The prevalence of constipation in adult psychiatric out-patients on clozapine treatment at a regional public hospital in Hong Kong

OBJECTIVE

To determine the occurrence of constipation in local patients on clozapine treatment, and to compare the demographical and clinical characteristics of patients on clozapine treatment with or without constipation.

METHODS

This is a cross-sectional, observational study. All adult psychiatric out-patients on clozapine treatment attending follow-up at a regional hospital were recruited for clinical interview and medical record review. The Enhanced Asian Rome III Questionnaire (EAR3Q) was used to define patients with constipation. The Bristol Stool Form Scale (BSFS) was used to assess stool form. The Brief Psychiatric Rating Scale-Anchored (BPRS-A) was used to measure psychiatric symptoms. The Brief Medication Adherence Scale (BMAS) was used to assess treatment adherence. Logistic regression was conducted to identify independent associating factors of constipation in patients on clozapine treatment.

RESULTS

The prevalence of constipation in patients on clozapine treatment was 26.3%, (95% CI [21.5%, 31.6%]). Independent associating factors included disorder of psychological development (aOR = 6.98, 95% CI [1.24, 39.18]), anxiety (very mild: aOR = 9.23, 95% CI [2.59, 32.87]; mild: aOR = 2.66, 95% CI [1.26, 5.62]), prescription with combination of laxatives (aOR = 0.40, 95% CI [0.17, 0.95]), and concomitant use of amisulpride (aOR = 2.52, 95% CI [1.09, 5.82]), quetiapine (aOR = 5.92, 95% CI [1.11, 31.56]) and metamucil (aOR = 9.30, 95% CI [1.53, 56.58]).

CONCLUSION

This study examined the prevalence of clozapine-associated constipation in Hong Kong using a validated questionnaire. The identification of independent factors associated with constipation could facilitate better risk stratification and risk modification in clinical practice.

First They Scream, Then They Laugh: The Cognitive Intersections of Humor and Fear

On the surface, fear and humor seem like polar opposite states of mind, yet throughout our lives they continually interact. In this paper, we synthesize neurobiological, psychological, and evolutionary research on fear and humor, arguing that the two are deeply connected. The evolutionary origins of humor reside in play, a medium through which animals benignly explore situations and practice strategies, such as fight or flight, which would normally be accompanied by fear. Cognitively, humor retains the structure of play. Adopting a view of humor as requiring two appraisals, a violation appraisal and a benign appraisal, we describe how fear-inducing stimuli can be rendered benignly humorous through contextual cues, psychological distance, reframing, and cognitive reappraisal. The antagonistic relationship between humor and fear in terms of their neurochemistry and physiological effects in turn makes humor ideal for managing fear in many circumstances. We review five real-world examples of humor and fear intersecting, presenting new data in support of our account along the way. Finally, we discuss the possible therapeutic relevance of the deep connection between humor and fear.

Exploring factors influencing user perspective of ChatGPT as a technology that assists in healthcare decision making: A cross sectional survey study

As ChatGPT emerges as a potential ally in healthcare decision-making, it is imperative to investigate how users leverage and perceive it. The repurposing of technology is innovative but brings risks, especially since AI's effectiveness depends on the data it's fed. In healthcare, ChatGPT might provide sound advice based on current medical knowledge, which could turn into misinformation if its data sources later include erroneous information. Our study assesses user perceptions of ChatGPT, particularly of those who used ChatGPT for healthcare-related queries. By examining factors such as competence, reliability, transparency, trustworthiness, security, and persuasiveness of ChatGPT, the research aimed to understand how users rely on ChatGPT for health-related decision-making. A web-based survey was distributed to U.S. adults using ChatGPT at least once a month. Bayesian Linear Regression was used to understand how much ChatGPT aids in informed decision-making. This analysis was conducted on subsets of respondents, both those who used ChatGPT for healthcare decisions and those who did not. Qualitative data from open-ended questions were analyzed using content analysis, with thematic coding to extract public opinions on urban environmental policies. Six hundred and seven individuals responded to the survey. Respondents were distributed across 306 US cities of which 20 participants were from rural cities. Of all the respondents, 44 used ChatGPT for health-related queries and decision-making. In the healthcare context, the most effective model highlights 'Competent + Trustworthy + ChatGPT for healthcare queries', underscoring the critical importance of perceived competence and trustworthiness specifically in the realm of healthcare applications of ChatGPT. On the other hand, the non-healthcare context reveals a broader spectrum of influential factors in its best model, which includes 'Trustworthy + Secure + Benefits outweigh risks + Satisfaction + Willing to take decisions + Intent to use + Persuasive'. In conclusion our study findings suggest a clear demarcation in user expectations and requirements from AI systems based on the context of their use. We advocate for a balanced approach where technological advancement and user readiness are harmonized.

How Do College Students Perceive Their Partner Responds to Them When They Refuse Sexual Activity?

Refusal communication is a dyadic process, with one person communicating a refusal and another person responding. To enhance our understanding of this process, we surveyed college students to assess their interpretation of their partners' responses when they declined vaginal-penile sexual activity. In an online survey, participants were prompted to describe their partners' reactions when participants refused their partner's vaginal-penile sex initiation. Through content analysis, three themes were present: (1) partner accepted the refusal, (2) partner experienced negative emotions, (3) partner ignored their refusals. Participants frequently reported their refusals were accepted. Sexual assault prevention initiatives should work to normalize refusal communication.

Exploring the role of professional identity in the implementation of clinical decision support systems-a narrative review

BACKGROUND

Clinical decision support systems (CDSSs) have the potential to improve quality of care, patient safety, and efficiency because of their ability to perform medical tasks in a more data-driven, evidence-based, and semi-autonomous way. However, CDSSs may also affect the professional identity of health professionals. Some professionals might experience these systems as a threat to their professional identity, as CDSSs could partially substitute clinical competencies, autonomy, or control over the care process. Other professionals may experience an empowerment of the role in the medical system. The purpose of this study is to uncover the role of professional identity in CDSS implementation and to identify core human, technological, and organizational factors that may determine the effect of CDSSs on professional identity.

METHODS

We conducted a systematic literature review and included peer-reviewed empirical studies from two electronic databases (PubMed, Web of Science) that reported on key factors to CDSS implementation and were published between 2010 and 2023. Our explorative, inductive thematic analysis assessed the antecedents of professional identity-related mechanisms from the perspective of different health care professionals (i.e., physicians, residents, nurse practitioners, pharmacists).

RESULTS

One hundred thirty-one qualitative, quantitative, or mixed-method studies from over 60 journals were included in this review. The thematic analysis found three dimensions of professional identity-related mechanisms that influence CDSS implementation success: perceived threat or enhancement of professional control and autonomy, perceived threat or enhancement of professional skills and expertise, and perceived loss or gain of control over patient relationships. At the technological level, the most common issues were the system's ability to fit into existing clinical workflows and organizational structures, and its ability to meet user needs. At the organizational level, time pressure and tension, as well as internal communication and involvement of end users were most frequently reported. At the human level, individual attitudes and emotional responses, as well as familiarity with the system, most often influenced the CDSS implementation. Our results show that professional identity-related mechanisms are driven by these factors and influence CDSS implementation success. The perception of the change of professional identity is influenced by the user's professional status and expertise and is improved over the course of implementation.

