Artificial intelligence-based prescription of personalized scalp cosmetics improved the scalp condition: efficacy results from 100 participants

Background: Scalp-related symptoms such as dandruff and itching are common with diverse underlying etiologies. We previously proposed a novel classification and scoring system for scalp conditions, called the scalp photographic index (SPI); it grades five scalp features using trichoscopic images with good reliability. However, it requires trained evaluators.Aim: To develop artificial intelligence (AI) algorithms for assessment of scalp conditions and to assess the feasibility of AI-based recommendations on personalized scalp cosmetics.Methods: Using EfficientNet, convolutional neural network (CNN) models (SPI-AI) ofeach scalp feature were established. 101,027 magnified scalp images graded according to the SPI scoring were used for training, validation, and testing the model Adults with scalp discomfort were prescribed shampoos and scalp serums personalized according to their SPI-AI-defined scalp types. Using the SPI, the scalp conditions were evaluated at baseline and at weeks 4, 8, and 12 of treatment.Results: The accuracies of the SPI-AI for dryness, oiliness, erythema, folliculitis, and dandruff were 91.3%, 90.5%, 89.6%, 87.3%, and 95.2%, respectively. Overall, 100 individuals completed the 4-week study; 43 of these participated in an extension study until week 12. The total SPI score decreased from 32.70 ± 7.40 at baseline to 15.97 ± 4.68 at week 4 (p < 0.001). The efficacy was maintained throughout 12 weeks.Conclusions: SPI-AI accurately assessed the scalp condition. AI-based prescription of tailored scalp cosmetics could significantly improve scalp health.

Preschoolers' retrospective and prospective judgements of immanent justice following distributive actions

Prior research provided evidence for retrospective and prospective judgements of immanent justice in adults, but the developmental origins of judgements of immanent justice remain unknown. Both retrospective and prospective judgements were investigated in preschool age, using explicit and implicit measures. In Experiment 1, 2.5- and 4-year-olds were first shown events in which one agent distributed resources fairly or unfairly, and then they saw test events in which both distributors were damaged by a misfortune. Later, they were presented with a verbal task, in which they had to respond to two questions on evaluation of the deservingness, by using explicit measures. All children were likely to approve of deserved outcomes when deeds and outcomes were congruent (i.e., unfair distributor-misfortune), and only older ones were likely to disapprove when they were incongruent (i.e., fair distributor-misfortune). In Experiment 2, 4-year-olds after seeing familiarization events of Experiment 1, were presented with two verbal questions to explore prospective judgements of immanent justice, by using explicit measures. In Experiment 3, 4-year-olds were first shown familiarization events of Experiment 1 and listened to respective narratives, then before the outcome was revealed they were assessed with a reaching task to investigate prospective judgements of immanent justice, by using implicit measures. Children reached the image depicting a bad outcome for the unfair distributor, and that illustrated a good outcome for the fair distributor. The results of the last two experiments demonstrated a fine ability to make prospective judgements at 4 years of life, and found that they were to be more prone to apply immanent justice reasoning to positive outcomes following good actions. Taken together, these results provide new evidence for preschoolers' retrospective and prospective judgements of immanent justice.

Leading in the development, standardised evaluation, and adoption of artificial intelligence in clinical practice: regional anaesthesia as an example

A recent study by Suissa and colleagues explored the clinical relevance of a medical image segmentation metric (Dice metric) commonly used in the field of artificial intelligence (AI). They showed that pixel-wise agreement for physician identification of structures on ultrasound images is variable, and a relatively low Dice metric (0.34) correlated to a substantial agreement on subjective clinical assessment. We highlight the need to bring structure and clinical perspective to the evaluation of medical AI, which clinicians are best placed to direct.

Variations in measurement of interprofessional core competencies: a systematic review of self-report instruments in undergraduate health professions education

Educating health care professionals for working in interprofessional teams is a key preparation for roles in modern healthcare. Interprofessional teams require members who are competent in their roles. Self-assessment instruments measuring interprofessional competence (IPC) are widely used in educational preparation, but their ability to accurately and reliably measure competence is unknown. We conducted a systematic review to identify variations in the characteristics and use of self-report instruments measuring IPC. Following a systematic search of electronic databases and after applying eligibility criteria, 38 articles were included that describe 8 IPC self-report instruments. A large variation was found in the extent of coverage of IPC core competencies as articulated by the Interprofessional Education Collaborative. Each instrument's strength of evidence, psychometric performance and uses varied. Rather than measuring competency as "behaviours", they measured indirect proxies for competence, such as attitudes towards core interprofessional competencies. Educators and researchers should identify the most appropriate and highest-performing IPC instruments according to the context in which they will be used.Systematic review registration: Open Science Framework (https://archive.org/details/osf-registrations-vrfjn-v1).

Artificial intelligence for ultrasound scanning in regional anaesthesia: a scoping review of the evidence from multiple disciplines

BACKGROUND

Artificial intelligence (AI) for ultrasound scanning in regional anaesthesia is a rapidly developing interdisciplinary field. There is a risk that work could be undertaken in parallel by different elements of the community but with a lack of knowledge transfer between disciplines, leading to repetition and diverging methodologies. This scoping review aimed to identify and map the available literature on the accuracy and utility of AI systems for ultrasound scanning in regional anaesthesia.

METHODS

A literature search was conducted using Medline, Embase, CINAHL, IEEE Xplore, and ACM Digital Library. Clinical trial registries, a registry of doctoral theses, regulatory authority databases, and websites of learned societies in the field were searched. Online commercial sources were also reviewed.

RESULTS

In total, 13,014 sources were identified; 116 were included for full-text review. A marked change in AI techniques was noted in 2016-17, from which point on the predominant technique used was deep learning. Methods of evaluating accuracy are variable, meaning it is impossible to compare the performance of one model with another. Evaluations of utility are more comparable, but predominantly gained from the simulation setting with limited clinical data on efficacy or safety. Study methodology and reporting lack standardisation.

CONCLUSIONS

There is a lack of structure to the evaluation of accuracy and utility of AI for ultrasound scanning in regional anaesthesia, which hinders rigorous appraisal and clinical uptake. A framework for consistent evaluation is needed to inform model evaluation, allow comparison between approaches/models, and facilitate appropriate clinical adoption.

Evaluation of Centers for Disease Control and Prevention's Evaluation Fellowship Program

OBJECTIVE

The Centers for Disease Control and Prevention's (CDC's) Evaluation Fellowship Program is a 2-year fellowship that includes training, placement with a CDC program, and professional development funds. We evaluated whether the program contributed to CDC's evaluation capacity, prepared fellows for evaluation work, and contributed to their career advancement during its first 10 years.

METHODS

We used a mixed-methods approach, including conducting an online survey and telephone interviews. External evaluators sent surveys to all 152 alumni and all 123 mentors who participated in the program from 2011 through 2020 (first 8 cohorts) and interviewed 9 mentors and 15 alumni.

RESULTS

A total of 110 alumni (72.4%) and 44 mentors (35.8%) completed surveys. Of 44 mentors, most agreed their fellow(s) contributed to their program's overall evaluation capacity (90.9%) and its ability to do more evaluation (88.6%). Most (84.2%-88.1%) alumni agreed that the Evaluation Fellowship Program prepared them to apply the 6 skill sets that aligned with CDC's Framework for Program Evaluation in Public Health. Support from the Fellowship office was significantly and positively correlated with performing evaluation tasks (β = 0.25; P = .004) and alumni obtaining their first job (β = 0.36; P < .001). Host program mentoring was significantly correlated with performing evaluation tasks (β = 0.27; P = .02) and alumni obtaining their first job (β = 0.34; P = .007).

CONCLUSION

CDC's Evaluation Fellowship Program has made progress toward building CDC's evaluation capacity and preparing a public health workforce to use evaluation skills in various settings. A service-learning model that provides training and applied experiences could prepare a workforce to build evaluation capacity.

Interrater reliability of face-to-face, tele- and video-based assessments with the modified Mallet classification in brachial plexus birth injuries

The modified Mallet classification is widely used to measure motor function in brachial plexus birth injuries. The aim of the study was to investigate agreement and reliability of this classification under three different evaluation conditions: face-to-face; live tele-assessment; and delayed video-based assessment. A total of 100 children aged 4-15 years were included. Children were assessed by two raters except for live tele-assessment, which was performed by four raters. Agreement between the three different assessment conditions for the same rater were between strong and excellent for both raters 1 and 2. The interrater reliability for raters 1 and 2 under different assessment conditions was strong to excellent. Interrater reliability among the four raters was moderate to strong in tele-assessment. The modified Mallet classification may have appropriate reliability to be used in remote medical follow-up.Level of evidence: III.

The Impact of Foreign Language Accent on Expert Listeners' Auditory-Perceptual Evaluations of Dysphonia

INTRODUCTION

Auditory-perceptual evaluations of dysphonia, though essential for comprehensive voice evaluation, are subject to listener bias. Knowledge of an underlying voice disorder can influence auditory-perceptual ratings. Accented speech results in increased listener effort and delays in word identification. Yet, little is known about the impact of foreign language accents on auditory-perceptual ratings for dysphonic speakers. The purpose of this work was to determine the impact of a foreign language accent on experts' auditory-perceptual ratings of dysphonic speakers.

