Understanding online health information: Evaluation, tools, and strategies

OBJECTIVE

Considering the status of the Internet as a prominent source of health information, assessing online health material has become a central issue in patient education. We describe the strategies available to evaluate the characteristics of online health information, including readability, emotional content, understandability, usability.

METHODS

Popular tools used in assessment of readability, emotional content and comprehensibility of online health information were reviewed. Tools designed to evaluate both printed and online material were considered.

RESULTS

Readability tools are widely used in online health material evaluation and are highly covariant. Assessment of emotional content of online health-related communications via sentiment analysis tools is becoming more popular. Understandability and usability tools have been developed specifically for health-related material, but each tool has important limitations and has been tested on a limited number of health issues.

CONCLUSION

Despite the availability of numerous assessment tools, their overall reliability differs between readability (high) and understandability (low). Approaches combining multiple assessment tools and involving both quantitative and qualitative observations would optimize assessment strategies.

PRACTICE IMPLICATIONS

Effective assessment of online health information should rely on mixed strategies combining quantitative and qualitative evaluations. Assessment tools should be selected according to their functional properties and compatibility with target material.

Assessment of online patient materials for breast reconstruction

BACKGROUND

Limited health literacy affects nearly half of American adults and adversely affects patient participation, satisfaction, health care costs, and overall outcomes. As patients increasingly search the Internet for health information, accessibility of online material is critical. Previous studies examining this topic have focused on the readability of these materials. This study evaluates online breast reconstruction resources with regard to reading level, however, adds new metrics to assess degree of complexity, and suitability for the intended audience.

METHODS

The 10 most popular patient Web sites for "breast reconstruction" were identified using the largest Internet search engine. The content of each site was assessed for readability using the simple measure of gobbledygook analysis, complexity using the PMOSE/iKIRSCH formula, and suitability using the suitability assessment of materials instrument. Resulting scores were analyzed overall and by Web site.

RESULTS

Readability analysis revealed an overall average grade level of 13.4 (range 10.7-15.8). All sites exceeded the recommended sixth grade level. Complexity evaluation revealed a mean PMOSE/iKIRSCH score of 6.3, consistent with "low" complexity and requiring an 8th-12th grade education; individual sites ranged from "very low" to "high" complexity. Suitability assessment overall produced a mean 41.2% score, interpreted as "adequate" for the intended patient audience. Five of the 10 sites were found to be "not suitable" when examined individually; the remaining five were "adequate."

CONCLUSIONS

Available online patient material for breast reconstruction is often too difficult for many patients to understand based on readability, complexity, and suitability metrics. Comprehensive assessment is needed to design appropriate patient material and minimize disparities related to limited health literacy.

Suitability of different containers for the sampling and storage of biogas and biomethane for the determination of the trace-level impurities--A review

The traceable and accurate measurement of biogas impurities is essential in order to robustly assess compliance with the specifications for biomethane being developed by CEN/TC408. An essential part of any procedure aiming to determinate the content of impurities is the sampling and the transfer of the sample to the laboratory. Key issues are the suitability of the sample container and minimising the losses of impurities during the sampling and analysis process. In this paper, we review the state-of-the-art in biogas sampling with the focus on trace impurities. Most of the vessel suitability studies reviewed focused on raw biogas. Many parameters need to be studied when assessing the suitability of vessels for sampling and storage, among them, permeation through the walls, leaks through the valves or physical leaks, sorption losses and adsorption effects to the vessel walls, chemical reactions and the expected initial concentration level. The majority of these studies looked at siloxanes, for which sampling bags, canisters, impingers and sorbents have been reported to be fit-for-purpose in most cases, albeit with some limitations. We conclude that the optimum method requires a combination of different vessels to cover the wide range of impurities commonly found in biogas, which have a wide range of boiling points, polarities, water solubilities, and reactivities. The effects from all the parts of the sampling line must be considered and precautions must be undertaken to minimize these effects. More practical suitability tests, preferably using traceable reference gas mixtures, are needed to understand the influence of the containers and the sampling line on sample properties and to reduce the uncertainty of the measurement.

The readability and suitability of sexual health promotion leaflets

OBJECTIVE

To investigate the readability and suitability of sexual health promotion leaflets.

METHOD

Application of SMOG, FRY and SAM tests to assess the readability and suitability of a selection of sexual health leaflets.

RESULTS

SMOG and FRY scores illustrate an average reading level of grade 9. SAM scores indicate that 59% of leaflets are superior in design and 41% are average in design. Leaflets generally perform well in the categories of content, literacy demand, typography and layout. They perform poorly in use of graphics, learning stimulation/motivation and cultural appropriateness.