CONCLUSION

This review highlights the need for health care managers to evaluate perceived professional identity threats to health care professionals across all implementation phases when introducing a CDSS and to consider their varying manifestations among different health care professionals. Moreover, it highlights the importance of innovation and change management approaches, such as involving health professionals in the design and implementation process to mitigate threat perceptions. We provide future areas of research for the evaluation of the professional identity construct within health care.

Index of Microcirculatory Resistance to predict microvascular obstruction in STEMI: A systematic review and meta-analysis

BACKGROUND

Microvascular obstruction (MVO) is an independent predictor of adverse cardiac events after ST-elevation myocardial infarction (STEMI). The Index of Microcirculatory Resistance (IMR) may be a useful marker of MVO, which could simplify the care pathway without the need for Cardiac Magnetic Resonance (CMR). We assessed whether the IMR can predict MVO in STEMI patients.

METHODS AND RESULTS

We conducted a systematic review and meta-analysis, including articles where invasive IMR was performed post primary percutaneous coronary intervention (PCI) in addition to MVO assessment with cardiac MRI. We searched PubMed, Scopus, Embase, and Cochrane databases from inception until January 2023. Baseline characteristics, coronary physiology and cardiac MRI data were extracted by two independent reviewers. The random-effects model was used to pool the data. Among 15 articles identified, nine articles (n = 728, mean age 61, 81% male) contained IMR data stratified by MVO. Patients with MVO had a mean IMR of 41.2 [95% CI 32.4-50.4], compared to 25.3 [18.3-32.2] for those without. The difference in IMR between those with and without MVO was 15.1 [9.7-20.6]. Meta-regression analyses demonstrated a linear relationship between IMR and TIMI grade (β = 0.69 [0.13-1.26]), as well as infarct size (β = 1.18 [0.24-2.11]) or ejection fraction at 6 months (β = -0.18 [-0.35 to -0.01]).

CONCLUSION

In STEMI, patients with MVO had 15-unit higher IMR than those without. IMR also predicts key prognostic endpoints such as infarct size, MVO, and long-term systolic function.

Evaluation of quality and readability of internet information on voice disorders

OBJECTIVES

The purpose of this study is to evaluate the readability and quality of Internet information related to vocal health, voice disorders and voice therapy.

STUDY DESIGN

This is a cross-sectional study.

METHODS

Eighty-two websites were included. Websites were then analyzed; their origin (clinic/hospital, non-profit, government), quality (Health On the Net [HON] certification and DISCERN scores) and readability (Ateşman readability formula and Bezirci-Yılmaz new readability formula) were assessed. Statistical analysis was used to examine differences between website origin and quality and readability scores and correlations between readability instruments.

RESULTS

Of the 82 websites, 93% were of private clinic/hospital, 6% were of non-profit organisation and 1% were of government. None of the 82 websites were HON certification, and the mean score of the item determining the general quality measure in DISCERN was 1.83 in a five-point scale. The mean of Ateşman readability formula value was calculated as 50.46 (±8.16). This value is defined as 'moderately hard' according to the readability scale. The average of Bezirci-Yılmaz new readability formula value is 13.85 (±3.48). This value is defined as 13th and 14th grade.

CONCLUSIONS

The quality of Internet-based health information about the voice is generally inadequate, and the sites examined in this study may be limited due to high readability levels. This may be a problem in people with poor literacy skills. For this reason, it is very important for speech and language therapists and other health professionals to evaluate and monitor the quality and readability of Internet-based information.

A novel agreement statistic using data on uncertainty in ratings

Many existing methods for estimating agreement correct for chance agreement by adjusting the observed proportion agreement by the probability of chance agreement based on different assumptions. These assumptions may not always be appropriate, as demonstrated by pathologists' ratings of kidney biopsy descriptors. We propose a novel agreement statistic that accounts for the empirical probability of chance agreement, estimated by collecting additional data on rater uncertainty for each rating. A standard error estimator for the proposed statistic is derived. Simulation studies show that in most cases, our proposed statistic is unbiased in estimating the probability of agreement after removing chance agreement.

Insights on the Current State and Future Outlook of AI in Health Care: Expert Interview Study

BACKGROUND

Artificial intelligence (AI) is often promoted as a potential solution for many challenges health care systems face worldwide. However, its implementation in clinical practice lags behind its technological development.

OBJECTIVE

This study aims to gain insights into the current state and prospects of AI technology from the stakeholders most directly involved in its adoption in the health care sector whose perspectives have received limited attention in research to date.

METHODS

For this purpose, the perspectives of AI researchers and health care IT professionals in North America and Western Europe were collected and compared for profession-specific and regional differences. In this preregistered, mixed methods, cross-sectional study, 23 experts were interviewed using a semistructured guide. Data from the interviews were analyzed using deductive and inductive qualitative methods for the thematic analysis along with topic modeling to identify latent topics.

RESULTS

Through our thematic analysis, four major categories emerged: (1) the current state of AI systems in health care, (2) the criteria and requirements for implementing AI systems in health care, (3) the challenges in implementing AI systems in health care, and (4) the prospects of the technology. Experts discussed the capabilities and limitations of current AI systems in health care in addition to their prevalence and regional differences. Several criteria and requirements deemed necessary for the successful implementation of AI systems were identified, including the technology's performance and security, smooth system integration and human-AI interaction, costs, stakeholder involvement, and employee training. However, regulatory, logistical, and technical issues were identified as the most critical barriers to an effective technology implementation process. In the future, our experts predicted both various threats and many opportunities related to AI technology in the health care sector.

CONCLUSIONS

Our work provides new insights into the current state, criteria, challenges, and outlook for implementing AI technology in health care from the perspective of AI researchers and IT professionals in North America and Western Europe. For the full potential of AI-enabled technologies to be exploited and for them to contribute to solving current health care challenges, critical implementation criteria must be met, and all groups involved in the process must work together.

Better to be in agreement than in bad company : A critical analysis of many kappa-like tests

We assessed several agreement coefficients applied in 2x2 contingency tables, which are commonly applied in research due to dichotomization. Here, we not only studied some specific estimators but also developed a general method for the study of any estimator candidate to be an agreement measurement. This method was developed in open-source R codes and it is available to the researchers. We tested this method by verifying the performance of several traditional estimators over all possible configurations with sizes ranging from 1 to 68 (total of 1,028,789 tables). Cohen's kappa showed handicapped behavior similar to Pearson's r, Yule's Q, and Yule's Y. Scott's pi, and Shankar and Bangdiwala's B seem to better assess situations of disagreement than agreement between raters. Krippendorff's alpha emulates, without any advantage, Scott's pi in cases with nominal variables and two raters. Dice's F1 and McNemar's chi-squared incompletely assess the information of the contingency table, showing the poorest performance among all. We concluded that Cohen's kappa is a measurement of association and McNemar's chi-squared assess neither association nor agreement; the only two authentic agreement estimators are Holley and Guilford's G and Gwet's AC1. The latter two estimators also showed the best performance over the range of table sizes and should be considered as the first choices for agreement measurement in contingency 2x2 tables. All procedures and data were implemented in R and are available to download from Harvard Dataverse https://doi.org/10.7910/DVN/HMYTCK.