METHODS

Twelve voice-specializing SLPs who spoke with a General American English (GAE) accent rated vocal percepts of 28 speakers with a foreign language accent and 28 with a GAE accent, all of whom had been diagnosed with a voice disorder. Speaker groups were matched based on sex, age, and mean smoothed cepstral peak prominence. Four linear mixed-effects models assessed the impact of a foreign language accent on expert auditory-perceptual ratings of the overall severity of dysphonia, roughness, breathiness, and strain.

RESULTS

The twelve raters demonstrated good inter- and intra-rater reliability (ICC[3, k] = .89; mean ICC = .89). The linear mixed-effects models revealed no significant impact of foreign language accent on ratings of overall severity of dysphonia, roughness, breathiness, or strain.

CONCLUSION

Despite the possibility of increased listener effort and bias, foreign language accent incongruence had no effect on expert listeners' auditory-perceptual evaluations for dysphonic speakers. Findings support the use of auditory-perceptual evaluations for voice disorders across sociolinguistically diverse populations.

LEVEL OF EVIDENCE

3 Laryngoscope, 134:2272-2276, 2024.

Reducing Firearm Access for Suicide Prevention: Implementation Evaluation of the Web-Based "Lock to Live" Decision Aid in Routine Health Care Encounters

Background

"Lock to Live" (L2L) is a novel web-based decision aid for helping people at risk of suicide reduce access to firearms. Researchers have demonstrated that L2L is feasible to use and acceptable to patients, but little is known about how to implement L2L during web-based mental health care and in-person contact with clinicians.

Objective

The goal of this project was to support the implementation and evaluation of L2L during routine primary care and mental health specialty web-based and in-person encounters.

Methods

The L2L implementation and evaluation took place at Kaiser Permanente Washington (KPWA)-a large, regional, nonprofit health care system. Three dimensions from the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) model-Reach, Adoption, and Implementation-were selected to inform and evaluate the implementation of L2L at KPWA (January 1, 2020, to December 31, 2021). Electronic health record (EHR) data were used to purposefully recruit adult patients, including firearm owners and patients reporting suicidality, to participate in semistructured interviews. Interview themes were used to facilitate L2L implementation and inform subsequent semistructured interviews with clinicians responsible for suicide risk mitigation. Audio-recorded interviews were conducted via the web, transcribed, and coded, using a rapid qualitative inquiry approach. A descriptive analysis of EHR data was performed to summarize L2L reach and adoption among patients identified at high risk of suicide.

Results

The initial implementation consisted of updates for clinicians to add a URL and QR code referencing L2L to the safety planning EHR templates. Recommendations about introducing L2L were subsequently derived from the thematic analysis of semistructured interviews with patients (n=36), which included (1) "have an open conversation," (2) "validate their situation," (3) "share what to expect," (4) "make it accessible and memorable," and (5) "walk through the tool." Clinicians' interviews (n=30) showed a strong preference to have L2L included by default in the EHR-based safety planning template (in contrast to adding it manually). During the 2-year observation period, 2739 patients reported prior-month suicide attempt planning or intent and had a documented safety plan during the study period, including 745 (27.2%) who also received L2L. Over four 6-month subperiods of the observation period, L2L adoption rates increased substantially from 2% to 29% among primary care clinicians and from <1% to 48% among mental health clinicians.

Conclusions

Understanding the value of L2L from users' perspectives was essential for facilitating implementation and increasing patient reach and clinician adoption. Incorporating L2L into the existing system-level, EHR-based safety plan template reduced the effort to use L2L and was likely the most impactful implementation strategy. As rising suicide rates galvanize the urgency of prevention, the findings from this project, including L2L implementation tools and strategies, will support efforts to promote safety for suicide prevention in health care nationwide.

Evaluation of Implicit Bias Training in Continuing Medical and Nursing Education to Address Racial Bias in Maternity Health Care Settings

OBJECTIVES

Implicit bias can affect clinical decisions that influence the care received by patients whose ancestors had been subjected to unfair medical and social practices. However, literature describing the effects of implicit bias training as part of continuing medical and nursing education is scarce. We conducted a longitudinal evaluation of a training for maternal health care clinical and nonclinical staff.

METHODS

A total of 80 staff members at 2 clinical sites in Cleveland, Ohio, participated in the training and evaluation in 2020 and 2021. We used a mixed-methods evaluation to capture changes in knowledge, awareness of bias, and application of strategies to reduce biased behavior by conducting pre- and posttraining surveys immediately after training and interviews at 3 and 6 months posttraining. We conducted univariate and bivariate analyses of the surveys and recorded, transcribed, and analyzed interviews for themes.

RESULTS

Using a threshold of answering 3 of 5 knowledge questions correctly, 50 of 80 (62.5%) trainees who engaged in the evaluation passed the pretraining knowledge questions and 67 (83.8%) passed the posttraining knowledge questions. Of the 80 participants, 75 (93.8%) were women. Interviewees (n = 11) said that low staff-to-patient ratios, lack of racial and ethnic diversity in leadership, inadequate training on implicit bias, and lack of institutional consequences for poor behavior exacerbated bias in maternity care. Interviewees reported having heightened awareness of bias and feeling more empowered after the training to advocate for themselves and patients to prevent and mitigate bias in the hospital.

CONCLUSION

Additional study describing the effect of implicit bias training as part of continuing medical education should be conducted, and administrative and management changes should also be made to prevent bias and improve quality of care.

The Olera.care Digital Caregiving Assistance Platform for Dementia Caregivers: Preliminary Evaluation Study

BACKGROUND

The increasing prevalence of Alzheimer disease and Alzheimer disease-related dementia in the United States has amplified the health care burden and caregiving challenges, especially for caregivers of people living with dementia. A web-based care planning tool, Olera.care, was developed to aid caregivers in managing common challenges associated with dementia care.

OBJECTIVE

This study aims to preliminarily evaluate the quality and usability of the Olera.care platform and assess the preferences of using the technology and interests in learning about different older adult care services among caregivers.

METHODS

For interview 1, we aim to understand caregiving needs and let the participants start engaging with the platform. After they engage with the platform, we schedule the second interview and let the participants complete the Mobile Application Rating Scale. The survey also included sociodemographic characteristics, caregiving experiences, communication preferences in technology adoption, and older adult care service use and interests. Descriptive statistics were used to describe the quality and usability of the platform and characteristics of the participants. We conducted 2-sample 2-tailed t tests to examine the differences in the Mobile Application Rating Scale evaluation scores by caregiver characteristics.

RESULTS

Overall, 30 adult caregivers in Texas completed the evaluation. The majority were aged ≥50 years (25/30, 83%), women (23/30, 77%), White (25/30, 83%), and financially stable (20/30, 67%). The Olera.care platform evaluation showed high satisfaction, with an overall mean rating of 4.57 (SD 0.57) of 5, and scored well in engagement (mean 4.10, SD 0.61), functionality (mean 4.46, SD 0.44), aesthetics (mean 4.58, SD 0.53), and information quality (mean 4.76, SD 0.44) consistently across all participants. A statistically significant difference (P=.02) was observed in functionality evaluation scores by duration of caregiving, with caregivers dedicating more hours to care rating it higher than those providing less care (mean 4.6, SD 0.4 vs mean 4.2, SD 0.5). In addition, caregivers with less caregiving experience reported significantly higher evaluation scores for aesthetics (P=.04) and information quality (P=.03) compared to those with longer years of caregiving. All participants expressed a willingness to recommend the app to others, and 90% (27/30) rated the app overall positively. Most of the participants (21/30, 70%) favored anonymous interactions before receiving personalized feedback and preferred computer browsers over mobile apps. Medical home health services were the most used, with a diverse range of services being used. Caregiver support groups, medical providers, memory care, meal services, and adult day care were among the most desired services for future exploration.

CONCLUSIONS

The Olera.care web-based platform is a practical, engaging, easy-to-use, visually appealing, and informative tool for dementia caregivers. Future development and research are essential to enhance the platform and comprehensively evaluate it among a broader population.

User-Centered Development of a Patient Decision Aid for Choice of Early Abortion Method: Multi-Cycle Mixed Methods Study

BACKGROUND

People seeking abortion in early pregnancy have the choice between medication and procedural options for care. The choice is preference-sensitive-there is no clinically superior option and the choice depends on what matters most to the individual patient. Patient decision aids (PtDAs) are shared decision-making tools that support people in making informed, values-aligned health care choices.

OBJECTIVE

We aimed to develop and evaluate the usability of a web-based PtDA for the Canadian context, where abortion care is publicly funded and available without legal restriction.

METHODS

We used a systematic, user-centered design approach guided by principles of integrated knowledge translation. We first developed a prototype using available evidence for abortion seekers' decisional needs and the risks, benefits, and consequences of each option. We then refined the prototype through think-aloud interviews with participants at risk of unintended pregnancy ("patient" participants). Interviews were audio-recorded and documented through field notes. Finally, we conducted a web-based survey of patients and health care professionals involved with abortion care, which included the System Usability Scale. We used content analysis to identify usability issues described in the field notes and open-ended survey questions, and descriptive statistics to summarize participant characteristics and close-ended survey responses.

