conclude that control and value constructs serve as proximal antecedents of boredom, alongside epistemic boredom as a distal antecedent. However, the relationships between boredom and its antecedents exhibit notable variations across different types of boredom.

Understanding the Effects of Smart-Speaker-Based Surveys on Panelist Experience in Immersive Consumer Testing

Utilizing immersive technologies to reintroduce the environmental context (i.e., visual, auditory, and olfactory cues) in sensory testing has been one area of research for improving panelist engagement. The current study sought to understand whether pairing smart-speaker questionnaires in immersive spaces could positively affect the panelist experience through enhanced ecological validity. To this end, subjects performed an immersive consumer test in which responses were collected using a traditional computer-based survey, a smart-speaker approach incorporating a direct translation of the computer questionnaire into a verbal survey requiring numeric responses, and an optimized smart-speaker survey with alternative question formatting requiring spoken word-based responses. After testing, participants answered the Engagement Questionnaire (EQ) to assess participant engagement during the test, and the System Usability Scale (SUS) survey to understand the ease, and potential adoption, of using the various survey technologies in the study. Results indicated that the traditional computer-based survey was the most engaging (p < 0.001) and usable (p < 0.001), with no differences found between the two smart-speaker surveys (p = 0.803 and p = 0.577, respectively). This suggests that the proposed optimizations for the smart-speaker surveys were not robust enough to influence engagement and usability, and further research is needed to enhance their conversational capabilities.

Cartilage repair strategies in the knee according to Dutch Orthopedic Surgeons: a survey study

BACKGROUND

This study surveyed Dutch orthopedic surgeons on the management of cartilage defects in the knee and the adherence to the recently updated Dutch knee cartilage repair consensus statement (DCS).

METHODS

A web-based survey was sent to 192 Dutch knee specialists.

RESULTS

The response rate was 60%. Microfracture, debridement and osteochondral autografts are performed by the majority, 93%, 70% and 27% of respondents, respectively. Complex techniques are used by < 7%. Microfracture is mainly considered in defects 1-2 cm² (by > 80%) but also in 2-3 cm² (by > 40%). Concomitant procedures, e.g., malalignment corrections, are performed by 89%. Twenty-one percent of surgeons treat patients aged 40-60 years. Microfracture, debridement and autologous chondrocyte implantation are not considered to be highly affected by age > 40 years by any of the respondents (0-3%). Moreover, for the middle-aged there is a large spread in treatments considered. In case of loose bodies, the majority (84%) only performs refixation in the presence of attached bone.

CONCLUSION

Small cartilage defects in ideal patients may be well treated by general orthopedic surgeons. The matter becomes complicated in older patients, or in case of larger defects or malalignment. The current study reveals some knowledge gaps for these more complex patients. Referral to tertiary centers might be indicated, as is stated by the DCS, and this centralization should enhance knee joint preservation. Since the data from present study are subjective, registration of all separate cartilage repair cases should fuel objective analysis of clinical practice and adherence to the DCS in the future.

Memory-Enhancing Effect of 8-Week Consumption of the Quercetin-Enriched Culinary Herbs-Derived Functional Ingredients: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial

Due to great demand for memory enhancers, the memory-enhancing effects and the possible underlying mechanisms of the functional ingredients derived from the combined extract of Polygonum odoratum and Morus alba were investigated. A total of 45 participants randomly received either a placebo or the developed herbal supplement at a dose of 50 or 1500 mg/day. The consumption was done once daily for 8 weeks. Working memory was assessed via both an event-related potential and computerized battery tests at baseline and at the end of the 8-week study period. Acetylcholinesterase (AChE) and monoamine oxidase type A and type B (MAO-A, MAO-B) levels were also measured at the end of the study. The subjects who consumed the supplement containing a developed functional ingredient at a dose of 1500 mg/day showed reduced latencies but increased amplitudes of N100 and P300. An improvement in working memory and the suppression of AChE, MAO-A, and MAO-B activities were also observed. Therefore, this study clearly demonstrates the cognitive enhancing effect of the developed herbal congee, which may be associated with the suppressions of AChE and both types of MAO.

A survey of Canadian respiratory therapists working in the COVID-19 pandemic: The RRT perspective

Introduction

Registered respiratory therapists (RRTs) are heavily involved in the care of individuals infected with COVID-19. The experiences and challenges specific to the RRT profession during the pandemic have not been qualified and the aim of this study is to bridge that gap.

Methods

With institutional ethics approval, a cross-sectional survey was created through the survey software Redcap and made available online from 29 May to 6 July 2020. Any RRT working in Canada during the COVID-19 pandemic was eligible to participate. Responses to yes/no questions were calculated as frequencies and percentages, and free-text responses were summarized.

