Despite their promise as a scalable intervention modality for binge eating and related problems, reviews show that engagement of app-based interventions is variable. Issues with usability may account ...for this. App developers should undertake usability testing so that any problems can be identified and fixed prior to dissemination. We conducted a qualitative usability evaluation of a newly-developed app for binge eating in 14 individuals with a diagnostic- or subthreshold-level binge eating symptoms. Participants completed a semi-structured interview and self-report measures. Qualitative data were organized into six themes: usability, visual design, user engagement, content, therapeutic persuasiveness, and therapeutic alliance. Qualitative and quantitative results indicated that the app demonstrated good usability. Key advantages reported were its flexible content-delivery formats, level of interactivity, easy-to-understand information, and ability to track progress. Concerns with visual aesthetics and lack of professional feedback were raised. Findings will inform the optimal design of app-based interventions for eating disorder symptoms.
Abstract
Far-ultraviolet (FUV; ∼1200–2000 Å) spectra are fundamental to our understanding of star-forming galaxies, providing a unique window on massive stellar populations, chemical evolution, ...feedback processes, and reionization. The launch of the James Webb Space Telescope will soon usher in a new era, pushing the UV spectroscopic frontier to higher redshifts than ever before; however, its success hinges on a comprehensive understanding of the massive star populations and gas conditions that power the observed UV spectral features. This requires a level of detail that is only possible with a combination of ample wavelength coverage, signal-to-noise, spectral-resolution, and sample diversity that has not yet been achieved by any FUV spectral database. We present the Cosmic Origins Spectrograph Legacy Spectroscopic Survey (CLASSY) treasury and its first high-level science product, the CLASSY atlas. CLASSY builds on the Hubble Space Telescope (HST) archive to construct the first high-quality (S/N
1500 Å
≳ 5/resel), high-resolution (
R
∼ 15,000) FUV spectral database of 45 nearby (0.002 <
z
< 0.182) star-forming galaxies. The CLASSY atlas, available to the public via the CLASSY website, is the result of optimally extracting and coadding 170 archival+new spectra from 312 orbits of HST observations. The CLASSY sample covers a broad range of properties including stellar mass (6.2 < log
M
⋆
(
M
⊙
) < 10.1), star formation rate (−2.0 < log SFR (
M
⊙
yr
−1
) < +1.6), direct gas-phase metallicity (7.0 < 12+log(O/H) < 8.8), ionization (0.5 < O
32
< 38.0), reddening (0.02 <
E
(
B
−
V
) < 0.67), and nebular density (10 <
n
e
(cm
−3
) < 1120). CLASSY is biased to UV-bright star-forming galaxies, resulting in a sample that is consistent with the
z
∼ 0 mass–metallicity relationship, but is offset to higher star formation rates by roughly 2 dex, similar to
z
≳ 2 galaxies. This unique set of properties makes the CLASSY atlas the benchmark training set for star-forming galaxies across cosmic time.
Few studies have assessed the relationship between poverty and the risk of infection with antimicrobial resistant organisms (AROs). We sought to identify, appraise, and synthesize the available ...published Canadian literature that analyzes living in poverty and risk of AROs.
A structured narrative review methodology was used, including a systematic search of three databases: MedLINE, EMBASE and Web of Science for articles pertaining to poverty, and infection with AROs in Canada between 1990 and 2020. Poverty was broadly defined to include economic measures and associated social determinants of health. Based on inclusion and exclusion criteria, there were 889 initial articles, and 43 included in the final review. The final articles were extracted using a standard format and appraised using the Joanna Briggs Institute Levels of Evidence framework.
Of 43 studies, 15 (35%) related to methicillin-resistant Staphylococcus aureus (MRSA). One study found a 73% risk reduction (RR 0.27, 95%CI 0.19-0.39, p = < 0.0001) in community-acquired MRSA (CA-MRSA) infection for each $100,000 income increase. Results pertaining to homelessness and MRSA suggested transmission was related to patterns of frequent drug use, skin-to-skin contact and sexual contact more than shelter contact. Indigenous persons have high rates of CA-MRSA, with more rooms in the house being a significant protective factor (OR 0.86, p = 0.023). One study found household income over $60,000 (OR 0.83, p = 0.039) in univariate analysis and higher maternal education (OR 0.76, 95%CI 0.63-0.92, p = 0.005) in multivariate analysis were protective for otitis media due to an ARO among children. Twenty of 43 (46.5%) articles pertained to tuberculosis (TB). Foreign-born persons were four times more likely to have resistant TB compared to Canadian-born persons. None of the 20 studies used income in their analyses.
There is an association between higher income and protection from CA-MRSA. Mixed results exist regarding the impact of homelessness and MRSA, demonstrating a nuanced relationship with behavioural risk factors. Higher income and maternal education were associated with reduced ARO-associated acute otitis media in children in one study. We do not have a robust understanding of the social measures of marginalization related to being foreign-born that contribute to higher rates of resistant TB infection.