RESULTS

A total of 61 individuals participated in this study. Further, 11 patients participated in think-aloud interviews. Overall, the response to the PtDA was positive; however, the content analysis identified issues related to the design, language, and information about the process and experience of obtaining abortion care. In response, we adapted the PtDA into an interactive website and revised it to include consistent and plain language, additional information (eg, pain experience narratives), and links to additional resources on how to find an abortion health care professional. In total, 25 patients and 25 health care professionals completed the survey. The mean System Usability Scale score met the threshold for good usability among both patient and health care professional participants. Most participants felt that the PtDA was user-friendly (patients: n=25, 100%; health care professionals: n=22, 88%), was not missing information (patients: n=21, 84%; health care professionals: n=18, 72%), and that it was appropriate for patients to complete the PtDA before a consultation (patients: n=23, 92%; health care professionals: n=23, 92%). Open-ended responses focused on improving usability by reducing the length of the PtDA and making the website more mobile-friendly.

CONCLUSIONS

We systematically designed the PtDA to address an unmet need to support informed, values-aligned decision-making about the method of abortion. The design process responded to a need identified by potential users and addressed unique sensitivities related to reproductive health decision-making.

Data-driven evaluation of electric vehicle energy consumption for generalizing standard testing to real-world driving

Standard energy-consumption testing, providing the only publicly available quantifiable measure of battery electric vehicle (BEV) energy consumption, is crucial for promoting transparency and accountability in the electrified automotive industry; however, significant discrepancies between standard testing and real-world driving have hindered energy and environmental assessments of BEVs and their broader adoption. In this study, we propose a data-driven evaluation method for standard testing to characterize BEV energy consumption. By decoupling the impact of the driving profile, our evaluation approach is generalizable to various driving conditions. In experiments with our approach for estimating energy consumption, we achieve a 3.84% estimation error for 13 different multiregional standardized test cycles and a 7.12% estimation error for 106 diverse real-world trips. Our results highlight the great potential of the proposed approach for promoting public awareness of BEV energy consumption through standard testing while also providing a reliable fundamental model of BEVs.

Evaluation of the Rural Interprofessional Behavioral Health Scholars Program to Expand Public Health Workforce Capacity During COVID-19

Mental health and substance use are growing nationwide public health concerns being exacerbated by the COVID-19 pandemic. At the same time, there is a dire shortage in the public health workforce. This paper shares the design and mixed-method outcome evaluation of a Behavioral Health Workforce Education and Training (BHWET)-funded rural, interprofessional, behavioral health training program (RIBHS) delivered during COVID-19 at one southeastern US public university. Twenty-six advanced year MSW students completed the RIBHS program. Data were collected from trainees via pre/post surveys and two focus groups. Trainees' self-reported statistically significant increases in teamwork, behavioral health, and rural practice competencies. Trainees also described how COVID-19 shaped their experience in the RIBHS program. The RIBHS program prepared trainees with the competencies needed to address the growing behavioral health crisis in the US and can serve as a training model for other social work and related public health workforce initiatives.

Can Chatbot Artificial Intelligence Replace Infectious Diseases Physicians in the Management of Bloodstream Infections? A Prospective Cohort Study

BACKGROUND

The development of chatbot artificial intelligence (AI) has raised major questions about their use in healthcare. We assessed the quality and safety of the management suggested by Chat Generative Pre-training Transformer 4 (ChatGPT-4) in real-life practice for patients with positive blood cultures.

METHODS

Over a 4-week period in a tertiary care hospital, data from consecutive infectious diseases (ID) consultations for a first positive blood culture were prospectively provided to ChatGPT-4. Data were requested to propose a comprehensive management plan (suspected/confirmed diagnosis, workup, antibiotic therapy, source control, follow-up). We compared the management plan suggested by ChatGPT-4 with the plan suggested by ID consultants based on literature and guidelines. Comparisons were performed by 2 ID physicians not involved in patient management.

RESULTS

Forty-four cases with a first episode of positive blood culture were included. ChatGPT-4 provided detailed and well-written responses in all cases. AI's diagnoses were identical to those of the consultant in 26 (59%) cases. Suggested diagnostic workups were satisfactory (ie, no missing important diagnostic tests) in 35 (80%) cases; empirical antimicrobial therapies were adequate in 28 (64%) cases and harmful in 1 (2%). Source control plans were inadequate in 4 (9%) cases. Definitive antibiotic therapies were optimal in 16 (36%) patients and harmful in 2 (5%). Overall, management plans were considered optimal in only 1 patient, as satisfactory in 17 (39%), and as harmful in 7 (16%).

CONCLUSIONS

The use of ChatGPT-4 without consultant input remains hazardous when seeking expert medical advice in 2023, especially for severe IDs.

RE-AIM for rural health innovations: perceptions of (mis) alignment between the RE-AIM framework and evaluation reporting in the Department of Veterans Affairs Enterprise-Wide Initiatives program

Background

The Department of Veterans Affairs (VA) Office of Rural Health (ORH) supports national VA program offices' efforts to expand health care to rural Veterans through its Enterprise-Wide Initiatives (EWIs) program. In 2017, ORH selected Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM), an implementation science framework, to structure the EWI evaluation and reporting process. As part of its mandate to improve EWI program evaluation, the Center for the Evaluation of Enterprise-Wide Initiatives conducted a qualitative evaluation to better understand EWI team' perceptions of, and barriers and facilitators to, the EWI evaluation process.

Methods

We conducted 43 semi-structured interviews with 48 team members (e.g., evaluators, program office leads, and field-based leads) representing 21 EWIs from April-December 2020. Questions focused on participants' experiences using strategies targeting each RE-AIM dimension. Interviews were inductively analyzed in MAXQDA. We also systematically reviewed 51 FY19-FY20 EWI annual reports to identify trends in misapplications of RE-AIM.

Results

Participants had differing levels of experience with RE-AIM. While participants understood ORH's rationale for selecting a common framework to structure evaluations, the perceived misalignment between RE-AIM and EWIs' work emerged as an important theme. Concerns centered around 3 sub-themes: (1) (Mis)Alignment with RE-AIM Dimensions, (2) (Mis)Alignment between RE-AIM and the EWI, and (3) (Mis)Alignment with RE-AIM vs. other Theories, Models, or Frameworks. Participants described challenges differentiating between and operationalizing dimensions in unique contexts. Participants also had misconceptions about RE-AIM and its relevance to their work, e.g., that it was meant for established programs and did not capture aspects of initiative planning, adaptations, or sustainability. Less commonly, participants shared alternative models or frameworks to RE-AIM. Despite criticisms, many participants found RE-AIM useful, cited training as important to understanding its application, and identified additional training as a future need.

Discussion

The selection of a shared implementation science framework can be beneficial, but also challenging when applied to diverse initiatives or contexts. Our findings suggest that establishing a common understanding, operationalizing framework dimensions for specific programs, and assessing training needs may better equip partners to integrate a shared framework into their evaluations.

An Empirical Evaluation of Prompting Strategies for Large Language Models in Zero-Shot Clinical Natural Language Processing: Algorithm Development and Validation Study

BACKGROUND

Large language models (LLMs) have shown remarkable capabilities in natural language processing (NLP), especially in domains where labeled data are scarce or expensive, such as the clinical domain. However, to unlock the clinical knowledge hidden in these LLMs, we need to design effective prompts that can guide them to perform specific clinical NLP tasks without any task-specific training data. This is known as in-context learning, which is an art and science that requires understanding the strengths and weaknesses of different LLMs and prompt engineering approaches.

OBJECTIVE

The objective of this study is to assess the effectiveness of various prompt engineering techniques, including 2 newly introduced types-heuristic and ensemble prompts, for zero-shot and few-shot clinical information extraction using pretrained language models.

METHODS

This comprehensive experimental study evaluated different prompt types (simple prefix, simple cloze, chain of thought, anticipatory, heuristic, and ensemble) across 5 clinical NLP tasks: clinical sense disambiguation, biomedical evidence extraction, coreference resolution, medication status extraction, and medication attribute extraction. The performance of these prompts was assessed using 3 state-of-the-art language models: GPT-3.5 (OpenAI), Gemini (Google), and LLaMA-2 (Meta). The study contrasted zero-shot with few-shot prompting and explored the effectiveness of ensemble approaches.

RESULTS

The study revealed that task-specific prompt tailoring is vital for the high performance of LLMs for zero-shot clinical NLP. In clinical sense disambiguation, GPT-3.5 achieved an accuracy of 0.96 with heuristic prompts and 0.94 in biomedical evidence extraction. Heuristic prompts, alongside chain of thought prompts, were highly effective across tasks. Few-shot prompting improved performance in complex scenarios, and ensemble approaches capitalized on multiple prompt strengths. GPT-3.5 consistently outperformed Gemini and LLaMA-2 across tasks and prompt types.