CONCLUSION

Sexual health leaflets have a reading level that is too high. Leaflets perform well on the suitability scores indicating they are reasonably suitable. There are a number of areas where sexual health leaflets could improve their design.

PRACTICE IMPLICATIONS

Numerous practical techniques are suggested for improving the readability and suitability of sexual health leaflets.

Readability, complexity, and suitability analysis of online lymphedema resources

BACKGROUND

Over 72% of Americans use online health information to assist in health care decision-making. Previous studies of lymphedema literature have focused only on reading level of patient-oriented materials online. Findings indicate they are too advanced for most patients to comprehend. This, more comprehensive study, expands the previous analysis to include critical elements of health materials beyond readability using assessment tools to report on the complexity and density of data as well as text design, vocabulary, and organization.

METHODS

The top 10 highest ranked websites on lymphedema were identified using the most popular search engine (Google). Website content was analyzed for readability, complexity, and suitability using Simple Measure of Gobbledygook, PMOSE/iKIRSCH, and Suitability Assessment of Materials (SAM), respectively. PMOSE/iKIRSCH and SAM were performed by two independent raters. Fleiss' kappa score was calculated to ensure inter-rater reliability.

RESULTS

Online lymphedema literature had a reading grade level of 14.0 (SMOG). Overall complexity score was 6.7 (PMOSE/iKIRSCH) corresponding to "low" complexity and requiring a 8th-12th grade education. Fleiss' kappa score was 80% (P = 0.04, "substantial" agreement). Overall suitability score was 45% (SAM) correlating to the lowest level of "adequate" suitability. Fleiss' kappa score was 76% (P = 0.06, "substantial" agreement).

CONCLUSIONS

Online resources for lymphedema are above the recommended levels for readability and complexity. The suitability level is barely adequate for the intended audience. Overall, these materials are too sophisticated for the average American adult, whose literacy skills are well documented. Further efforts to revise these materials are needed to improve patient comprehension and understanding.

The suitability of biotypes Q and B of Bemisia tabaci (Gennadius) (Hemiptera: Aleyrodidae) at different nymphal instars as hosts for Encarsia formosa Gahan (Hymenoptera: Aphelinidae)

Encarsia formosa Gahan (Hymenoptera: Aphelinidae) is a solitary endoparasitoid that is commercially reared and released for augmentative biological control of whiteflies infesting greenhouse crops. In most areas in China, the invasive and destructive whitefly Bemisia tabaci (Gennadius) (Hemiptera: Aleyrodidae) biotype Q has replaced B. tabaci biotype B and has become dominant between the two. A better understanding of the suitability of different nymphal instars of B. tabaci biotypes Q and B as hosts for E. formosa is needed to improve the use of this parasitoid for biological control. Parasitism of the four nymphal instars of B. tabaci biotypes Q and B by the commercial strain of E. formosa mass reared on Trialeurodes vaporariorum (Westwood) (Hemiptera: Aleyrodidae) was assessed in the laboratory. The results indicated that E. formosa parasitized and successfully developed on all instars of both biotypes but performed best on the 3rd instar of B. tabaci biotype B and on the 2nd, 3rd, and 4th instars of B. tabaci biotype Q. The host-feeding rate of the adult parasitoid was generally higher on nymphal instars of B. tabaci biotype Q than on the corresponding nymphal instars of biotype B and was significantly higher on the 2nd and 3rd instars. For both whitefly biotypes, the parasitoid’s immature developmental period was the longest on the 1st instar, intermediate on the 2nd and 3rd instars, and the shortest on the 4th instar. The parasitoid emergence rate was significantly lower on the 1st instar than on the other three instars and did not significantly differ between B. tabaci biotype B and biotype Q. Offspring longevity was greater on the 3rd and 4th instars than on the 1st instar and did not significantly differ between the two B. tabaci biotypes. The results indicate that commercially-produced E. formosa can parasitize all instars of B. tabaci biotypes B and Q, making this parasitoid a promising tool for the management of the two biotypes of B. tabaci present in China.

Measures of readiness for cognitive behavioural therapy in people with intellectual disability: A systematic review

BACKGROUND AND AIMS

Cognitive behavioural therapy (CBT) is a promising treatment for mental health problems in people with intellectual disabilities but some may not be suited or ready. This review critically evaluates the quality and utility of measures of CBT readiness in people with intellectual disabilities.

METHODS AND PROCEDURES

Twelve studies of six measures based on three aspects of CBT readiness were identified through systematic review.

OUTCOMES AND RESULTS

Across measures, measurement quality was largely poor or un-assessed. Only one study evaluated measurement change over the course of CBT. Not all participants with intellectual disabilities could 'pass' readiness measures and performance may be affected by levels of language and cognitive functioning. There was some evidence that CBT readiness is trainable with brief interventions.