Pharmacophore-Based Machine Learning Model To Predict Ligand Selectivity for E3 Ligase Binders

E3 ligases are enzymes that play a critical role in ubiquitin-mediated protein degradation and are involved in various cellular processes. Pharmacophore analysis is a useful approach for predicting E3 ligase binding selectivity, which involves identifying key chemical features necessary for a ligand to interact with a specific protein target cavity. While pharmacophore analysis is not always sufficient to accurately predict ligand binding affinity, it can be a valuable tool for filtering and/or designing focused libraries for screening campaigns. In this study, we present a fast and an inexpensive approach using a pharmacophore fingerprinting scheme known as ErG, which is used in a multi-class machine learning classification model. This model can assign the correct E3 ligase binder to its known E3 ligase and predict the probability of each molecule to bind to different E3 ligases. Practical applications of this approach are demonstrated on commercial libraries such as Asinex for the rational design of E3 ligase binders. The scripts and data associated with this study can be found on GitHub at https://github.com/Fraunhofer-ITMP/E3_binder_Model.

The Dependence of Chance-Corrected Weighted Agreement Coefficients on the Power Parameter of the Weighting Scheme: Analysis and Measurement

We consider the dependence of a broad class of chance-corrected weighted agreement coefficients on the weighting scheme that penalizes rater disagreements. The considered class encompasses many existing coefficients with any number of raters, and one real-valued power parameter defines the weighting scheme that includes linear, quadratic, identity, and radical weights. We obtain the first-order and second-order derivatives of the coefficients with respect to the power parameter and decompose them into components corresponding to all pairs of different category distances. Each component compares its two distances in terms of the ratio of observed to expected-by-chance frequency. A larger ratio for the smaller distance than the larger distance contributes to a positive relationship between the power parameter and the coefficient value; the opposite contributes to a negative relationship. We provide necessary and sufficient conditions for the coefficient value to increase or decrease and the relationship to intensify or weaken as the power parameter increases. We use the first-order and second-order derivatives for corresponding measurement. Furthermore, we show how these two derivatives allow other researchers to obtain quite accurate estimates of the coefficient value for unreported values of the power parameter, even without access to the original data.

Skill-Mix Changes Targeting Health Promotion and Prevention Interventions and Effects on Outcomes in all Settings (Except Hospitals): Overview of Reviews

Objectives: Skill-mix changes to step up health promotion and prevention are increasing, but there is limited evidence on their effects. Methods: Overview of reviews, based on a protocol. The search was carried out in six databases, screening was performed ensuring high interrater reliability. All countries, health professions and lay workers in all settings (except hospitals) were included, quality appraisals performed. Results: A total of 31 systematic reviews were included. Expanded roles performing outreach (e.g., home visits) had mostly positive effects on access and health outcomes, primarily for hard-to-reach groups. Task-shifting in colorectal or skin cancer screenings (performed by advanced practice nurses) were suggested effective; supporting roles (by community health workers) increased uptake in screenings, but based on limited evidence. Expanded roles of various professions focusing on lifestyle modification showed promising effects in most reviews, including weight, diet, smoking cessation and physical activity. Reviews on cost-effectiveness were based on limited evidence. Conclusion: Promising skill-mix changes included expanded roles providing lifestyle modifying interventions, task-shifting, and outreach roles for hard-to-reach groups, whereas evidence on costs was limited.

Becoming Culturally Responsive: Equitable and Inequitable Translations of CRE Theory into Teaching Practice

Research on Culturally Responsive Education (CRE) to date has mostly focused on identifying the aspects of education that already work for Black, Indigenous, and Students of Color. Building on this important literature base, this qualitative study examines the implementation, rather than the identification, of CRE practices. The seven New York City public schools that participated in the study were making school-wide changes for CRE as part of a program for Competency-Based Education (CBE) for personalizing learning for students. Both CRE and CBE are employed in schools to address common issues associated with educational inequities such as irrelevant lessons, teacher biases, one-size-fits-all instruction, and systemic racism. Based on interviews with teachers at the study schools, our findings demonstrated that teachers translated CRE theory into their CBE practice in three key ways: (1) deficit practices, where instructional choices were treated as neutral; (2) access practices, where instruction was differentiated but was not culturally responsive; and (3) transformative practices, where student agency challenged traditional structures. We argue that for schools and educators to meaningfully grapple with the issues of power they seek to address by engaging in CRE, they must embrace and nurture a more radical CRE imagination that leads to deeper school transformation.

Placement educators' perspectives of international social work students' sociopragmatic communication skills

International students who speak English as an additional language report experiencing communication issues while completing their studies and work-integrated learning placements in a range of Anglophone countries, including Canada, the United Kingdom, the United States of America and Australia. To address this issue, accreditation and registration bodies for a number of health professions, such as social work and nursing, have advocated for increasing the test score requirements for university English language entry. However, from a sociolinguistic perspective, decisions concerning ways to address communication challenges need to take into account the unique communication skills required for functioning in specific workplace settings. It is therefore essential to identify the types of communication issues occurring during work-integrated learning opportunities (e.g. placement) and to then assess whether these should be addressed by raising general English proficiency or providing structured learning opportunities for profession-specific communication development within the course content. The present study uses sociolinguistic theory to examine placement educators' perspectives on international students' communication issues using the context of social work placement. It draws on the thematic analysis of interviews with 15 placement educators in Australia. One major finding is that international students' general proficiency or ability to use specific linguistic tools (pragmalinguistic competence) is not a key area of concern for educators. The main challenge seems to involve the students' understanding of sociocultural norms underlying workplace communication (sociopragmatic competence). This finding suggests that, rather than increasing English language entry requirements, universities need to provide international students opportunities to develop their sociopragmatic competence both before and during placement. The paper concludes with a set of recommendations aimed at supporting international students who speak English as an additional language to develop their workplace communication during their studies.

Assessing Sorority Women's Perceptions of Barriers to Reporting Sexual Assaults That Occur Within College Campus Greek Organizations

Involvement in college campus Greek organizations is associated with an elevated risk of experiencing sexual assault victimization. Experiencing sexual assault victimizaiton is associated with myriad of consequences that could be mitigated by reporting the experience to friends, campus authorities, or police, yet researchers' understanding of reasons why women participating in Greek organizations do not report sexual assaults committed by a fraternity member is understudied. Thus, the goal of this study was to assess perceived barriers to reporting a sexual assault committed by a member of a fraternity. Women associated with Greek organizations from two large universities in the south and southwestern region of the US (n = 235) completed an online survey about sexual assault. Participants were asked to describe why they thought women assaulted by a fraternity member would not report their experience. An inductive and deductive coding process suggested women perceived barriers to reporting across intrapersonal (e.g. feeling afraid/shame), interpersonal (e.g. sorority sisters would ostracize them), organizational (e.g. reporting would jeopardize Greek life), community (e.g. reporting on campus/police is challenging) and societal levels (e.g. victim blame culture). Findings suggest larger socio-cultural factors may influence whether women would report a sexual assault committed by a fraternity member. Collaboration between Greek organizations, campus Fraternity and Sorority advisors, and sexual assault prevention advocates could help to provide a supportive environment for women when sexual assaults occur.

Evaluating and Tracking Qualitative Content Coder Performance Using Item Response Theory

Content analysis of traditional and social media has a central role in investigating features of media content, measuring media exposure, and calculating calculation of media effects. The reliability of content coding is usually evaluated using "Kappa-like" agreement measures, but these measures produce results that aggregate individual coder decisions, which obscure the performance of individual coders. Using a data set of 105 advertisements for sports and energy drinks media content coded by five coders, we demonstrate that Item Response Theory can track coder performance over time and give coder-specific information on the consistency of decisions over qualitatively coded objects. We conclude that IRT should be added to content analysts' tool kit of useful methodologies to track and measure content coders' performance.