CONCLUSIONS

This study provides a rigorous evaluation of prompt engineering methodologies and introduces innovative techniques for clinical information extraction, demonstrating the potential of in-context learning in the clinical domain. These findings offer clear guidelines for future prompt-based clinical NLP research, facilitating engagement by non-NLP experts in clinical NLP advancements. To the best of our knowledge, this is one of the first works on the empirical evaluation of different prompt engineering approaches for clinical NLP in this era of generative artificial intelligence, and we hope that it will inspire and inform future research in this area.

How dyadic appraisal moderate the association between dyadic coping and diabetes management efficacy

To explore the moderating role of dyadic appraisal in the association between dyadic coping and diabetes management efficacy. Two hundred seventy six middle-aged and older couple pairs with one spouse who had diabetes were recruited from 14 community healthcare centers across Guangzhou. The moderating role of dyadic appraisal was investigated using the actor-partner interdependence moderation model. When both couples considered diabetes to be a shared condition, statistically-significant associations were found between patients' negative (β = -22.7, p = 0.008) and neutral behaviors (β = 13.6, p = 0.017), plus spouses' positive behaviors (β = 22.8, p = 0.009) on their own diabetes management efficacy, respectively (i.e. actor effects); as well as between spouses' positive (β = 16.8, p = 0.028), negative (β = -28.5, p  <  0.001), and neutral behaviors (β = 16.9, p = 0.006) on patient's diabetes management efficacy (i.e. partner effects). Dyadic appraisal moderates the association between dyadic coping and diabetes management efficacy.

Scalable Approach to Consumer Wearable Postmarket Surveillance: Development and Validation Study

Background

With the capability to render prediagnoses, consumer wearables have the potential to affect subsequent diagnoses and the level of care in the health care delivery setting. Despite this, postmarket surveillance of consumer wearables has been hindered by the lack of codified terms in electronic health records (EHRs) to capture wearable use.

Objective

We sought to develop a weak supervision-based approach to demonstrate the feasibility and efficacy of EHR-based postmarket surveillance on consumer wearables that render atrial fibrillation (AF) prediagnoses.

Methods

We applied data programming, where labeling heuristics are expressed as code-based labeling functions, to detect incidents of AF prediagnoses. A labeler model was then derived from the predictions of the labeling functions using the Snorkel framework. The labeler model was applied to clinical notes to probabilistically label them, and the labeled notes were then used as a training set to fine-tune a classifier called Clinical-Longformer. The resulting classifier identified patients with an AF prediagnosis. A retrospective cohort study was conducted, where the baseline characteristics and subsequent care patterns of patients identified by the classifier were compared against those who did not receive a prediagnosis.

Results

The labeler model derived from the labeling functions showed high accuracy (0.92; F1-score=0.77) on the training set. The classifier trained on the probabilistically labeled notes accurately identified patients with an AF prediagnosis (0.95; F1-score=0.83). The cohort study conducted using the constructed system carried enough statistical power to verify the key findings of the Apple Heart Study, which enrolled a much larger number of participants, where patients who received a prediagnosis tended to be older, male, and White with higher CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes, stroke, vascular disease, age 65-74 years, sex category) scores (P<.001). We also made a novel discovery that patients with a prediagnosis were more likely to use anticoagulants (525/1037, 50.63% vs 5936/16,560, 35.85%) and have an eventual AF diagnosis (305/1037, 29.41% vs 262/16,560, 1.58%). At the index diagnosis, the existence of a prediagnosis did not distinguish patients based on clinical characteristics, but did correlate with anticoagulant prescription (P=.004 for apixaban and P=.01 for rivaroxaban).

Conclusions

Our work establishes the feasibility and efficacy of an EHR-based surveillance system for consumer wearables that render AF prediagnoses. Further work is necessary to generalize these findings for patient populations at other sites.

Design and evaluation of a web-based electronic health record for amblyopia

Introduction

Amblyopia, or lazy eye, is a type of visual impairment in which the eyesight is not complete, even with the use of glasses. For the treatment of this disease, accurate and continuous examinations are needed. Nowadays, patient-centered care, by relying on web-based electronic records for amblyopia, has the potential to reduce treatment costs, increase the quality of care, and improve the safety and effectiveness of treatment. Therefore, the purpose of this study is to design and evaluate an Electronic Health Record (EHR) for patients with amblyopia.

Methods

The present study is applied developmental research. Using a Morgan table as a sampling tool, a straightforward random sampling technique selected 150 records from 1,500 records that were free of flaws. The design of the electronic version proceeded in a cascading manner so that after the design of each part, it was presented to the amblyopia experts, and if approved, the next part was designed. To design this EHR, the C# programming language and MySQL database were used. A system evaluation was performed by entering and recording patient information. For this purpose, the standard Questionnaire of User Interaction Satisfaction (QUIS), consisting of 18 questions, was used.

Results

According to the amblyopia EHR data elements, the data of physician and patient, examinations, website members, and members' roles were determined. After defining the fields and classes that explain the tables, the EHR was designed. The usability evaluation of the system showed that the mean selection of very good and good options by the users of EHRs was over 90%, indicating the patients' acceptance of web-based EHRs.

Conclusion

The design of an EHR for amblyopia is an effective step toward integrating and improving the information management of these patients. It will also enable the storage and retrieval of patients' information to reduce and facilitate the control of amblyopia complications.

Using ChatGPT in Psychiatry to Design Script Concordance Tests in Undergraduate Medical Education: Mixed Methods Study

Background

Undergraduate medical studies represent a wide range of learning opportunities served in the form of various teaching-learning modalities for medical learners. A clinical scenario is frequently used as a modality, followed by multiple-choice and open-ended questions among other learning and teaching methods. As such, script concordance tests (SCTs) can be used to promote a higher level of clinical reasoning. Recent technological developments have made generative artificial intelligence (AI)-based systems such as ChatGPT (OpenAI) available to assist clinician-educators in creating instructional materials.

Objective

The main objective of this project is to explore how SCTs generated by ChatGPT compared to SCTs produced by clinical experts on 3 major elements: the scenario (stem), clinical questions, and expert opinion.

Methods

This mixed method study evaluated 3 ChatGPT-generated SCTs with 3 expert-created SCTs using a predefined framework. Clinician-educators as well as resident doctors in psychiatry involved in undergraduate medical education in Quebec, Canada, evaluated via a web-based survey the 6 SCTs on 3 criteria: the scenario, clinical questions, and expert opinion. They were also asked to describe the strengths and weaknesses of the SCTs.

Results

A total of 102 respondents assessed the SCTs. There were no significant distinctions between the 2 types of SCTs concerning the scenario (P=.84), clinical questions (P=.99), and expert opinion (P=.07), as interpretated by the respondents. Indeed, respondents struggled to differentiate between ChatGPT- and expert-generated SCTs. ChatGPT showcased promise in expediting SCT design, aligning well with Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria, albeit with a tendency toward caricatured scenarios and simplistic content.

Conclusions

This study is the first to concentrate on the design of SCTs supported by AI in a period where medicine is changing swiftly and where technologies generated from AI are expanding much faster. This study suggests that ChatGPT can be a valuable tool in creating educational materials, and further validation is essential to ensure educational efficacy and accuracy.

Exploring a GPT-based large language model for variable autonomy in a VR-based human-robot teaming simulation

In a rapidly evolving digital landscape autonomous tools and robots are becoming commonplace. Recognizing the significance of this development, this paper explores the integration of Large Language Models (LLMs) like Generative pre-trained transformer (GPT) into human-robot teaming environments to facilitate variable autonomy through the means of verbal human-robot communication. In this paper, we introduce a novel simulation framework for such a GPT-powered multi-robot testbed environment, based on a Unity Virtual Reality (VR) setting. This system allows users to interact with simulated robot agents through natural language, each powered by individual GPT cores. By means of OpenAI's function calling, we bridge the gap between unstructured natural language input and structured robot actions. A user study with 12 participants explores the effectiveness of GPT-4 and, more importantly, user strategies when being given the opportunity to converse in natural language within a simulated multi-robot environment. Our findings suggest that users may have preconceived expectations on how to converse with robots and seldom try to explore the actual language and cognitive capabilities of their simulated robot collaborators. Still, those users who did explore were able to benefit from a much more natural flow of communication and human-like back-and-forth. We provide a set of lessons learned for future research and technical implementations of similar systems.

Prevalence, characteristics, evaluation, and management of carotid body tumors: Systematic analysis based on available evidence

BACKGROUND

Although carotid body tumors (CBTs) are rare, they attract particular attention because of their propensity for malignant transformation and the high surgical risk. Because data are scarce and as it is difficult to achieve a large sample size, no study has yet comprehensively analyzed the characteristics, management, or operative complications of CBTs. Therefore, we collected and analyzed all currently available information on CBTs and used the pooled data to derive quantitative information on disease characteristics and management.