CONCLUSIONS AND IMPLICATIONS

Before using readiness measures in a clinical context, further work is needed to extend initial evidence on recognising cognitive mediation as a CBT readiness ability. Given the lack of consensus as to the definition of CBT readiness and the heterogeneity of CBT interventions, future research could also focus on developing readiness measures using a bottom up approach, developing measures within the context of CBT interventions themselves, before further refining and establishing their psychometric properties.

WHAT THIS PAPER ADDS

This paper is the first to systematically review measures of skills thought necessary to be ready for cognitive behavioural therapy in intellectual disabilities. The findings suggest that while readiness skills may be trainable with brief interventions, the available measures of these skills have not been fully evaluated for quality. Levels of functioning on these measures have yet to be established relative to those without intellectual disabilities and critically, there is very little evidence as to whether these skills are important in cognitive behavioural therapy process and outcome. We suggest that future research could focus on those constructs where there is preliminary evidence for utility such as recognising cognitive mediation and also on developing the concept of readiness perhaps by developing measures within the context of specific CBT interventions. Until this is done, clinicians should exercise caution in using these measures to assess readiness for cognitive behavioural therapy in people with intellectual disabilities.

Request of thyroid function tests from Primary Care in Spain

BACKGROUND AND OBJECTIVES

Laboratory tests are crucial for diagnosis and monitoring of thyroid disorders. It is therefore necessary to study the pattern and variability in requests of thyroid function tests. The study objectives were to compare the inter-regional variability in the request of laboratory thyroid tests by general practitioners (GPs) in Spain, and to investigate the potential economic savings if the goals set for some suitability indicators were reached.

METHODS

Test requests per 1,000 inhabitants and test ratios (free thyroxine (FT4)/thyrotropin (TSH), free triiodothyronine (FT3)/TSH, thyroglobulin antibody (TgAb)/peroxidase antibody (TPOAb)) were compared between the different areas, according to their setting, location, and management. The resulting savings if each department achieved the goals for indicator (0.25 for FT4/TSH, 0.1 for FT3/TSH) were estimated.

RESULTS

Seventy-six laboratories covering a population of 17,679,195 inhabitants participated in the study. TSH was requested significantly less in urban-rural areas, and the requests for FT3/1,000 inhabitants, FT3/TSH, and TgAb/TPOAb were higher in departments with private management. The savings generated if specifications for the ratios of related tests were met would be 937,260.5 €.

CONCLUSIONS

The high variability reported in requests for thyroid function and autoimmunity tests in Spain suggests the need for implementing strategies to improve use of such tests.

Mapping a Plasmodium transmission spatial suitability index in Solomon Islands: a malaria monitoring and control tool

BACKGROUND

Malaria remains a challenge in Solomon Islands, despite government efforts to implement a coordinated control programme. This programme resulted in a dramatic decrease in the number of cases and mortality however, malaria incidence remains high in the three most populated provinces. Anopheles farauti is the primary malaria vector and a better understanding of the spatial patterns parasite transmission is required in order to implement effective control measures. Previous entomological studies provide information on the ecological preferences of An. farauti but this information has never before been gathered and "translated" in useful tools as maps that provide information at both the national level and at the scale of villages, thus enabling local targeted control measures.

METHODS

A literature review and consultation with entomology experts were used to determine and select environmental preferences of An. farauti. Remote sensing images were processed to translate these preferences into geolocated information to allow them to be used as the basis for a Transmission Suitability Index (TSI). Validation was developed from independent previous entomological studies with georeferenced locations of An. farauti. Then, TSI was autoscaled to ten classes for mapping.

RESULTS

Key environmental preferences for the An. farauti were: distance to coastline, elevation, and availability of water sources. Based on these variables, a model was developed to provide a TSI. This TSI was developed using GIS and remote sensing image processing, resulting in maps and GIS raster layer for all the eight provinces and Honiara City at a 250 m spatial resolution. For a TSI ranging from 0 as not suitable to 13 as most suitable, all the previous collections of An. farauti had mean TSI value between 9 and 11 and were significantly higher than where the vector was searched for and absent. Resulting maps were provided after autoscaling the TSI into ten classes from 0 to 9 for visual clarity.