Results

In total, 345 RRTs working in 11/13 of the provinces and territories, with varying years of experience completed the survey. The results reflected impacts of the pandemic that affected RRTs in a variety of ways at work, from being reassigned (30.7%) to caring for COVID-19 positive patients (57.4%) and intubated COVID-19 positive patients (50.7%). RRTs experienced communication issues around guidelines (66.7%) and some departments had run out of personal protective equipment (PPE; 19%). RRTs were personally impacted, including feeling overwhelmed by new and frequently changing guidelines (89.6%) and feeling concerned for themselves or their family members becoming infected because of their proximity to COVID-19 positive patients (89%).

Discussion

RRTs reported being required to work more during the pandemic. The unpredictability and constantly changing schedules were sources of stress and anxiety. RRTs were faced with issues of overwhelming amounts of new information and had difficulty in disseminating it in a timely manner. Lack of guidance and lack of confidence in the current protocols added to the confusion, anxiety, and stress. RRTs were at the center of many high-risk moments for contracting the virus (intubation, extubation), and PPE shortages were a major challenge reported. RRTs working during the pandemic have been concerned for their own health and the health of their family members.

Conclusion

The COVID-19 pandemic adds another layer of stress for RRT professionals who are working in high-risk situations and feel anxious, overwhelmed, and concerned about their personal safety.

Integrative Proposals of Sports Monitoring: Subjective Outperforms Objective Monitoring

Current trends in sports monitoring are characterized by the massive collection of tech-based biomechanical, physiological and performance data, integrated through mathematical algorithms. However, the application of algorithms, predicated on mechanistic assumptions of how athletes operate, cannot capture, assess and adequately promote athletes' health and performance. The objective of this paper is to reorient the current integrative proposals of sports monitoring by re-conceptualizing athletes as complex adaptive systems (CAS). CAS contain higher-order perceptual units that provide continuous and multilevel integrated information about performer-environment interactions. Such integrative properties offer exceptional possibilities of subjective monitoring for outperforming any objective monitoring system. Future research should investigate how to enhance this human potential to contribute further to athletes' health and performance. This line of argument is not intended to advocate for the elimination of objective assessments, but to highlight the integrative possibilities of subjective monitoring.

Cystic fibrosis transmembrane conductance regulator function in patients with chronic pancreatitis

BACKGROUND

Pathogenesis of chronic pancreatitis (CP) is still not entirely understood with many patients probably having more than 1 underlying etiology. Besides toxic-metabolic factors, genetics contribute to disease development. Mutations in cystic fibrosis transmembrane conductance regulator (CFTR) are shown to increase risk for CP. Activity of CFTR can easily be accessed in vivo by measurement of nasal potential difference (PD).

METHODS

We compared in this monocentric study 17 CP patients from the outpatient unit of our university hospital with 30 healthy controls regarding nasal PDs by using a superfusion protocol. Additionally, demographic and lifestyle data of all persons were recorded.

RESULTS

Seventeen patients (12% female, median age 48 years) with CP and 30 healthy volunteers (47% female, 25 years) were included in the study. Patients with CP had a significant higher proportion of CFTR dysfunction (P = .04). Furthermore, demographics differed between the 2 groups with CP patients being older (P < .001). There were differences in daily alcohol consumption (P = .001) and smoking habits (smokers vs nonsmokers: P = .01, pack years: P = .002).

CONCLUSIONS

PD measurement is an easily accessible way to show CFTR dysfunction as an etiological factor of CP. Cigarette smoking might impair CFTR function and therefore be 1 preventable cause of CP evolution.

Ten year trends in hospital encounters for pediatric asthma: an Indiana experience

INTRODUCTION

Pediatric asthma is a common cause of emergency department visits, hospital admissions, and mortality. Population incidence studies have historically used large-scale survey data. We measured these epidemiologic trends using a health information exchange.

METHODS

In this retrospective cohort study, we used electronic health record data from a regional health information exchange to study clinical trends in pediatric patients presenting to the hospital for asthma in the State of Indiana. Data was obtained from 2010 to 2019 and included all patients ages 2-18 years. Study participants were identified using international classification of disease codes. The measured outcomes were number of hospital encounters per year, percentage of admissions per year, and mortality rates.