METHODS

We systematically searched PubMed, Embase, the Cochrane Library, and the Web of Science up to 1 December 2022 for studies that investigated the characteristics and management of CBTs. The primary objective was to identify the prevalence of the various characteristics and the incidence of complications. The secondary objective was to compare patients who underwent preoperative embolization (PE) and those who did not (non-PE), as well as to compare patients with different Shamblin grades and those with and without succinate dehydrogenase (SDH) mutations in terms of CBT characteristics and complications. Two reviewers selected studies for inclusion and independently extracted data. All statistical analyses were performed using the standard statistical procedures of Review Manager 5.2 and Stata 12.0.

RESULTS

A total of 155 studies with 9,291 patients and 9,862 tumors were identified. The pooled results indicated that the median age of CBT patients was 45.72 years and 65% were female. The proportion of patients with bilateral lesions was 13%. In addition, 16% of patients had relevant family histories, and the proportion of those with SDH gene mutations was 36%. 16% patients experienced multiple paragangliomas and 12% CBTs had catecholamine function. The incidence of cranial nerve injury (CNI) was 27%, and 14% of patients suffered from permanent CNI. The incidence rates of operative mortality and stroke were both 1%, and 4% of patients developed transient ischemic attacks. Of all CBTs, 6% were malignant or associated with metastases or recurrences. The most common metastatic locations were the lymph nodes (3%) and bone (3%), followed by the lungs (2%). Compared to non-PE, PE reduced the estimated blood loss (EBL) (standardized mean difference [SMD] -0.95; 95% confidence interval [CI] -1.70, -0.20) and the operation time (SMD -0.56; 95% CI -1.03, -0.09), but it increased the incidence of stroke (odds ratio 2.44; 95% CI 1.04‒ 5.73). Higher Shamblin grade tumors were associated with more operative complications. SDH gene mutation-positive patients were more likely to have a relevant family history and had more symptoms.

CONCLUSIONS

CBT was most common in middle-aged females, and early surgical resection was feasible; there was a low incidence of serious operative complications. Routine PE is not recommended because this may increase the incidence of stroke, although PE somewhat reduced the EBL and operation time. Higher Shamblin grade tumors increased the incidence of operative complications. SDH gene mutation-positive patients had the most relevant family histories and symptoms.

Development of the electronic consultation long-term care utilization and savings estimator tool to model the potential impact of electronic consultation for residents living in long-term care

Ageing populations have resulted in more patients living in long-term care or nursing homes, where they face challenges to accessing prompt specialist care exacerbated in many cases by physical or cognitive decline. Electronic consultation has demonstrated an ability to improve access to specialist care for vulnerable groups and offers a potential solution to this gap in care. To support electronic consultation's uptake among long-term care homes, we created the electronic consultation long-term care utilization and savings estimator, an Excel-based tool that estimates the number of off-site appointments that patients in a long-term care home could avoid through electronic consultation, along with the consequent time and cost savings. In this brief report, we discuss the electronic consultation long-term care utilization and savings estimator's creation and function, and provide a case study using long-term care data to demonstrate its potential impact. We anticipate the electronic consultation long-term care utilization and savings estimator will be a highly impactful tool and intend to test it in real-world conditions following the relaxation of COVID-19 restrictions.

Are YouTube videos about skull bone anatomy useful for students?

The aim of this study was to evaluate the content, quality, and functionality of YouTube videos on the anatomy of skull bones and to measure their educational usefulness. In this cross-sectional study, the keywords "skull bones" and "skull anatomy" were searched in the YouTube search tab. Demographic data such as type, source, duration, upload date, and view rates of the videos were recorded. The quality and content of the videos were measured using the total content score (TCS), modified DISCERN scale, JAMA score, and Global Quality Scale (GQS). SPSS 26.0 software was used for statistical analysis. Twenty-five (34.7%) of the first 72 videos found by keyword searches were included in the study. According to the GQS criteria, six of them (24%) were considered useful and 19 (76%) not useful. There was a strong statistically significant correlation between the GQS and DISCERN scores (r = 0.813, p < 0.001). There were strong statistically significant positive correlations between TCS and GQS scores (r = 0.887, p < 0.001) and between TCS and modified DISCERN scores (r = 0.691, p < 0.001). Additionally, there was a moderately strong statistically significant positive correlation between GQS and JAMA scores (r = 0.507, p < 0.05). There were also moderately strong statistically significant correlations between JAMA score and DISCERN score (r = 0.521, p < 0.001), video length (r = 0.416, p < 0.05), number of comments (r = 0.457, p < 0.05), and number of "likes" (r = 0.608, p < 0.001). There was a moderately strong statistically significant positive correlation between TCS and JAMA scores (r = 0.431, p < 0.05). Most YouTube videos have insufficient information about skull bones to meet the expectations of medical and dental school curricula. Anatomists and institutions should be encouraged to prepare and present YouTube videos using assessment systems such as DISCERN, JAMA, GQS, and TCS, in line with current anatomy curricula.

Measuring the Impact of Patient Engagement in Health Research: An Exploratory Study Using Multiple Survey Tools

Background

Studies report various ways in which patients are involved in research design and conduct. Limited studies explore the influence of patient engagement (PE) at each research stage in qualitative research from the perspectives of all stakeholders.

Methods

We established two small research groups, a Patient Researcher-Led Group and an Academic Researcher-Led Group. We recruited patient research partners (PRP; n = 5), researchers (n = 5), and clinicians (n = 4) to design and conduct qualitative research aimed at identifying candidate attributes related to patient preferences for tapering biologic treatments in inflammatory bowel disease. We administered surveys before starting, two months into, and post-project work. The surveys contained items from three PE evaluation tools. We assessed the two groups regarding the influence and impact each stakeholder had during the different research stages.

Results

PRPs had a moderate or a great deal of influence on the critical research activities across the research stages. They indicated moderate/very/extremely meaningful engagement and agreed/strongly agreed impact of PE. PRPs helped operationalize the research question; design the study and approach; develop study materials; recruit participants; and collect and interpret the data.

Conclusion

The three tools together provide deeper insight into the influence of PE at each research stage. Lessons learnt from this study suggest that PE can impact many aspects of research including the design, process, and approach in the context of qualitative research, increasing the patient-centeredness of the study. More comprehensive validated tools are required that work with a more diverse subject pool and in other contexts.

Empowerment Self-Defense Intervention Outcomes: A Descriptive Review of Measures

Global research about empowerment self-defense (ESD)-a sexual assault resistance intervention recommended as a component of a comprehensive sexual assault prevention strategy-continues to emerge, with studies reporting positive effects, including reduced risk of sexual assault victimization. Researchers have suggested ESD may produce additional positive public health outcomes beyond the prevention of sexual violence, but more research is needed to understand the benefits associated with ESD training. However, to conduct high-quality research, scholars have suggested a need for improved measurement tools. To better understand these measurement gaps, the purpose of this study was to identify and review measures used in ESD outcome studies; and in doing so, to determine the range of outcomes previously measured in quantitative studies. Within the 23 articles meeting study inclusion criteria, there were 57 unique scales that measured a range of variables. These 57 measures were grouped into nine construct categories: assault characteristics (n = 1); attitudes and beliefs (n = 6); behavior and behavioral intentions (n = 12); fear (n = 4); knowledge (n = 3); mental health (n = 8); any past unwanted sexual experiences (n = 7); perception of risk and vulnerability (n = 5); and self-efficacy (n = 11). Except for mental health, most scales were developed in the Global North using college student populations, so measures for diverse populations (e.g., diverse in age, culture, ethnicity, geographical origin) are critically needed. Future research should focus on identifying and/or developing standardized tools that measure the full constellation of targeted outcomes. Evaluation of the methodological quality of studies assessing psychometric performance of the tools should also be prioritized.

Safety assessment of the substance 'phosphorous acid, triphenyl ester, polymer with 1,4-cyclohexanedimethanol and polypropylene glycol, C10-16 alkyl esters', for use in food contact materials

The EFSA Panel on Food Contact Materials, Enzymes and Processing Aids (CEP) assessed the safety of the substance 'phosphorous acid, triphenyl ester, polymer with 1,4-cyclohexanedimethanol and polypropylene glycol, C10-16 alkyl esters', when used as an additive in all types of polyolefins. The substance is a polymer containing ≤ 13% w/w of a low molecular weight fraction (LMWF, < 1000 Da). A polyethylene sample with 0.15% w/w of the substance was used in a comprehensive set of migration tests with food simulants. The specific migration was up to 0.014 and 0.023 mg/kg in 4% acetic acid and 10% ethanol, respectively. Migration into olive oil was estimated by the Panel to be up to 5.3 mg/kg under worst-case conditions of use. The migrating LMWF species were comprehensively identified. Those without phosphorous were either without alerts for genotoxicity or listed in Regulation (EU) 10/2011 with worst-case migrations well below their respective specific migration limits. Toxicological studies were performed using phosphite and phosphate versions of the substance enriched in its LMWF. The substance does not raise a concern for genotoxicity. From a repeated dose 90-day oral toxicity study in rats with a 50:50 phosphite:phosphate blend, the Panel identified a NOAEL of 250 mg/kg bw per day for each component of the blend. No delayed neurotoxicity in hens was observed. The CEP Panel concluded that the substance does not raise a safety concern for the consumer if its LMWF is not higher than 13% w/w, if it is used at up to 0.15% w/w in polyolefin materials and articles intended for contact with all food types, except for infant formula and human milk, for long-term storage at room temperature and below, after hot-fill and/or heating up to 100°C for up to 2 h, and if its migration does not exceed 5 mg/kg food.