CONCLUSIONS

The TSI model developed here provides useful predictions of likely malaria transmission larval sources based on the environmental preferences of the mosquito, An. farauti. These predictions can provide sufficient lead-time for agencies to target malaria prevention and control measures and can assist with effective deployment of limited resources. As the model is built on the known environmental preferences of An. farauti, the model should be completed and updated as soon as new information is available. Because the model did not include any other malaria transmission factors such as care availability, diagnostic time, treatment, prevention, and entomological parameters other than the ecological preferences neither, our suitability mapping represents the upper bound of transmission areas. The results of this study can now being used as the basis of a malaria monitoring system which has been jointly implemented by the Solomon Islands National Vector Borne Disease Control Programme, the Solomon Islands Meteorological Services and the Australian Bureau of Meteorology. The TSI model development method can be applied to other regions of the world where this mosquito occurs and could be adapted for other species.

Assessment of online patient education materials designed for people with age-related macular degeneration

Background

Age-related macular degeneration (AMD) is a chronic eye condition that leads to permanent vision loss in the central visual field. AMD makes reading challenging and inefficient. People with AMD often find it difficult to access, process and understand written patient education materials (PEMs). To promote health literacy, the demands of written PEMs must match the literacy capacities of the target audience. This study aims to evaluate the readability (grade level) and suitability (appropriateness) of online PEMs designed for people with AMD.

Methods

Online PEMs were sourced from websites of national organizations providing patient education materials designed for people with AMD. The Flesch-Kincaid Grade Level formula and the Suitability Assessment of Materials instrument were used to assess the readability and suitability of PEMs. Descriptive statistics were used to compare online PEMs by organization based on national guidelines for readability level (≤ sixth grade) and the recommended suitability score (≥ 70%) for “superior” material.

Results

One hundred online PEMs were evaluated from websites of 16 professional organizations. The mean readability level was 9.3 (range 5.0–16.6). The mean suitability score was 53% (range 18–78%). Only six (6%) of PEMs achieved the recommended guidelines for readability level and suitability score.

Conclusion

The majority of online PEMs designed for people with AMD were written above the recommended readability level, and below the suggested suitability score. To promote health literacy, the demands of written health information must match the reading capacities of the target audience. Heeding to evidence-based guidelines for providing written information to patients with low health literacy and low vision is beneficial for both patients and health care providers. Future research is warranted.

Holistic suitability for regional biomass power generation development in China: An application of matter-element extension model

In the context of tremendously promoting bioenergy utilization, regional suitability for industrial development of biomass power generation is a critical factor when deploying region-specific strategies. An integrated framework is developed incorporating resource potential, development demands and development conditions to evaluate the suitability for regional industrial development of power generation utilizing agricultural bioresources. Twelve indicators reflecting local resource, environmental and socioeconomic features are used to measure the suitability of 31 provincial regions in China. An improved matter-element extension model combined with the entropy weight method is adopted to attain holistic and hierarchical suitability ranks. The results reveal that the distribution of holistic suitability ranks among regions is imbalanced with the eastern regions presenting more advantages compared with the western regions. Three regions belonging to Rank I (optimum) are Henan, Shandong and Xinjiang. Hainan, Tibet, Qinghai are classified into Rank V (unsuited). Moreover, there are great differences in the limiting factors of the suitability among regions. Resource potential is a limiting factor for Beijing, Shanghai, Fujian, Hainan and Guizhou; Development demands refrain Fujian, Guangxi and Yunnan; Tianjin and Ningxia are limited by development conditions. Tibet and Qinghai have the worst performance on each criterion. The results and region-targeted policy recommendations can provide insights for bioenergy utilization development in accordance with local conditions closely.

Validation of a Spectral Method for Quantitative Measurement of Color in Protein Drug Solutions

A quantitative spectral method has been developed to precisely measure the color of protein solutions. In this method, a spectrophotometer is utilized for capturing the visible absorption spectrum of a protein solution, which can then be converted to color values (L*a*b*) that represent human perception of color in a quantitative three-dimensional space. These quantitative values (L*a*b*) allow for calculating the best match of a sample's color to a European Pharmacopoeia reference color solution. In order to qualify this instrument and assay for use in clinical quality control, a technical assessment was conducted to evaluate the assay suitability and precision. Setting acceptance criteria for this study required development and implementation of a unique statistical method for assessing precision in 3-dimensional space. Different instruments, cuvettes, protein solutions, and analysts were compared in this study. The instrument accuracy, repeatability, and assay precision were determined. The instrument and assay are found suitable for use in assessing color of drug substances and drug products and is comparable to the current European Pharmacopoeia visual assessment method.