Developing a Healthcare Technology Acceptance Model (H-TAM) for Older Adults with Hypertension

Older adults with a chronic health condition (e.g., hypertension) use various self-management methods. Healthcare technologies have the potential to support health self-management. However, it is necessary to understand the acceptance of these technologies as a precursor to older adults' adoption and integration into their health plan. Our focus was on the factors older adults with hypertension initially consider when introduced to three new healthcare technologies that might support their health self-management. We compared their considerations for a blood pressure monitor, an electronic pillbox, and a multifunction robot to simulate incrementally more complex technologies. Twenty-three participants (aged 65-84) completed four questionnaires and a semi-structured interview. The interview transcripts were analyzed using a thematic analysis approach. We identified the factors that were frequently mentioned among the participants for each of the three healthcare technologies. The factors that older adults initially considered were familiarity, perceived benefits, perceived ease of use, perceived need for oneself, relative advantage, complexity, and perceived need for others. Upon further reflection, participants considered advice acceptance, compatibility, convenience, facilitating conditions, perceived usefulness, privacy, subjective norm, and trust. We integrated the factors that older adults considered into the Healthcare Technology Acceptance Model (H-TAM), which elucidates the complexity of healthcare technology acceptance and provides guidance for future explorations.

Enablers and Barriers of Community Garden Use in New Orleans, Louisiana: An Environmental Assessment and Qualitative Analysis

PURPOSE

To explore factors associated with community garden use.

APPROACH

Environmental assessment of community gardens and semi-structured interviews.

SETTING

New Orleans, Louisiana.

PARTICIPANTS

10 community gardens (environmental assessment), 20 community members (including garden users and non-users) and garden administrators (qualitative interviews).

METHOD

Gardens were assessed based on (1) accessibility, (2) information, (3) design, (4) cleanliness, (5) walkability, (6) parking, and (7) noise. Semi-structured interviews took place over Zoom; transcribed interviews were analyzed using thematic analysis.

RESULTS

Gardens assessed in the environmental assessment ranked high in design and cleanliness but low on accessibility and information availability. Salient themes from the qualitative interviews include skill-building, access to fresh foods, and increased social engagement as enablers of community garden participation, with availability of information and time as both potential enablers of, or barriers to, participation. Community members perceived that gardens could increase fresh food access, while administrators believed that it is not possible for community gardens to produce enough food to create community-wide impact, highlighting instead the importance of the social aspects of the garden as beneficial for health.

CONCLUSION

Community gardens should improve garden physical accessibility and information availability to incentivize use. Community gardens are valued as means for skill-building and social engagement. Future research should prioritize investigating the association between the social aspects of participating in community gardens and health outcomes.

Provision of Compassionate and Empathic Care as a Well-Being Preservation Tool for Emergency Physicians: A Scoping Review

Objective

Compassion and physician well-being are two key components related to quality care in health including emergency medicine. The objective of this study was to explore the impact of compassion in care on the well-being of emergency physicians. We conducted a scoping review to explore the impact of provision of compassionate care by emergency physicians on their well-being and subconcepts.

Methods

Four electronic databases and grey literature were searched to find evidence related to compassion, empathy, self-compassion, and their impact on emergency physicians' well-being. Following title and abstract review, two reviewers independently screened full-text articles, and extracted data. Data were presented using descriptive statistics and a narrative analysis.

Results

A total of 803 reports were identified in databases. Three articles met eligibility criteria for data extraction. None directly examined compassion and well-being. Included studies addressed empathy and burnout in emergency medicine professionals.

Conclusion

No high-quality evidence could be found on the topic in the population of interest. Literature related to the topic of compassion in physicians, especially in emergency physicians, a field known for its high demand and stress levels, is currently scarce and additional evidence is needed to better describe and understand the association between physicians' compassion and well-being.

Environmental cleaning battling against Covid-19 infection in health-care facilities

Purpose

This study aims to identify and validate the environmental cleaning elements and performance criteria to prevent Covid-19 infection in health-care facilities.

Design/methodology/approach

Eight elements and 38 performance criteria were identified from the literature, and a questionnaire survey that involved environmental cleaning experts was carried out. Content validity index was used to validate the content of the environmental cleaning elements and performance criteria in this study.

Findings

The result indicates that the performance criteria of “Finishes, furnishings” and “Equipment Maintenance Log” were not relevant to be applied in current fighting against Covid-19 infection in health care. However, the remaining 36 performance criteria were proved as relevant and acceptable.

Practical implications

The findings of this study can provide a significant contribution to the built environment industry. By knowing the environmental cleaning elements and performance criteria, efforts can be carried out to explore measures that can be taken to improve the environmental cleaning practice in health care to battle against Covid-19 infection.

Originality/value

This paper fulfils an identified need to study how environmental cleaning can be implemented in health-care facilities.

Two decades of digital interventions for anxiety disorders: a systematic review and meta-analysis of treatment effectiveness

BACKGROUND

Digital interventions for anxiety disorders are a promising solution to address barriers to evidence-based treatment access. Precise and powerful estimates of digital intervention effectiveness for anxiety disorders are necessary for further adoption in practice. The present systematic review and meta-analysis examined the effectiveness of digital interventions across all anxiety disorders and specific to each disorder v. wait-list and care-as-usual controls.

METHODS

A systematic search of bibliographic databases identified 15 030 abstracts from inception to 1 January 2020. Forty-seven randomized controlled trials (53 comparisons; 4958 participants) contributed to the meta-analysis. Subgroup analyses were conducted by an anxiety disorder, risk of bias, treatment support, recruitment, location and treatment adherence.

RESULTS

A large, pooled effect size of g = 0.80 [95% Confidence Interval: 0.68-0.93] was found in favor of digital interventions. Moderate to large pooled effect sizes favoring digital interventions were found for generalized anxiety disorder (g = 0.62), mixed anxiety samples (g = 0.68), panic disorder with or without agoraphobia (g = 1.08) and social anxiety disorder (g = 0.76) subgroups. No subgroups were significantly different or related to the pooled effect size. Notably, the effects of guided interventions (g = 0.84) and unguided interventions (g = 0.64) were not significantly different. Supplemental analysis comparing digital and face-to-face interventions (9 comparisons; 683 participants) found no significant difference in effect [g = 0.14 favoring digital interventions; Confidence Interval: -0.01 to 0.30].

CONCLUSION

The precise and powerful estimates found further justify the application of digital interventions for anxiety disorders in place of wait-list or usual care.

A benchmark for automatic medical consultation system: frameworks, tasks and datasets

MOTIVATION

In recent years, interest has arisen in using machine learning to improve the efficiency of automatic medical consultation and enhance patient experience. In this article, we propose two frameworks to support automatic medical consultation, namely doctor-patient dialogue understanding and task-oriented interaction. We create a new large medical dialogue dataset with multi-level fine-grained annotations and establish five independent tasks, including named entity recognition, dialogue act classification, symptom label inference, medical report generation and diagnosis-oriented dialogue policy.

RESULTS

We report a set of benchmark results for each task, which shows the usability of the dataset and sets a baseline for future studies.

AVAILABILITY AND IMPLEMENTATION

Both code and data are available from https://github.com/lemuria-wchen/imcs21.

SUPPLEMENTARY INFORMATION

Supplementary data are available at Bioinformatics online.