Validation of the Measurement Approaches to Partnership Success (MAPS) Questionnaire

Conceptualizing and testing factors that contribute to the success of community-academic partnerships are critical to understanding their contributions to the health and well-being of communities. Most measures to date focus on factors that contribute to the development of new partnerships, and only a few have been adequately tested and validated. Methods. The Measurement Approaches to Partnership Success (MAPS) study followed a community-based participatory research (CBPR) approach and a multiphase process that included the construction and pilot testing of a questionnaire, and a national survey to validate the psychometric properties of the questionnaire in long-standing CBPR partnerships (existing ≥ six years). All members within partnerships were recruited to complete the survey (55 partnerships with 563 partners). We used confirmatory factor analysis (CFA), Cronbach's alpha statistics, and a pairwise correlations approach to assess discriminant and convergent validity, and assessed internal consistency, and test-retest reliability. Results. All MAPS Questionnaire dimensions demonstrated strong validity and reliability and demonstrated agreement over time. Conclusion. The MAPS Questionnaire includes seven dimensions and 81 items related to the MAPS conceptual model and provides a scientific, in-depth measurement tool that allows long-standing CBPR partnerships to evaluate their work toward achieving health equity.

Development and content validity of EVAD: A novel tool for evaluating and classifying the severity of adverse events for psychotherapeutic clinical trials

OBJECTIVE

Develop and obtain content validity of a new tool for Evaluating and Classifying the Severity of Adverse Events for Psychotherapeutic Clinical Trials (EVAD).

METHOD

Study of the development process of EVAD in four stages: (1) identify the domain and concept definition through a literature review, (2) instrument design, (3) expert judgment of the EVAD items through Gwent's concordance coefficient, and (4) applicability.

RESULTS

In the absence of a consistent conceptual framework of adverse events in psychotherapeutic clinical trials, we have developed a framework and defined it. We have designed EVAD items and their complementary tool for rating adverse events. Content validation by expert judges resulted in CVR = 1.0 for each item and CVI = 0.79 in sufficiency, 0.76 in clarity, 0.91 in coherence and 0.95 in relevance for all items (p < 0.001). Final version of EVAD were applied to three participants for 7 weeks. Overall EVAD seems to be clear and meaningful for participants.

CONCLUSIONS

EVAD is a semistructured interview based on a consistent conceptual framework, and proven content validity following the most important guidelines described in the literature.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT03878186.

"Breaking the silence" suicide Prevention media campaign in Oregon: Evaluation of impact on help-seeking and suicide mortality

INTRODUCTION

Research has established that suicide-related media can impact suicide rates both positively and negatively, supporting efforts to engage the media in the service of suicide prevention. The goal of the current study is to evaluate the impact of a suicide prevention media campaign implemented April 7-14, 2019 in Oregon.

METHODS

Several indices of help-seeking behavior and suicide risk were employed: suicide-related Google Health API searches, National Suicide Prevention Lifeline (Lifeline) (currently known as the 988 Suicide and Crisis Lifeline) call volume, and state suicide mortality data from April 7, 2016-May 6, 2019. Eight states with similar 2016-2018 average suicide rates were compared with Oregon. Bayesian structural time-series modeling in R was used to test intervention effects.

RESULTS

During the 30 days following the start of the campaign, there was a significant increase in Lifeline calls from Oregon area codes (2488 observed vs. 2283 expected calls, p = 0.03). There were no significant changes in suicide mortality or suicide-related Google searches in Oregon.

CONCLUSIONS

The campaign appeared to increase help-seeking behavior in the form of Lifeline calls, without any indication of an iatrogenic suicide contagion effect. However, the campaign's potential to reduce suicide mortality was unmet.

Renal cortex microperfusion evaluated by laser speckle contrast imaging in an ex vivo perfused kidney model-A proof-of-concept study

BACKGROUND

Validated quantitative biomarkers for assessment of renal graft function during normothermic machine perfusion (NMP) conditions are lacking. The aim of this project was to quantify cortex microperfusion during ex vivo kidney perfusion using laser speckle contrast imaging (LSCI), and to evaluate the sensitivity of LSCI when measuring different levels of renal perfusion. Furthermore, we aimed to introduce LSCI measurements during NMP in differentially damaged kidneys.

METHODS

Eleven porcine kidneys were nephrectomized and perfused ex vivo. Cortex microperfusion was simultaneously monitored using LSCI. First, a flow experiment examined the relationship between changes in delivered renal flow and corresponding changes in LSCI-derived cortex microperfusion. Second, renal cortical perfusion was reduced stepwise by introducing a microembolization model. Finally, LSCI was applied for measuring renal cortex microperfusion in kidneys exposed to minimal damage or 2 h warm ischemia (WI).

RESULTS

Cortex microperfusion was calculated from the LSCI-obtained data. The flow experiment resulted in relatively minor changes in cortex microperfusion compared to the pump-induced changes in total renal flow. Based on stepwise injections of microspheres, we observed different levels of cortex microperfusion that correlated with administrated microsphere dosages (r2 = 0.95-0.99). We found no difference in LSCI measured cortex microperfusion between the kidneys exposed to minimal damage (renal cortex blood flow index, rcBFI = 2090-2600) and 2 h WI (rcBFI = 2189-2540).

CONCLUSIONS

Based on this preliminary study, we demonstrated the feasibility of LSCI in quantifying cortex microperfusion during ex vivo perfusion. Furthermore, based on LSCI-measurements, cortical microperfusion was similar in kidneys exposed to minimal and 2 h WI.

Impact of Text-Based Monthly Check-Ins on Pre-Exposure Prophylaxis Retention at a Sexual Health Clinic

ABSTRACT

We conducted a retrospective cohort study of preexposure prophylaxis patients at the municipal Sexual Health Clinic in Seattle-King County, Washington from 2019 to 2021 to determine whether monthly check-in text messages impacted 4- and 6-month pre-exposure prophylaxis retention. Monthly check-ins did not appear to improve retention above and beyond open-ended texting and appointment reminders.

Assessment of knowledge, attitude and practice for oxygen therapy among medical staff at the Colonial War Memorial Hospital in Fiji

BACKGROUND

Oxygen therapy (OT) is a commonly prescribed essential medicine for people of all ages in the management of hypoxia. The adverse effects of inappropriate OT supplementation may be underestimated by health professionals and lead to poor health outcomes among hospitalised patients. Knowledge, attitude and practice (KAP) assessments of medical staff members to OT guidelines are essential to ensure optimal patient care.

AIMS

To perform a KAP assessment of OT administration among doctors and nurses employed at the national hospital of Fiji in 2021.

METHODS

Prospective cross-sectional study design. KAP assessment was performed with an online questionnaire and clinical observation.

RESULTS

The study population (N = 116) consisted of doctors (20.7%) and nurses (79.3%) representing the acute medical, burns, cardiac care, intensive care, surgical and postanaesthetic recovery units. Overall, the proportion of participants who obtained a good score (>70%) was 87% for knowledge, 87.93% for attitudes and 84% for practice. Best knowledge scores were obtained for general OT indications (71%) and scenarios where immediate oxygen application is required (70%). Lowest knowledge scores were for OT contraindications (14%) and oxygen saturation for acute myocardial infarction (32%), asthma (36%) and healthy newborns (43%). The most positive attitudes were in response to the statement that OT guidelines are essential (96%). A total of 78 (80.4%) patients were being cared for with good OT practice.

CONCLUSIONS

Good KAP scores were obtained for medical staff in Fiji regarding OT administration. Ongoing professional education activities should include updated training of OT contraindications and optimal oxygen saturation levels for special patient groups.

Using Ecometric Data to Explore Sources of Cross-Site Impact Variance in Multi-Site Trials

In 2003, Bloom, Hill, and Riccio (BHR) published an influential paper introducing novel methods for explaining the variation in local impacts observed in multi-site randomized control trials of socio-economic interventions in terms of site-level mediators. This paper seeks to improve upon this previous work by using student-level data to measure site-level mediators and confounders. Development of asymptotic behavior backed up with simulations and an empirical example. Students and training providers. Two simulations and an empirical application to data from an evaluation of the Health Professions Opportunity Grants (HPOG) Program. This empirical analysis involved roughly 6600 participants across 37 local sites. We examine bias and mean square error of estimates of mediation coefficients as well as the true coverage of nominal 95-percent confidence intervals on the mediation coefficients. Simulations suggest that the new methods generally improve the quality of inferences even when there is no confounding. Applying this methodology to the HPOG study shows that program-average FTE months of study by month six was a significant mediator of both career progress and long-term degree/credential receipt. Evaluators can robustify their BHR-style analyses by the use of the methods proposed here.