LAY ABSTRACT

In the biotechnology industry, a visual assessment is the most commonly used method for color characterization, batch release, and stability testing of liquid protein drug solutions. Using this method, an analyst visually determines the color of the sample by choosing the closest match to a standard color series. This visual method can be subjective because it requires an analyst to make a judgment of the best match of color of the sample to the standard color series, and it does not capture data on hue and chroma that would allow for improved product characterization and the ability to detect subtle differences between samples. To overcome these challenges, we developed a quantitative spectral method for color determination that greatly reduces the variability in measuring color and allows for a more precise understanding of color differences. In this study, we established a statistical method for assessing precision in 3-dimensional space and demonstrated that the quantitative spectral method is comparable with respect to precision and accuracy to the current European Pharmacopoeia visual assessment method.

A model for effective planning of SME support services

This paper presents a model for effective planning of support services for small and medium-sized enterprises (SMEs). The idea is to scrutinize and measure the suitability of support services in order to give recommendations for the improvement of a support planning process. We examined the applied support services and matched them with the problems and needs of SMEs, based on the survey conducted in 2013 on a sample of 336 SMEs in Serbia. We defined and analysed the five research questions that refer to support services, their consistency with the SMEs' problems and needs, and the relation between the given support and SMEs' success. The survey results have shown a statistically significant connection between them. Based on this result, we proposed an eight-phase model as a method for the improvement of support service planning for SMEs. This model helps SMEs to plan better their requirements in terms of support; government and administration bodies at all levels and organizations that provide support services to understand better SMEs' problems and needs for support.

The assessment of good character in nursing and midwifery pre-registration students: A modified Delphi approach

AIMS

To examine the perspectives of decision-makers when assessing the good character of nursing and midwifery pre-registration students in relation to their continued fitness to practise.

DESIGN

A qualitative iterative survey design in the interpretive paradigm.

METHODS

An expert panel of fitness to practise decision-makers was established to examine their perspectives when assessing the good character of nursing and midwifery pre-registration students. A qualitative modified Delphi approach was used to collect data via an on-line asynchronous questionnaire through a series of three iterative rounds in 2016. Qualitative data from all rounds were analysed using thematic analysis. A final overall analysis and interpretation was undertaken.

RESULTS

The assessment of good character in nursing and midwifery pre-registration students is complex and appears to be heavily influenced by contextual factors including moral beliefs and the student's stage on the course. Determining seriousness and the potential for repetition of behaviour were key components of the decision-making process and were influenced by the student's ability to demonstrate self-awareness through reflection and remorse, and honesty and integrity through a professional duty of candour.

CONCLUSION

Educating students to understand how good character is assessed and the importance of epistemological reflection along with recognition of the student status in Nursing and Midwifery Council fitness to practise documentation is recommended to promote consistency in the assessment of good character between higher education institutions. Consistent decision-making with regard to good character may assist in maintaining public protection, trust and confidence in the nursing and midwifery professions in the future.

"Who needs secure services for personality disorder?" Results of an expert Delphi study with professional staff

BACKGROUND

Personality Disorder (PD) is an enduring, multi-faceted mental disorder, associated with adverse health effects, difficulties with interpersonal relationships and in some cases increased risk to others. A limited number of dedicated forensic mental health services are available for serious offenders with severe personality disorder. The recent Offender Personality Disorder (OPD) strategy aims to ensure that most such offenders are treated in prison rather than secure psychiatric services, except in highly complex cases where this is not possible. While the strategy sets out very broad criteria relating to this, greater clarity is needed to support decisions about appropriate transfer and hence enhance public protection. This study explored which characteristics professional experts associate with appropriate transfer from prison to forensic mental health services for high-risk offenders with PD.

METHOD

A modified Delphi survey distributed through an online survey system was conducted in two-rounds with a group of professional experts recruited from forensic mental healthcare; criminal justice and specialist commissioning.

RESULTS

Fifty-one (56%) respondents completed stage one of the Delphi and 34 (61%) of these completed stage two. Consensus was reached for a total of 22 items indicating complexity, including co-morbid mental illness, high level of risk, lack of progress in prison and high motivation for treatment. A preliminary checklist for these factors was developed. Panel members consistently emphasised the importance of the individual's presenting need, the overall clinical picture and formulation in their free text responses.

CONCLUSIONS

Professionals face a complex picture when making decisions regarding suitability for hospital admission for high-risk male offenders with PD, with varied opinions amongst professional experts as to priorities for intervention and a focus on individual needs through formulation. It was, nevertheless, possible to condense these views into a set of consistent variables that can be used to highlight the need for transfer into hospital-based treatment services.