Evaluation of a civic engagement approach to catalyze built environment change and promote healthy eating and physical activity among rural residents: a cluster (community) randomized controlled trial

BACKGROUND

Prior studies demonstrate associations between risk factors for obesity and related chronic diseases (e.g., cardiovascular disease) and features of the built environment. This is particularly true for rural populations, who have higher rates of obesity, cancer, and other chronic diseases than urban residents. There is also evidence linking health behaviors and outcomes to social factors such as social support, opposition, and norms. Thus, overlapping social networks that have a high degree of social capital and community cohesion, such as those found in rural communities, may be effective targets for introducing and maintaining healthy behaviors.

METHODS

This study will evaluate the effectiveness of the Change Club (CC) intervention, a civic engagement intervention for built environment change to improve health behaviors and outcomes for residents of rural communities. The CC intervention provides small groups of community residents (approximately 10-14 people) with nutrition and physical activity lessons and stepwise built environment change planning workshops delivered by trained extension educators via in-person, virtual, or hybrid methods. We will conduct process, multilevel outcome, and cost evaluations of implementation of the CC intervention in a cluster randomized controlled trial in 10 communities across two states using a two-arm parallel design. Change in the primary outcome, American Heart Association's Life's Simple 7 composite cardiovascular health score, will be evaluated among CC members, their friends and family members, and other community residents and compared to comparable samples in control communities. We will also evaluate changes at the social/collective level (e.g., social cohesion, social trust) and examine costs as well as barriers and facilitators to implementation.

DISCUSSION

Our central hypothesis is the CC intervention will improve health behaviors and outcomes among engaged citizens and their family and friends within 24 months. Furthermore, we hypothesize that positive changes will catalyze critical steps in the pathway to improving longer-term health among community residents through improved healthy eating and physical activity opportunities. This study also represents a unique opportunity to evaluate process and cost-related data, which will provide key insights into the viability of this approach for widespread dissemination.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT05002660 , Registered 12 August 2021.

The Predictive Value of Computed Tomography Findings for Poor Visual Outcome in Traumatic Eye Injury

Background. The prognosis of visual outcome is important for patients and healthcare providers and guides proper decision-making in traumatic eye injury. In this study, we have evaluated the predictive value of computed tomography (CT) scan findings for poor visual outcomes in patients with traumatic eye injuries. Methods. In a retrospective survey, documents of 200 patients with traumatic eye injury who underwent a diagnostic orbital CT scan were reviewed. Disorganized or collapsed globe, intraocular foreign body or gas, increased or decreased anterior chamber size, hemorrhage in the anterior or posterior chamber, crystalline or intraocular lens dislocation, posterior sclera thickening, globe borders haziness, orbital fracture, orbital hemorrhage, and foreign body, optic canal, and optic nerve injuries are the diagnostic clues for eye injury in CT scan. The predictive value of CT scan findings for poor visual outcome was calculated by sensitivity, specificity, accuracy, predictive values, hazard ratios, and binary logistic regression model. Results. The sensitivity, specificity, accuracy, and positive predictive values showed to be high. However, there was a low negative predictive value of CT findings for the prediction of poor vision. Among the investigated factors, disorganized/collapsed globe (HR 47.72, CI 6.13–371.62), increased/decreased anterior chamber size (HR 5.04, CI 2.57–9.88), hemorrhage in anterior/posterior chamber (HR 3.58, CI 1.900–6.774/3.62, CI 1.90–6.89), globe borders haziness (HR 3.06, CI 1.33–7.01), orbital foreign body (HR 3.66, CI 1.11–12.05), and optic canal/nerve injury (HR 21.62, CI 4.73–98.78) reached the statistical significance for increasing the hazard ratio for poor visual outcome in patients with a traumatic eye injury. Logistic regression analysis showed only evidence for disorganized/collapsed globe and optic canal/nerve injury in orbital CT scan as independent predictive factors for poor visual outcome. Conclusion. CT scan findings can be used as prognostic factors for visual outcomes in patients with a traumatic eye injury.

A Three-Step Reliability Strategy Applied to Police-Worn Body Camera Footage

Strong inferences are drawn from police-worn body camera (BWC) footage, frequently without an assessment of reliability. Unique characteristics of BWC footage (i.e., capturing trends and less frequent behavior, a focal actor (officer) is absent) suggest a specific reliability strategy. A three-step strategy of selecting appropriate reliability indexes, providing salient reliability categories, and ranking the reliability categories was applied to BWC footage. Five interrater agreement ( $\text{A}{\text{C}}_1$ , ${\widehat{\alpha }}_K$ , $B-P$ coefficient, $r_{\text{wg}}$ , $\text{ad}.\text{m}$ ), two interrater consistency $\left(\text{ICC}\left(1,1\right),\text{ICC}\left(2,1\right)\right)$ , and three internal consistency ( ${\omega }_t$ , ${\omega }_h$ , $\text{GLB}$ ) indexes were applied to police BWC footage. A focus was to ascertain the upper limits of reliability for BWC footage. Item development and rater training were conducted to optimize rating reliability. Using a within design and confidence intervals, the relatively stronger and weaker reliabilities across the six domains of video completeness, respect (passive, active, discourse), threats, and behavioral stance were assessed. Applied to the admissibility of court evidence, central aspects of video completeness have relatively stronger reliabilities. For research, lower reliabilities have a cost of limited generalizability and ecological validity. Policy recommendations include the usage of a standardized scale with multiple ratings to determine what information should be used in high-stake decision-making based on BWC footage. The three-step strategy integrated the reliability indexes into a single figure to reflect a reliability summary of each component of BWC footage. Weighted rankings found the Overall Audio Quality (-4.9) and Empathy (-4.9) items to have the weakest reliabilities and the Clarification (5.1) and Physical Resistance (4.9) items to have the strongest reliabilities.

Foreign Direct Investment, Environmental Pollution and Economic Growth—An Insight from Non-Linear ARDL Co-Integration Approach

The paper examines the impact of foreign direct investment and environmental pollution on economic growth in an emerging economy. We used annual data covering the period of 1986–2020 and the non-linear autoregressive distributed lag (NARDL) to analyze the positive and negative co-integrated variables, and our findings support the asymmetric relationship between foreign direct investment, environmental pollution and economic growth in both the short and long run, as well as a long-run relationship between environmental pollution and economic growth. A one-percent increase in environmental pollution leads to a positive change in economic performance by 0.662 percent. Adversely, a one-percent decrease in environmental pollution leads to a negative change in economic performance by 0.212 percent. Vietnam is an emerging market, and capital needs for economic activities are essential. However, the research results show that a disproportionate impact of foreign direct investment on economic growth is recorded in the long run, and a disproportionate impact of environmental pollution on the economy occurs in both the short and long term. Therefore, the government needs to have policies to attract foreign investment to develop a green and sustainable economy.