Executive summary of the KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease: known knowns and known unknowns

The Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease (CKD) updates the KDIGO 2012 guideline and has been developed with patient partners, clinicians, and researchers around the world, using robust methodology. This update, based on a substantially broader base of evidence than has previously been available, reflects an exciting time in nephrology. New therapies and strategies have been tested in large and diverse populations that help to inform care; however, this guideline is not intended for people receiving dialysis nor those who have a kidney transplant. The document is sensitive to international considerations, CKD across the lifespan, and discusses special considerations in implementation. The scope includes chapters dedicated to the evaluation and risk assessment of people with CKD, management to delay CKD progression and its complications, medication management and drug stewardship in CKD, and optimal models of CKD care. Treatment approaches and actionable guideline recommendations are based on systematic reviews of relevant studies and appraisal of the quality of the evidence and the strength of recommendations which followed the "Grading of Recommendations Assessment, Development, and Evaluation" (GRADE) approach. The limitations of the evidence are discussed. The guideline also provides practice points, which serve to direct clinical care or activities for which a systematic review was not conducted, and it includes useful infographics and describes an important research agenda for the future. It targets a broad audience of people with CKD and their healthcare, while being mindful of implications for policy and payment.

[The DoC-feeling scale, a paramedical assessment tool improving the diagnostic accuracy of the state of consciousness of non-communicative patients]

The Neurological Intensive Care Unit (ICU) at Pitié-Salpêtrière Hospital cares for patients with severe brain injuries, which can lead to acute or chronic disorders of consciousness. To assess the patient's state of consciousness, the team relies on precise clinical examination. This article presents the assessment tools used to establish the patient's prognosis.

Evaluation of a Nutrition Education and Skills Training programme in vulnerable adults who are at high risk of food insecurity

BACKGROUND

In Australia, the prevalence of food insecurity increased by 1.5% between 2014 and 2016 and 2018 and 2020 due to effects of the COVID-19 pandemic. OzHarvest offers a 6-week Nutrition Education and Skills Training (NEST) programme to adults at risk of food insecurity. NEST provides 2.5-h weekly cooking workshops on simple, healthy and affordable meals. This study aimed to determine the immediate (post) and longer-term (6 months) impacts of participation in NEST.

METHODS

A quasi-experimental study with pre-post surveys (n = 258) and 6-month follow-up surveys (n = 20) was conducted from June 2019 to July 2022. Survey results were obtained from NEST programme participants (≥18 years) from six major Australian cities.

RESULTS

Participants demonstrated immediate improvement in nutrition knowledge (p < 0.001), food preparation behaviours (p < 0.001) and confidence and self-efficacy (n = 222; p < 0.001). Intake of discretionary foods decreased (p < 0.001), whereas fruit, vegetable and water intake increased (p < 0.001). Food security improved from 57% to 68% immediately after the completion of the programme (p < 0.001). Participants demonstrated longer-term improvements in nutrition knowledge (p < 0.001), cooking confidence (n = 8; p = 0.03), food preparation behaviours (p = 0.003) and increased vegetable (p = 0.03) and fruit intake (p = 0.01).

CONCLUSIONS

Participation in OzHarvest's NEST programme results in short-term improvements in food security levels and dietary behaviours. Over the longer term, these changes were sustained but to a lesser degree, indicating that systemic changes are required to address underlying socio-economic disadvantages.

Promoting diversity in geoheritage evaluation: creating an evaluation method for the scientific value of Quaternary sites in arid environments

A rigorous assessment is an essential part of geoconservation, and choosing an appropriate evaluation method is essential for this process. Globally, an increasing number of sites are being assessed for their geoheritage values, but the most popular methods have been created by researchers with experiences centred in Europe, without considerations of regional differences. To understand whether regional perspectives are required in the evaluation process, this study developed a new method targeting the scientific value of Quaternary geoheritage sites in arid environments, using input from 49 researchers in geosciences and related disciplines with interests in arid landscapes. The results demonstrated the need for a new or modified method, given the different preferences in the weighting system and the necessity to include additional criteria specific to the type of sites targeted by the study. The strong preference to include a new criterion on connections with archaeology/anthropology highlighted the significance of the interdisciplinary scientific values of Quaternary geoheritage sites in arid environments. These findings imply the need for regional diversity or adjustments in geoheritage evaluation. Future research is required to consider such differences for geoheritage values beyond the scientific dimension, such as educational values and touristic values in diverse geographical settings. This article is part of the Theo Murphy meeting issue 'Geodiversity for science and society'.

A preliminary exploration of conversation sampling in pediatric voice disorders

OBJECTIVE

Current methods of eliciting running speech for subjective rating, or perceptual analysis, in the assessment of pediatric voice disorders are not standardized. Whilst different assessment tools have different requirements, a commonality is the requirement to judge the perceptual characteristics of the individual's everyday speaking voice. However, it is unclear whether current practices yield ecologically valid running speech samples. The aim of this study was to analyse the length and characteristics of conversational responses, to stimuli that were designed to elicit running speech samples from pediatric clients.

METHOD

Twenty conversations, conducted as part of the evaluation of voice in a pediatric population, were analysed. Length of responses, number of responses and question types were recorded.

RESULTS

The median maximum utterance length was 15.9 s; seven participants presented with a maximum of less than 10 s. Response length was significantly associated with question type, F = 10.68, p<.001. The most frequent number of responses produced was 11 (range = 17, IQR = 5, 11). There was a moderate correlation between response length and number of responses, r(18)=.53, p=.02.

DISCUSSION

These data demonstrated that informal conversational methods did not consistently yield running speech samples of greater than 10 s in length, the minimum sample length recommended by the CAPE-V protocol. There was considerable variability in the characteristics of the responses produced by participants. Using a task such as a narrative re-tell might allow for better standardization of responses, including elicitation of vocal behaviors of interest, as well as yield a longer sample.

Gender and Professional Title Use in Internal Medicine Resident Narrative Assessments

Background: Residency is a time of personal and professional growth. Resident assessment and feedback are an integral part of that process. However, assessment may be influenced by various types of bias, including gender bias. Women are less likely than men to be identified by their professional titles in many settings. The use of professional titles for residents in written assessments is unknown and may be a marker of bias. Objective: To assess for differences and trends regarding the use of professional and personal titles in formal resident assessments related to gender-based resident-faculty pairs. Methods: Electronic assessments of postgraduate year 1 (PGY1) internal medicine residents from the 2019-2020 academic year were used. Professional title use was analyzed, as it relates to resident-faculty gendered dyads, among other variables. The primary outcome of professional title usage was split into a binary variable by professional versus other titles and analyzed using logistic regression and random-effects model. Results: We analyzed 1,363 unique electronic assessments (37.8% from female faculty). Female residents were more likely to be addressed by a professional title than their male colleagues (odds ratio [OR], 1.7; confidence interval [CI], 1.2-2.4; p = 0.02). We found no difference in professional title usage based on resident-faculty gendered dyads. After adjusting for repeated faculty and resident encounters with random-effects model, secondary analysis found no significant difference in evaluation of word count between gendered dyads. Conclusions: The analysis found no significant difference in professional title usage based on resident-faculty dyads. In our analysis, female residents were significantly more likely to have their professional title used on assessments than male residents.

A preliminary analysis of passport to practice: investigating development of core competencies in undergraduate health promotion students

BACKGROUND

Equipping tertiary health promotion students with skills and knowledge to contribute meaningfully to the health promotion workforce begins with enhancing their health promotion competence via well-designed curriculum. This includes a focus on work-integrated learning, global citizenship, professional identity and competency mapping in line with the International Union for Health Promotion and Education Core Competencies and Professional Standards for Health Promotion.

METHODS

In this paper we report baseline results for the Passport to Practice project, a mixed-methods prospective cohort study to track undergraduate health promotion student progress across their degree, to evaluate a new approach for assessing student achievement of the Competencies and Standards developed by the International Union for Health Promotion and Education. Baseline data were collected from first-year students via document analysis of student reflection papers (n = 40); and an online survey (n = 29) to measure self-reported health promotion competence, development of global citizenship and professional identity, and PebblePad usability.

RESULTS

Findings suggest the Passport to Practice initiative positively contributed to professional identity and health promotion competence. Students appreciated work-integrated learning opportunities that enabled them to plan for future activities to address gaps in their competence; and students excelled in the social responsibility dimension of global citizenship but lagged in the political voice category of the global civic engagement dimension.

CONCLUSION

Findings provide insights about strategies and concepts required to equip students with the skills and knowledge required for their role as health promotion practitioners to address complex public health challenges.