Suitability evaluation of carrying capacity and utilization patterns on tidal flats of Bohai Rim in China

Tidal flats in the Bohai Rim are facing threats from human activities. Quantifying the carrying capacity and suitability of tidal flats is of great significance to the regional environment and resource management. In this study, the existing social and natural data were collected and the natural conditions of tidal flats, e.g., the distributions and utilization patterns, were investigated through remote sensing image interpretation and field investigation in the Bohai Rim. Then, a multi-index evaluation system was developed with indexes organized under the framework of the analytic hierarchy process (AHP) and the Drivers-State-Impact (DSI) framework, processed by fuzzy evaluation, and weighted by the entropy method. The studies show that the rapid expansion of industry-port-town, salt pans or aquafarms in the Bohai Rim during 1990-2020 squeezed the space of tidal flats. Despite the limitation of the declining resource condition, the carrying capacity of tidal flats in the Bohai Rim increased slightly during 2000-2018 because of the great improvement in economic and ecological conditions. We estimate 59.93% of the land resources are suitable for economic development while others are temporarily unsuitable for reclamation due to their high ecological importance. The land use data and macro-evaluation system of tidal flat utilization patterns herein can provide references for coastal resource management and ecological restoration.

Asymmetric cellulose triacetate is a safe and effective alternative for online haemodiafiltration

BACKGROUND

In post-dilution haemodiafiltration only synthetic membranes have been used to date. Asymmetric cellulose triacetate (ATA™) is now available, whose characteristics are suitable for this technique.

OBJECTIVES

To describe the in vivo performance and behaviour of this membrane, to identify its depurative effectiveness, use in clinical practice and its biocompatibility, both acute and after one month of treatment.

METHODS

Observational prospective study of 23 patients who were dialysed for 4 weeks using an ATA™ membrane and who maintained their prior regimen.

RESULTS

A total of 287 sessions were performed and 264 complete sessions were collected. With an effective time of 243.7 (17.6) min and a mean blood flow of 371.7 (23) ml/min, an average Kt of 56.3 (5.3) l was observed, as well as a convection volume of 27.1 (4.2) l, a filtration fraction of 29.9 (3.7) %, a urea reduction ratio (RR) of 81 (5.2) %, a creatinine RR of 74.7 (4.6) %, a β₂-microglobulin RR of 76.5 (4.8) % and a retinol binding protein RR of 18.6 (7.6) %. There were no technical problems or alarms. Changing the heparin dosage was not necessary. No increases in C3a or C5a concentrations or leukopenia were observed in the first 30min of the session. Neither the monocyte subpopulations nor IL-β1 or IL-6 were significantly altered after one month of treatment.

CONCLUSIONS

The new ATA™ membrane achieves adequate Kt and convection volume, without technical problems and with good biocompatibility and inflammatory profiles. It is therefore a valid option for post-dilution haemodiafiltration, particularly in patients allergic to synthetic membranes.

Thoracoscopy as a safe and effective technique for exploring calves affected with bovine respiratory disease

Background

Bovine respiratory disease (BRD) is one of the leading causes of economic losses in the beef and dairy industry. Reliable antemortem tools for diagnosing BRD would improve the efficacy of treatment and reduce costs. Here we examined whether the relatively simple technique of thoracoscopy can support BRD diagnosis under field conditions. We also compared various equipment set-ups in order to optimize the safety and efficacy of the procedure. A total of 24 thoracoscopic procedures were performed in 17 calves diagnosed with BRD and in 2 healthy control calves. Rigid and flexible endoscopes and industrial videoscopes were tested using various insertion approaches. The suitability of the technique was assessed in terms of duration, volume of air extracted, visualization score, and image quality. Safety was assessed in terms of rectal temperature, body weight, breaths/min, presence of fibrinogen, pain score, recovery time, intraoperative complications and risk of laceration or threatening collapse.

Results

Insertion of a flexible endoscope via a right, dorso-caudal approach at the 5^th intercostal space allowed complete examination of the right lung in 15 min, as well as identification of main lung lesions and adherences in calves with BRD, without compromising calf welfare. While the dorso-caudal approach was optimal, it was associated with substantial discomfort when rigid endoscopes were used, minimal complications or mortality due to thoracoscopy were observed up to 28 days after the procedure. Videoscopes were as safe and easy to use as endoscopes, but endoscopes provided better image quality.

Conclusion

This study provides the first field evidence that thoracoscopy can be safe to explore BRD-diseased calves. These results justify a larger study to rigorously assess the diagnostic performance of the technique.