An Assessment of the Cues College Students Interpret From a Sexual Partner to Determine They Are Refusing

The purpose of this study was to assess the cues college students use to determine a sexual partner is refusing vaginal-penile sex (i.e., refusal interpretations). As a secondary aim, we explored the influence of item wording (not willing/non-consent vs refusal) on college students' self-reported refusal interpretations. A sample of 175 college students from Canada and the United States completed an open-ended online survey where they were randomly assigned to one of two wording conditions (not willing/non-consent vs refusal); students were then prompted to write about the cues they used to interpret their partner was refusing. An inductive coding procedure was used to analyze open-ended data. Themes included explicit and implicit verbal and nonverbal cues. The refusal condition elicited more explicit and implicit nonverbal cues than the not willing/non-consent condition. Frequency results suggested men reported interpreting more explicit and implicit verbal cues. Women reported interpreting more implicit nonverbal cues from their partner. Our findings reflect prior research and appear in line with traditional gender and sexual scripts. We recommend researchers consider using the word refusal when assessing the cues students interpret from their sexual partners as this wording choice may reflect college students' sexual experiences more accurately.

Risk factors and pooled incidence of intestinal stoma complications: systematic review and Meta-analysis

OBJECTIVE

The present systematic review aimed to identify, critically assess and summarize which risk factors might determine the onset of ostomy complications, describing a pooled incidence and stratified incidences by each identified risk factor.

METHODS

A systematic literature review with a meta-analysis of observational studies was performed by following the PRISMA statement and flow chart. The quality assessment of the included articles was performed through the Newcastle-Ottawa Scale (NOS).

RESULTS

Sixteen articles published between 1990 and 2018 focused on the risk factors related to intestinal stomal complications, and the performed analysis led to identifying influenceable and non-influenceable risk factors. The median of the NOS evaluation was 6 (IQR = 5.75-6). Among 10,520 included patients, the pooled incidence of stomal complications was 35%, ranging from 9% to 63%, regardless of the nature of the complications. Analysis of the sub-groups highlighted obesity and ostomy surgery performed via laparoscopy or emergency conditions have significant incidences, respectively, of 66% and 68%.

CONCLUSIONS

The pooled incidence of stomal complications requires greater attention for its relevant epidemiology. From the clinical point of view, patients with obesity and chronic conditions require more attention to prevent complications, possibly employing accurate educational interventions to enhance proper stoma management.

Measuring equity of access to eye health outreach camps in rural Malawi

Introduction

Equity in the access and use of health services is critical if countries are to make progress towards universal health coverage and address the systematic exclusion of the most vulnerable groups. The purpose of this study was to assess if the Co-ordinated Approach To Community Health programme implemented by Sightsavers was successful in reaching the poorest population, women, and people living with disabilities in Kasungu district, Malawi.

Methods

Between April and September 2017, data on socio-economic status, household characteristics and functional disability were collected from patients attending at eye camps in Kasungu district, Malawi. Using asset-based tools to measure household wealth (EquityTool© and Simple Poverty Scorecard©) and the Washington Group Short Set of Questions, individuals were categorised by wealth quintiles, poverty status, and functional disability status and then compared to relevant representative national household surveys. In addition, a follow-up household survey was conducted to check the validity of self-reported household characteristics at eye camps.

Results

A total of 1,358 individuals participated in the study. The study shows that self-reported data on household characteristics and assets are reliable and can be collected in clinical settings (instead of relying on direct observations of assets). Individuals attending outreach camps were poorer in terms of relative wealth and absolute poverty rates compared to the rest of the population in Kasungu. It was estimated that 9% of the participants belonged to the poorest quintile compared to 4% for the population in Kasungu (DHS 2015–2016). The ultra-poverty rate was also lower among respondents (13%) compared to 15% for Kasungu district (IHS 2017). The functional disability rate was 27.5% for study participants, and statistically higher than the general population (5.6%, SENTIF 2017). Even though women are more at risks than men, 54% of the participants were men.

Conclusions

Our study shows that existing tools can be reliably used, and combined, if based on recent population data, to assess equity of access to health services for vulnerable groups of the population. The findings suggest that the programme was successful in reaching the poorest people of the Kasungu district population as well as those with disabilities through outreach camps but that more men than women were reach through the programme. Subsequently, our study showed that self-reported household characteristics are a reliable method to measure asset-based wealth of camps’ attendee. However, it is essential to use sub-national data (district or regional level) from recent surveys for the purpose of benchmarking in order to produce accurate results.

Towards a Non-Contact Method for Identifying Stress Using Remote Photoplethysmography in Academic Environments

Stress has become a common condition and is one of the chief causes of university course disenrollment. Most of the studies and tests on academic stress have been conducted in research labs or controlled environments, but these tests can not be extended to a real academic environment due to their complexity. Academic stress presents different associated symptoms, anxiety being one of the most common. This study focuses on anxiety derived from academic activities. This study aims to validate the following hypothesis: by using a non-contact method based on the use of remote photoplethysmography (rPPG), it is possible to identify academic stress levels with an accuracy greater than or equal to that of previous works which used contact methods. rPPG signals from 56 first-year engineering undergraduate students were recorded during an experimental task. The results show that the rPPG signals combined with students' demographic data and psychological scales (the State-Trait Anxiety Inventory) improve the accuracy of different classification methods. Moreover, the results demonstrate that the proposed method provides 96% accuracy by using K-nearest neighbors, J48, and random forest classifiers. The performance metrics show better or equal accuracy compared to other contact methods. In general, this study demonstrates that it is possible to implement a low-cost method for identifying academic stress levels in educational environments.

Phonetic Documentation in Three Collections: Topics and Evolution

Phonetic aspects of many languages have been documented, though the breadth and focus of such documentation varies substantially. In this survey, phonetic aspects (here called "categories") that are typically reported were assessed in three English-language collections-the Illustrations of the IPA, articles from the Journal of Phonetics, and papers from the Ladefoged/Maddieson Sounds of the World's Languages (SOWL) documentation project. Categories were defined for consonants (e.g., Voice Onset Time (VOT) and frication spectrum; 10 in total), vowels (e.g., formants and duration; 7 total) and suprasegmentals (e.g., stress and distinctive vowel length, 6 total). The Illustrations, due to their brevity, had, on average, limited coverage of the selected categories (12% of the 23 categories). Journal of Phonetics articles were typically theoretically motivated, but 64 had sufficient measurements to count as phonetic documentation; these also covered 12% of the categories. The SOWL studies, designed to cover as much of the phonetic structure as feasible in an article-length treatment, achieved 41% coverage on average. Four book-length studies were also examined, with an average of 49% coverage. Phonetic properties of many language families have been studied, though Indo-European is still disproportionately represented. Physiological measures were excluded as being less common, and perceptual measures were excluded as being typically more theoretical. This preliminary study indicates that certain acoustic properties of languages are typically measured and may be considered as an impetus for later, fuller coverage, but broader consensus on the categories is needed. Current documentation efforts could be more useful if these considerations were addressed.

Identifying Nonphysical Intimate Partner Violence in Relationships: The Role of Beliefs and Schemas

While substantial research has been conducted on intimate partner violence (IPV), comparatively little research has examined peoples' perceptions of which behaviors comprise this form of abuse. Early identification of IPV is critical to ending abuse, however, forms of IPV that typically occur earlier in a relationship (e.g., nonphysical abuse) may not be core components of peoples' mental frameworks (schemas) of IPV and may therefore be less commonly identified as abusive. To explore this, in Study 1 participants from an Australian University (N = 86) separately described the relationships with IPV and nonphysical IPV. Analyses identified control, power imbalance, stereotypical gender dynamics (male perpetrator, female victim), physical abuse, and having a low socioeconomic status abuser as common components of participants' IPV schema when not prompted with type of abuse. However, participants largely failed to describe nonphysical IPV behaviors, suggesting limited awareness of the specific behaviors that constitute abuse. To explore this in Study 2, participants from an Australian University (N = 305) were asked to categorize a range of specific behaviors (including physically abusive, nonphysically abusive, and nonabusive behaviors) as definitely, maybe, or never abusive. Drawing on the known positive association between gender and romantic beliefs with the experience of abuse, we also assessed the relationship of identification of IPV behaviors to these beliefs. Moderated multilevel modeling showed that nonphysical IPV behaviors were generally perceived as less abusive than physical IPV behaviors. In addition, stronger endorsement of romantic jealousy was associated with evaluating nonphysical IPV as less abusive. However, romantic jealousy beliefs were not significantly associated with the perceived abusiveness of physical IPV behaviors. Findings support the conclusion that individuals' IPV schemas contribute to a failure to identify nonphysical IPV behaviors as abusive, and this is particularly true for people who more strongly endorse romantic jealousy.