Translation, Transcultural Adaptation, and Validation of the Brazilian Portuguese Version of the Body Image Disturbance Questionnaire for Scoliosis (BR-BIDQ-S)

Objective  The Body Image Disturbance Questionnaire for Scoliosis (BIDQ-S) for scoliosis derives from the Body Image Disturbance Questionnaire (BIDQ) with specific adaptation for scoliosis patients. Despite its significance and applicability, this instrument has never been translated into Brazilian Portuguese. The current study aimed to translate, transculturally adapt, and validate the BIDQ-S into Brazilian Portuguese. Methods  BIDQ-S was translated and culturally adapted into Brazilian Portuguese using the American Association of Orthopedic Surgeons (AAOS) criteria. The questionnaire validation relied on internal consistency and comparison with the Cobb angle, Pediatric Quality of Life Inventory (PedsQL), and Scoliosis Research Society (SRS-22). The Brazilian version (BR-)BIDQ-S validation occurred in a sample of 35 adolescents with scoliosis waiting for specialized treatment. Results  Internal consistency of the BR-BIDQ-S was 0.899 according to the Cronbach's index (i.e., virtually perfect). Although BR-BIDQ-S did not correlate with the Cobb angle, it presented correlations with the Physical, Emotional, and Social domains from the PedsQL and the Function/Activity domain from the SRS-22. Conclusion  BR-BIDQ-S was reliable in evaluating the body image of adolescents with scoliosis, presenting an internal consistency of 0,899 (virtually perfect). Moreover, similar to the original instrument, it correlated with PedsQL and SRS-22.

Suggestion for Objective Evaluation of Comparative Pulse Diagnosis

Objectives

Pulse is a method of Korean medicine diagnosis and is an important clue to detect the organs, nature, and progress of the disease. Pulse examination is included in the basic examination of Korean medicine doctors, but there is no standardized method for diagnosing pulse although the types and methods of the pulse taking are briefly described in the literature, making it difficult to spread the examination method. In this regard, I would like to propose an objective evaluation method.

Methods

Although the importance of pulse examination and the method of pulse examination are known in the literature, it is difficult for undergraduate students or inexperienced Korean medicine doctors to access it, so in this paper a method of marking the size of the pulse power in the blank space for objective evaluation was devised and presented.

Results

The size of the pulse power should be indicated using the 1-cell, 3-cell, or 5-cell method according to the left and right wrists and the cun, guan and chi on both sides.

Conclusion

The method of pulse diagnosis is an important diagnostic method as a verification process for making a Korean medical diagnosis. The remaining Korean medicine diagnostic methods, including pulse diagnosis, also need to undergo objectification. It is believed that the objectification of these diagnostic methods will lead to an improvement in the treatment rate of Korean medicine.

Creating and running an escape room for healthcare curricula: AMEE Guide No. 168

In this guide we provide instructions and recommendations about creating and running escape rooms for healthcare education. In recent years there has been a growing interest in adopting escape rooms as an educational tool to be included in healthcare curricula, and we attempt to explain why and how these tools are fit for the particularities of this type of education. We first describe the steps that a design team will have to follow to create an educational escape room from scratch, from core characteristics like target audience and learning goals to actual puzzle design and testing. We then continue by providing recommendations to operators and lecturers about how to run such escape room as part of an overall teaching session that also includes a lecture, briefing, debriefing and evaluation. We finalise this guide by listing a set of tools for validating and evaluating these types of escape rooms.

Telehealth Evaluation in the United States: Protocol for a Scoping Review

BACKGROUND

The rapid expansion of telehealth services, driven by the COVID-19 pandemic, necessitates systematic evaluation to guarantee the quality, effectiveness, and cost-effectiveness of telehealth services and programs in the United States. While numerous evaluation frameworks have emerged, crafted by various stakeholders, their comprehensiveness is limited, and the overall state of telehealth evaluation remains unclear.

OBJECTIVE

The overarching goal of this scoping review is to create a comprehensive overview of telehealth evaluation, incorporating perspectives from multiple stakeholder categories. Specifically, we aim to (1) map the existing landscape of telehealth evaluation, (2) identify key concepts for evaluation, (3) synthesize existing evaluation frameworks, and (4) identify measurements and assessments considered in the United States.

METHODS

We will conduct this scoping review in accordance with the Joanna Briggs Institute (JBI) methodology for scoping reviews and in line with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). This scoping review will consider documents, including reviews, reports, and white papers, published since January 1, 2019. It will focus on evaluation frameworks and associated measurements of telehealth services and programs in the US health care system, developed by telehealth stakeholders, professional organizations, and authoritative sources, excluding those developed by individual researchers, to collect data that reflect the collective expertise and consensus of experts within the respective professional group.

RESULTS

The data extracted from selected documents will be synthesized using tools such as tables and figures. Visual aids like Venn diagrams will be used to illustrate the relationships between the evaluation frameworks from various sources. A narrative summary will be crafted to further describe how the results align with the review objectives, facilitating a comprehensive overview of the findings. This scoping review is expected to conclude by August 2024.

CONCLUSIONS

By addressing critical gaps in telehealth evaluation, this scoping review protocol lays the foundation for a comprehensive and multistakeholder assessment of telehealth services and programs. Its findings will inform policy makers, health care providers, researchers, and other stakeholders in advancing the quality, effectiveness, and cost-effectiveness of telehealth in the US health care system.

TRIAL REGISTRATION

OSF Registries osf.io/aytus; https://osf.io/aytus.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/55209.

Performance evaluation of a novel platelet count parameter, hybrid platelet count, on the BC-780 automated hematology analyzer

OBJECTIVES

Automated hematology analysis is expected to improve the performance of platelet counting. We evaluated the performance of a new platelet counting, hybrid (PLT-H) and also impedance (PLT-I) and optical (PLT-O) on the BC-780 automated hematology analyzer compared to the international reference method (IRM) in blood samples with thrombocytopenic and platelet interference.

METHODS

The basic platelet count performance of the BC-780 automated hematology analyzer was evaluated according to the requirements of the Clinical Laboratory and Standards Institute (CLSI) Document H26-A2. Additionally, the thrombocytopenic (low PLT count) blood samples and the platelet interference blood samples including fragmented red blood cells (RBCs), microcytes or small RBCs, and giant platelets were determined with the BC-780 hematology analyzer compared to the IRM.

RESULTS

Blank counting and the carry-over contamination rate of platelet count using the BC-780 both met the manufacturers' claim. For both 123 thrombocytopenic and 232 platelet interference blood samples (72 fragmented RBCs, 91 microcytes and 51 giant platelets), all three platelet counting methods exhibited high comparability with the IRM (the lowest correlation (r)=0.916). Interestingly, the comparability of PLT-H (r=0.928-0.986) with the IRM was better than that of PLT-I (r=0.916-0.979).

CONCLUSIONS

The performance of PLT-H in the BC-780 met the manufacturer's specifications. PLT-H exhibits better reproducibility than did PLT-I, correlates well with the PLT-O for thrombocytopenic samples and demonstrates good anti-interference ability. PLT-H counting is therefore recommended as a zero-cost alternative platelet counting method for platelet interference samples in clinical settings.

Optimizing biochar application for enhanced cotton and sugar beet production in Xinjiang: a comprehensive study

BACKGROUND

Optimizing biochar application is vital for enhancing crop production and ensuring sustainable agricultural production. A 3-year field experiment was established to explore the effects of varying the biochar application rate (BAR) on crop growth, quality, productivity and yields. BAR was set at 0, 10, 50 and 100 t ha-1 in 2018; 0, 10, 25, 50 and 100 t ha-1 in 2019; and 0, 10, 25 and 30 t ha-1 in 2020. Crop quality and growth status and production were evaluated using the dynamic technique for order preference by similarity to ideal solution with the entropy weighted method (DTOPSIS-EW), principal component analysis (PCA), membership function analysis (MFA), gray relation analysis (GRA) and the fuzzy Borda combination evaluation method.

RESULTS

Low-dose BAR (≤ 25 t ha-1 for cotton; ≤ 50 t ha-1 for sugar beet) effectively increased biomass, plant height, leaf area index (LAI), water and fertility (N, P and K) productivities, and yield. Biochar application increased the salt absorption and sugar content in sugar beet, with the most notable increases being 116.45% and 20.35%, respectively. Conversely, BAR had no significant effect on cotton fiber quality. The GRA method was the most appropriate for assessing crop growth and quality. The most indicative parameters for reflecting cotton and sugarbeet growth and quality status were biomass and LAI. The 10 t ha-1 BAR consistently produced the highest scores and was the most economically viable option, as evaluated by DTOPSIS-EW.

CONCLUSION

The optimal biochar application strategy for improving cotton and sugar beet cultivation in Xinjiang, China, is 10 t ha-1 biochar applied continuously. © 2024 Society of Chemical Industry.

Implementation support for the data-driven components of care in a multisite network of coordinated specialty care programs

Beyond training providers prior to the roll-out of coordinated specialty care (CSC) for first-episode psychosis in clinical settings, implementation support for data-informed care remains an area that has received very little attention. The current paper describes the development and refinement of implementation support for the data-driven components of care in the New Journeys network, Washington State's CSC model for psychosis, comprised of 14 CSC programs. Using the Evidence-Based System for Innovation Support Logic Model, this paper outlines the individual components for implementation support, tools, training, technical assistance, and quality improvement/evaluation that have been developed for the New Journeys network. We present examples of modifications that have occurred over nine years to address the needs of clients, providers, and state-level network administrators to facilitate the data-driven components of care. We conclude with recommendations based on lessons learned in Washington State aimed at improving implementation of data-driven care in CSC models throughout the USA.