A case study on the suitability of STARS for green campus in China

With the continuous development of China's green campus, its future construction should learn from foreign advanced development experience and achievements. On the one hand, STARS, a global advanced green campus evaluation system, should be introduced to China's green campus construction and on the other hand, the suitability for China's actual needs should also be considered. Therefore, this study mainly studies the suitability of STARS indicators for green campus in China. Taking a representative university of green campus in China as a specific case, starting from the demand side, this paper uses the fuzzy comprehensive evaluation method to evaluate the users' satisfaction of green campus construction. Comparing the result of satisfaction assessment with the result of STARS's sustainable evaluation, the STARS's indexes are divided into four regional grades by two-dimensional suitability evaluation coordinate system. The results show that STARS is generally suitable for green campus evaluation in China, but two of the evaluation categories need to modify the evaluation scores and weights; the other two categories are not suitable and need to be removed or changed. The purpose is to provide suggestions for the optimization of the evaluation of green campus in China.

Development of a suitability assessment model for the cultivation of intertidal macroalgae in the United States

The focus of this novel study was to determine the comparative suitability of intertidal macroalgae production along the coast of the contiguous United States and determine the optimal locations to consider commercial cultivation using geographic information systems (GIS) software. Intertidal macroalgae cultivation represents an immense opportunity in the United States. The market demand for macroalgae has been growing and is expected to continue with the discovery of new uses. Currently, the coastal waters of the United States are extremely underutilized, particularly for macroalgae production. This study considered economic and environmental factors at a national scale, finally assessing the viability in a representative body of water with in-situ water sampling. The results of this study suggest that intertidal macroalgae cultivation is most ideally suited for the southeastern United States, primarily due to lower costs of production and more hospitable coastlines. Based on a limited water quality samples, it is feasible for macroalgae cultivation. However, due to the informational deficits, as acknowledged in this study, more work is required to refine and enhance the assessment model. This paper identifies these gaps and lists recommendations to overcome these knowledge gaps.

Identification of irrigation potential areas, using multi-criteria analysis in Khyber District, Pakistan

This study explores the opportunities for irrigated agriculture in Khyber District of Former Federally Administered Tribal Area (FATA). Agriculture continues to be most important economic activity in Pakistan and former FATA is no exception. However, agriculture in the semi-arid Khyber District continues to suffer a decline due to excessive reliance on rainfall, which is drastically insufficient. Khyber District have large expanses of fertile land; however, farmers depend on unpredictable rain-fed agriculture, which has low productivity and food insecurity. There are a number of rivers in the region where great prospects exist for irrigated farming. Geographical information systems (GIS)-based multi-criteria analysis can be used to map areas with irrigation potential. The current study focused on different variables including soil texture, perennial rivers, land cover, topography, and dams. For this study, data was collected from diverse sources which include Google earth images, top sheets, land use land cover, soil texture map of FATA, and SRTM 30 Meter. The collected data was analyzed by using multi-criteria analysis in Arc GIS 10.2.2 by using MIF technique. The results of this research indicate that there is great potential for irrigated farming in the study area. Potential land for this purpose were divided into three categories, i.e., highly suitable which consisted of 678 km², or 26% of the total area; 1044 km² representing 40% were moderately suitable to irrigation; while the remaining 698 km² representing 27% were considered least suitable for irrigation. Likewise, 204 km² representing 7% were deemed unsuitable for irrigated agriculture mostly consisting of barren rocks. The results also illustrate how GIS as a tool can be used in the exploration of water resources in a scientific approach, thus making decision-making easier and more accurate.

Poor suitability for psychotherapy - a risk factor for treatment non-attendance?

BACKGROUND

Patient suitability has been suggested to predict treatment non-attendance but information on its effect is limited.

AIM

To study the prediction of the Suitability for Psychotherapy Scale (SPS), on occurrence of treatment non-attendance.

METHODS

Altogether 326 outpatients, with depressive or anxiety disorder, were randomized to short-term psychodynamic psychotherapy (SPP), long-term psychodynamic psychotherapy (LPP), and solution-focused therapy (SFT). SPS was based on seven components from three suitability domains: nature of problems, ego strength, and self-observing capacity. Treatment non-attendance was defined as refusal of engaging therapy and of premature termination. The Cox model and logistic regression were used.

RESULTS

Treatment non-attendance was significantly more common in LPP patients with poor SPS (RR = 2.76, 95% CI = 1.45-5.26). This was mainly due to poor flexibility of interaction, poor self-concept, and poor reflective ability. Premature termination in SFT showed a similar trend but due to other SPS components: absence of a circumscribed problem, poor modulation of affects, and poor response to trial interpretation. On the contrary, individuals with good values of SPS were more prone to premature termination in SPP.

LIMITATIONS

The prediction of suitability on refusal could only be studied in the LPP group due to few refusals in the short-term therapy groups. The sample consisted of patients who participated in a trial. Thus the findings may not be directly generalized to unselected patients in the public mental health setting.

CONCLUSIONS

Poor suitability, apparently, predicts non-attendance in LPP and SFT, but not in SPP. More studies on large cohorts are needed.