Reliability and agreement of point-of-care carotid artery examinations by experts using hand-held ultrasound devices in patients with ischaemic stroke or transitory ischaemic attack

Objectives

To investigate the reliability and agreement of hand-held ultrasound devices (HUDs) compared with conventional duplex ultrasound (HIGH) in examination for carotid stenosis in patients with suspected transitory ischaemic attack (TIA) or ischaemic stroke.

Methods

Cardiologists, experienced in carotid ultrasound, examined patients admitted to a community hospital with suspected stroke or TIA. Patients were first examined by an HUD and second by HIGH as per usual care. Different operators performed HUD and HIGH blinded to each other. On clinical discretion, CT angiography (CTA) was performed, and analysed by a radiologist blinded to the results from the ultrasound.

Results

Of 80 patients included, 9 (11%) were found to have >50% internal carotid artery (ICA) stenosis on reference examination. Agreement for classification of the degree of ICA stenosis was good for HUD versus HIGH (weighted Kappa 0.76) and HUD versus CTA (weighted Kappa 0.66). Agreement between HUD and HIGH examinations was excellent when ICA was classified as <50% diameter stenosis by HUD (99% agreement), but significantly lower when ICA diameter stenosis was classified as >50% by HUD (OR 0.15, 95% CI 0.06 to 0.42). Overall, HUD tended to overestimate the degree of carotid stenoses rather than underestimate (p=0.048).

Conclusion

Hand-held carotid ultrasound performed by experts demonstrated good agreement with conventional duplex ultrasound. The use of HUDs was reliable for ruling out significant carotid artery disease, but less reliable for ruling in significant disease.

An Empirical Comparative Assessment of Inter-Rater Agreement of Binary Outcomes and Multiple Raters

Background: Many methods under the umbrella of inter-rater agreement (IRA) have been proposed to evaluate how well two or more medical experts agree on a set of outcomes. The objective of this work was to assess key IRA statistics in the context of multiple raters with binary outcomes. Methods: We simulated the responses of several raters (2–5) with 20, 50, 300, and 500 observations. For each combination of raters and observations, we estimated the expected value and variance of four commonly used inter-rater agreement statistics (Fleiss’ Kappa, Light’s Kappa, Conger’s Kappa, and Gwet’s AC1). Results: In the case of equal outcome prevalence (symmetric), the estimated expected values of all four statistics were equal. In the asymmetric case, only the estimated expected values of the three Kappa statistics were equal. In the symmetric case, Fleiss’ Kappa yielded a higher estimated variance than the other three statistics. In the asymmetric case, Gwet’s AC1 yielded a lower estimated variance than the three Kappa statistics for each scenario. Conclusion: Since the population-level prevalence of a set of outcomes may not be known a priori, Gwet’s AC1 statistic should be favored over the three Kappa statistics. For meaningful direct comparisons between IRA measures, transformations between statistics should be conducted.

Are the concerns destroying mental health of college students?: A qualitative analysis portraying experiences amidst COVID-19 ambiguities

Coronavirus presenting an unforeseeable chain of events has exaggerated misery for students in India as they attracted the most detrimental experiences associated with lockdown restrictions leading to a shutdown of colleges as a preventive measure. The research endeavors to furnish a review of the overall hardships and psychological state of mind of college students and improvement in the implementation of policy decisions. Researchers conceptualize the newly discovered phenomenon by adopting grounded theory. Data from 256 newspaper articles, online articles and magazines have been gathered and converted into 256 separate files. To broaden the justification of research, social media analysis employing tweets, Facebook posts and Whatsapp messages are considered adding to the contributory prospects of the study. Compiled data is then refined through data mining technique. Triangulation approach amalgamating content analysis and thematic analysis has been deployed, thereby exploring the qualitative aspect of data gathering. Reviews from 31 students through telephonic conversation and 8 academic experts extended more accuracy to the research process. Findings administered academic disruptions with career concern, emotional suffering, financial concern, online learning, overseas injustice and psychological effects as the final themes representing various concerns experienced by college students. Hence, this work concludes with some constructive suggestions to deteriorate the amplified concerns.

Bayesian inference of dependent kappa for binary ratings

In medical and social science research, reliability of testing methods measured through inter- and intraobserver agreement is critical in disease diagnosis. Often comparison of agreement across multiple testing methods is sought in situations where testing is carried out on the same experimental units rendering the outcomes to be correlated. In this article, we first developed a Bayesian method for comparing dependent agreement measures under a grouped data setting. Simulation studies showed that the proposed methodology outperforms the competing methods in terms of power, while maintaining a decent type I error rate. We further developed a Bayesian joint model for comparing dependent agreement measures adjusting for subject and rater-level heterogeneity. Simulation studies indicate that our model outperforms a competing method that is used in this context. The developed methodology was implemented on a key measure on a dichotomous rating scale from a study with six raters evaluating three classification methods for chest radiographs for pneumoconiosis developed by the International Labor Office.

COVID-19, Telecommuting, and (Virtual) Sickness Presenteeism: Working From Home While Ill During a Pandemic

This study explored (virtual) sickness presenteeism in the context of the COVID-19 pandemic. Using qualitative data from 505 members of the German working population, it investigates how working from home, which rapidly increased because of the COVID-19 outbreak, is perceived with regard to the pandemic. The study explored how this development affects the decision to show absence or presence in case of illness. More than 1,300 responses to different open-end questions by presenteeists and non-presenteeists were analyzed. The findings suggest that many previously identified reasons for deciding for or against presenteeism are still applicable. However, noteworthy differences with regard to both telecommuting and the pandemic occurred. Virtual sickness presenteeism seems to be strongly encouraged by the possibility to adjust working conditions at home. Additionally, COVID-19 has affected the perceptions of health at work. The study contributes to a more in-depth understanding of (virtual) sickness presenteeism during a global pandemic. Six propositions for future research are developed, and the importance of context for the consequences of virtual sickness presenteeism is discussed.

Recognizing motor imagery tasks from EEG oscillations through a novel ensemble-based neural network architecture

Brain-Computer Interfaces (BCI) provide effective tools aimed at recognizing different brain activities, translate them into actions, and enable humans to directly communicate through them. In this context, the need for strong recognition performances results in increasingly sophisticated machine learning (ML) techniques, which may result in poor performance in a real application (e.g., limiting a real-time implementation). Here, we propose an ensemble approach to effectively balance between ML performance and computational costs in a BCI framework. The proposed model builds a classifier by combining different ML models (base-models) that are specialized to different classification sub-problems. More specifically, we employ this strategy with an ensemble-based architecture consisting of multi-layer perceptrons, and test its performance on a publicly available electroencephalography-based BCI dataset with four-class motor imagery tasks. Compared to previously proposed models tested on the same dataset, the proposed approach provides greater average classification performances and lower inter-subject variability.