RESULTS

Data included 50,393 unique patients and 88,772 unique encounters, with 57% male patients. Over the ten-year period, hospital encounters ranged from 5000 to 8000 per year with no change in trajectory. Between 2010 and 2012, the percent of encounters admitted to the hospital was ∼30%. This decreased to ∼20-25% for 2015-2019. Patient mortality rates increased from 1 to 3 per 1000 patient encounters in 2010-2014 to between 5 and 7 per 1000 patient encounters from 2016 to 2019. White patients had a significantly higher admission percentage compared to other racial groups, but no difference in mortality rate.

CONCLUSIONS

Asthma continues to be a common condition requiring hospital care for pediatric patients. Regional health information exchanges can enable public health researchers to follow asthma trends in near real time, and have potential for informing patient-level public health interventions.

The impact of COVID-19 on road safety in Canada and the United States

The COVID-19 pandemic has led to the implementation of unprecedented public health measures. The effect of these lockdown measures on road safety remain to be fully understood, however preliminary data shows reductions in traffic volume and increases in risky driving behaviors. The objective of the present study is to compare self-reported risky driving behaviors (speeding, distracted driving, drinking and driving, and drugged driving) during the pandemic in Canada and the U.S. to determine what differences exist between these two countries. Data was collected using the Road Safety Monitor (RSM), an annual online public opinion survey that investigates key road safety issues, administered to a representative sample of N = 1,500 Canadian drivers and N = 1,501 U.S. drivers. Respondents were asked about the likelihood of engaging in risky driving during the pandemic as compared to before COVID-19. Results show the majority of respondents indicated their behavior did not change, and most positively, a small proportion reported they were less likely to engage in these risky driving behaviors. However, notable proportions indicated they were more likely to engage in risky driving behaviors during the pandemic, as compared to before COVID-19. Of those who indicated this, U.S. drivers had significantly higher percentages compared to their Canadian counterparts. Behaviors most often reported by this sub-section of drivers who admit to being more likely to engage in risky driving during the pandemic were speeding (7.6%) and drinking and driving (7.6%) in the U.S., and speeding (5.5%) and distracted driving (4.2%) in Canada. Logistic regression results confirm that country was a significant factor, as U.S. drivers had greater odds of reporting they were more likely to engage in these risky driving behaviors, with the exception of speeding. Age also had a significant effect, as increasing age was associated with lower odds of reporting that these risky driving behaviors were more likely during the pandemic. Conversely, sex did not have a significant effect. Overall, the current findings suggest that a small proportion of drivers reported being more likely to engage in risky driving behaviors and the pandemic may have led to changes in the profiles of those drivers engaging in risky driving behaviors during lockdown measures. These results have important implications for policies and can inform how to manage road safety during future lockdowns.

Prospective observational study to examine health-related quality of life and develop models to predict long-term patient-reported outcomes 6 months after hospital discharge with blunt thoracic injuries

OBJECTIVE

This study aimed to examine the long-term outcomes and health-related quality of life in patients with blunt thoracic injuries over 6 months from hospital discharge and develop models to predict long-term patient-reported outcomes.

DESIGN

A prospective observational study using longitudinal survey design.

SETTING

The study recruitment was undertaken at 12 UK hospitals which represented diverse geographical locations and covered urban, suburban and rural areas across England and Wales.

PARTICIPANTS

337 patients admitted to hospital with blunt thoracic injuries were recruited between June 2018-October 2020.

METHODS

Participants completed a bank of two quality of life surveys (Short Form-12 (SF-12) and EuroQol 5-Dimensions 5-Levels) and two pain questionnaires (Brief Pain Inventory and painDETECT Questionnaire) at four time points over the first 6 months after discharge from hospital. A total of 211 (63%) participants completed the outcomes data at 6 months after hospital discharge.

OUTCOMES MEASURES

Three outcomes were measured using pre-existing and validated patient-reported outcome measures. Outcomes included: Poor physical function (SF-12 Physical Component Score); chronic pain (Brief Pain Inventory Pain Severity Score); and neuropathic pain (painDETECT Questionnaire).

RESULTS

Despite a trend towards improving physical functional and pain at 6 months, outcomes did not return to participants perceived baseline level of function. At 6 months after hospital discharge, 37% (n=77) of participants reported poor physical function; 36.5% (n=77) reported a chronic pain state; and 22% (n=47) reported pain with a neuropathic component. Predictive models were developed for each outcome highlighting important data collection requirements for predicting long-term outcomes in this population. Model diagnostics including calibration and discrimination statistics suggested good model fit in this development cohort.

CONCLUSIONS

This study identified the recovery trajectories for patients with blunt thoracic injuries over the first 6 months after hospital discharge and present prognostic models for three important outcomes which after external validation could be used as clinical risk stratification scores.