Modeling coffee (Coffea arabica L.) climate suitability under current and future scenario in Jimma zone, Ethiopia

Climate suitability is important for coffee (Coffea arabica L.) production in climate variability-prone regions like Ethiopia. The aim of this study was to assess the current and future climate suitability for the species in the Jimma zone under moderate (RCP4.5) and worst (RCP8.5) climate change scenarios. Field surveys and Worldclim and Paleoclim databases were used to capture 224 C. arabica species' location points and 9 bioclimatic data, respectively. The MaxEnt model with integration of ArcGis was used to simulate and characterize these data. The diagnostic outcome of the model showed that the anticipated climate change will increase the areas of suitability in the first and third coffee sub-zones, while there will be a decrease in the second sub-zone. Net suitability under the RCP4.5 would be decreased by 4.75 and 6.09% in the 2050s and 2070s, respectively. Indeed, under the RCP8.5, total suitability will be expected to be increased by 2.52% and 2.25% in the 2050s and 2070s, respectively. For the 2050s and 2070s, the suitability gap between RCP4.5 and RCP8.5 was estimated to be 401 km² and 1567 km², respectively. To summarize, with the exemption of RCP 8.5 within the 2070s, the suitability would be improved and come up short in all circumstances. To keep Arabica coffee in its original habitat, we suggest that the entire climate change adjustment procedures that are prearranged under the RCP4.5 ought to be executed to sustain the crop trees in its origin. Otherwise, moving the crop plant from impeded areas to suitable ones is crucial.

The EPAGE guidelines are not an effective strategy for managing colonoscopies during the COVID-19 pandemic

Introducción La pandemia producida por el virus SARS-CoV-2 ha generado un grave impacto en el funcionamiento de las unidades de endoscopia digestiva. La Asociación Española de Gastroenterología y la Sociedad Española de Endoscopia Digestiva (AEG-SEED) han propuesto la utilización de la guía European Panel on the Appropriateness of Gastrointestinal Endoscopy II (EPAGE) para la gestión de las colonoscopias pospuestas.

Objetivo

Evaluar la guía EPAGE como herramienta de gestión en comparación con el test de sangre oculta en heces inmunológico (TSOHi) y con una calculadora de riesgo (CR), que incluye la edad, el sexo y el TSOHi, para la detección de cáncer colorrectal (CCR) y lesión significativa colónica (LSC).

Métodos

Estudio unicéntrico prospectivo. Se incluyeron 743 pacientes derivados para una colonoscopia diagnóstica. Se clasificó cada solicitud según EPAGE en apropiada, indeterminada e inapropiada. Se les entregó un TSOHi y se calculó el valor de la CR.

Resultados

El TSOHi (p<0,001), pero no EPAGE (p = 0,742), fue una variable independiente de riesgo de CCR. El área bajo la curva receiver operating characteristic (ROC) de EPAGE, TSOHi y CR fue: 0,61(IC 95% 0,49 a 0,75), 0,95 (0,93 a 0,97) y 0,90 (0,87 a 0,93) para CCR; y 0,55 (0,49 a 0,61), 0,75 (0,69 a 0,813) y 0,78 (0,73 a 0,83) para LSC, respectivamente. El número necesario de colonoscopias para detectar un CCR y una LSC fue de 38 y siete para EPAGE, de siete y dos para TSOHi, y de 19 y cuatro para CR ≥ cinco puntos, respectivamente.

Conclusión

La EPAGE, a diferencia del TSOHi, no es adecuada para seleccionar a los pacientes candidatos a colonoscopia diagnóstica para la detección de CCR. El TSOHi, en combinación con la edad y el sexo, es la estrategia correcta para gestionar la demanda de endoscopia en un escenario de acceso restrictivo.

The Psychological Assessment of Clerics

The psychological assessment of novice and experienced clerics is an important component of ordination, suitability, and risk evaluation to ensure that representatives of religious organizations are equipped, motivated, and safe for a life commitment to a faith vocation. It is the authors' opinion that such assessments should be conducted by skilled psychologists with expertise that covers occupational, clinical, and forensic domains. Further, the authors emphasize the importance of an objective and secular assessment to better inform the church about its role and responsibility for the oversight and spiritual development of the cleric. A thorough psychological assessment should incorporate a multimodal approach to information gathering, which includes a comprehensive review of background information and medical records, a personal history interview, a mental status examination, and administration of relevant psychometric measures and assessment tools. We also advise that, upon completion of the assessment, the requesting religious organization should be offered the opportunity to meet with the evaluating psychologist to discuss suitability issues and, if necessary, risk management planning.