Interclinician agreement on the recognition of selected respiratory clinical signs in dogs and cats with abnormal breathing patterns

In humans, classification of abnormal breathing patterns (ABP) and recognition of ancillary respiratory signs are difficult, as reflected by poor-to-moderate interclinician agreement. The aims of this study were to assess interclinician agreement for respiratory sign recognition in dogs and cats and evaluate the influence of clinical experience on agreement. Dogs and cats with ABP were recruited from three hospitals. Included animals were evaluated by three clinicians at each hospital before therapeutic intervention. Consensual definitions for each respiratory clinical sign were provided to all clinicians. Interclinician agreement was measured via Fleiss' kappa and intraclass correlation coefficient statistics. Influence of clinical experience on interobserver agreement was studied via mixed-effects logistic regression. One-hundred and fifteen dogs and 49 cats with ABP were recruited. Out of 12 clinical signs evaluated, only stertor (kappa, 0.80), stridor (kappa, 0.64), attenuation of heart/lung sounds (kappa, 0.60), and goose honking (kappa, 0.84) in dogs, and stertor (kappa, 0.65) and open-mouth breathing (kappa, 0.75) in cats, were considered sufficiently reliable among clinicians. Agreement on respiratory rate estimation was good in both species (intraclass correlation coefficient, 0.75). The greater the difference in clinical experience between two clinicians, the lower the odds of agreement between the two clinicians' respiratory physical examination findings. Interclinician agreement was demonstrated to be poor for recognition of most respiratory clinical signs in dogs and cats. Teaching and clinical experience acquisition should be encouraged to improve respiratory clinical sign recognition.

On the quality of quantitative instruments to measure digital competence in higher education: A systematic mapping study

In this study, we report on a Systematic Mapping Study (SMS) on how the quality of the quantitative instruments used to measure digital competencies in higher education is assured. 73 primary studies were selected from the published literature in the last 10 years in order to 1) characterize the literature, 2) evaluate the reporting practice of quality assessments, and 3) analyze which variables explain such reporting practices. The results indicate that most of the studies focused on medium to large samples of European university students, who attended social science programs. Ad hoc, self-reported questionnaires measuring various digital competence areas were the most commonly used method for data collection. The studies were mostly published in low tier journals. 36% of the studies did not report any quality assessment, while less than 50% covered both groups of reliability and validity assessments at the same time. In general, the studies had a moderate to high depth of evidence on the assessments performed. We found that studies in which several areas of digital competence were measured were more likely to report quality assessments. In addition, we estimate that the probability of finding studies with acceptable or good reporting practices increases over time.

Bayesian approaches to the weighted kappa-like inter-rater agreement measures

Inter-rater agreement measures are used to estimate the degree of agreement between two or more assessors. When the agreement table is ordinal, different weight functions that incorporate row and column scores are used along with the agreement measures. The selection of row and column scores is effectual on the estimated degree of agreement. The weighted measures are prone to the anomalies frequently seen in agreement tables such as unbalanced table structures or grey zones due to the assessment behaviour of the raters. In this study, Bayesian approaches for the estimation of inter-rater agreement measures are proposed. The Bayesian approaches make it possible to include prior information on the assessment behaviour of the raters in the analysis and impose order restrictions on the row and column scores. In this way, we improve the accuracy of the agreement measures and mitigate the impact of the anomalies in the estimation of the strength of agreement between the raters. The elicitation of prior distributions is described theoretically and practically for the Bayesian estimation of five agreement measures with three different weights using an agreement table having two grey zones. A Monte Carlo simulation study is conducted to assess the classification accuracy of the Bayesian and classical approaches for the considered agreement measures for a given level of agreement. Recommendations for the selection of the highest performing agreement measure and weight combination are made in the breakdown of the table structure and sample size.

Histological interpretation of differentiated vulvar intraepithelial neoplasia (dVIN) remains challenging-observations from a bi-national ring-study

Differentiated vulvar intraepithelial neoplasia (dVIN) is a premalignant lesion that is known to progress rapidly to invasive carcinoma. Accurate histological diagnosis is therefore crucial to allow appropriate treatment. To identify reliable diagnostic features, we evaluated the inter-observer agreement in the histological assessment of dVIN, among a bi-national, multi-institutional group of pathologists. Two investigators from Erasmus MC selected 36 hematoxylin-eosin-stained glass slides of dVIN and no-dysplasia, and prepared a list of 15 histological features of dVIN. Nine participating pathologists (i) diagnosed each slide as dVIN or no-dysplasia, (ii) indicated which features they used for the diagnosis, and (iii) rated these features in terms of their diagnostic usefulness. Diagnoses rendered by > 50% participants were taken as the consensus (gold standard). p53-immunohistochemistry (IHC) was performed for all cases, and the expression patterns were correlated with the consensus diagnoses. Kappa (ĸ)-statistics were computed to measure inter-observer agreements, and concordance of the p53-IHC patterns with the consensus diagnoses. For the diagnosis of dVIN, overall agreement was moderate (ĸ = 0.42), and pair-wise agreements ranged from slight (ĸ = 0.10) to substantial (ĸ = 0.73). Based on the levels of agreement and ratings of usefulness, the most helpful diagnostic features were parakeratosis, cobblestone appearance, chromatin abnormality, angulated nuclei, atypia discernable under × 100, and altered cellular alignment. p53-IHC patterns showed substantial concordance (ĸ = 0.67) with the consensus diagnoses. Histological interpretation of dVIN remains challenging with suboptimal inter-observer agreement. We identified the histological features that may facilitate the diagnosis of dVIN. For cases with a histological suspicion of dVIN, consensus-based pathological evaluation may improve the reliability of the diagnosis.

Barriers to preventive care utilization among Hong Kong community-dwelling older people and their views on using financial incentives to improve preventive care utilization

BACKGROUND

Financial incentive is increasingly used as a mean to promote preventive care utilization (PCU), but the current Elderly Health Care Voucher Scheme (EHCVS) in Hong Kong is ineffective for encouraging PCU.

OBJECTIVE

To explore the older people's barriers to PCU and their views on financial incentive, including EHCVS, for improving private PCU.

DESIGN AND SETTING

Focus-group discussions were conducted in community elderly centres located in five districts of Hong Kong.

PARTICIPANTS

Community-dwelling older people aged 60 years or above.

RESULTS

Lack of understanding about preventive care and low awareness of the need for preventive care were key factors for the low motivation for PCU. Uncertainty over the level of service fee charged and concerns over service quality hindered the choice of using the private service providers under the current EHCVS. Financial incentives specific for preventive care services were thought to be cues to actions and guides for service promotion. However, some flexibility in service coverage and a set time limit of the financial incentives were preferred to accommodate individual needs.

CONCLUSIONS

Apart from promoting knowledge of preventive care, official monitoring for service fee and quality is important for empowering older people to choose private service providers for preventive care. Financial incentives for preventive care services should be more specific to cue service promotion and uptake of preventive care while maintaining flexibility to accommodate individual needs.

PATIENT OR PUBLIC CONTRIBUTION

Participants were recruited using purposive sampling with the coordination of community elderly centres. Data were analysed using thematic coding.