The microbiology of cardiac implantable electronic device (CIED) infections in Calgary, Alberta was described, identifying 50 infections from 2013 to 2019. The majority were
(40.0%). There is ...significant economic burden, mostly related to inpatient costs, associated with CIED infections. However, there were no significant differences in costs stratified by organism.
Anxiety is commonly experienced by people living with mild cognitive impairment (MCI) and dementia. Whilst there is strong evidence for late-life anxiety treatment using cognitive behavioural therapy ...(CBT) and delivery via telehealth, there is little evidence for the remote delivery of psychological treatment for anxiety in people living with MCI and dementia. This paper reports the protocol for the Tech-CBT study which aims to investigate the efficacy, cost-effectiveness, usability and acceptability of a technology-assisted and remotely delivered CBT intervention to enhance delivery of anxiety treatment for people living with MCI and dementia of any aetiology.
A hybrid II single-blind, parallel-group randomised trial of a Tech-CBT intervention (n = 35) versus usual care (n = 35), with in-built mixed methods process and economic evaluations to inform future scale-up and implementation into clinical practice. The intervention (i) consists of six weekly sessions delivered by postgraduate psychology trainees via telehealth video-conferencing, (ii) incorporates voice assistant app technology for home-based practice, and (iii) utilises a purpose-built digital platform, My Anxiety Care. The primary outcome is change in anxiety as measured by the Rating Anxiety in Dementia scale. Secondary outcomes include change in quality of life and depression, and outcomes for carers. The process evaluation will be guided by evaluation frameworks. Qualitative interviews will be conducted with a purposive sample of participants (n = 10) and carers (n = 10), to evaluate acceptability and feasibility, as well as factors influencing participation and adherence. Interviews will also be conducted with therapists (n = 18) and wider stakeholders (n = 18), to explore contextual factors and barriers/facilitators to future implementation and scalability. A cost-utility analysis will be undertaken to determine the cost-effectiveness of Tech-CBT compared to usual care.
This is the first trial to evaluate a novel technology-assisted CBT intervention to reduce anxiety in people living with MCI and dementia. Other potential benefits include improved quality of life for people with cognitive impairment and their care partners, improved access to psychological treatment regardless of geographical location, and upskilling of the psychological workforce in anxiety treatment for people living with MCI and dementia.
This trial has been prospectively registered with ClinicalTrials.gov: NCT05528302 September 2, 2022.
Cardiac implantable electronic devices (CIED) are being inserted with increasing frequency. Severe surgical site infections (SSI) that occur after device implantation substantially impact patient ...morbidity and mortality and can result in multiple hospital admissions and repeat surgeries. It is important to understand the costs associated with these infections as well as healthcare utilization. Therefore, we conducted a population-based study in the province of Alberta, Canada to understand the economic burden of these infections.
A cohort of adult patients in Alberta who had CIEDs inserted or generators replaced between January 1, 2011 and December 31, 2019 was used. A validated algorithm of International Classification of Diseases (ICD) codes to identify complex (deep/organ space) SSIs that occurred within the subsequent year was applied to the cohort. The overall mean 12-month inpatient and outpatient costs for the infection and non-infection groups were assessed. In order to control for variables that may influence costs, propensity score matching was completed and incremental costs between those with and without infection were calculated. As secondary outcomes, number of outpatient visits, hospitalizations and length of stay were assessed.
There were 26,049 procedures performed during our study period, of which 320 (1.23%) resulted in SSIs. In both unadjusted costs and propensity score matched costs the infection group was associated with increased costs. Overall mean cost was $145,312 in the infection group versus $34,264 in the non-infection group. The incremental difference in those with infection versus those without in the propensity score match was $90,620 (Standard deviation $190,185). Approximately 70% of costs were driven by inpatient hospitalizations. Inpatients hospitalizations, length of stay and outpatient visits were all increased in the infection group.
CIED infections are associated with increased costs and are a burden to the healthcare system. This highlights a need to recognize increasing SSI rates and implement measures to minimize infection risk. Further studies should endeavor to apply this work to full economic evaluations to better understand and identify cost-effective infection mitigation strategies.
Abstract Subseasonal prediction fills the gap between weather forecasts and seasonal outlooks. There is evidence that predictability on subseasonal timescales comes from a combination of atmosphere, ...land, and ocean initial conditions. Predictability from the land is often attributed to slowly varying changes in soil moisture and snowpack, while predictability from the ocean is attributed to sources such as the El Niño Southern Oscillation. Here we use a set of subseasonal reforecast experiments with CESM2 to quantify the respective roles of atmosphere, land, and ocean initial conditions on subseasonal prediction skill over land. These reveal that the majority of prediction skill for global surface temperature in weeks 3–4 comes from the atmosphere, while ocean initial conditions become important after week 4, especially in the Tropics. In the CESM2 subseasonal prediction system, the land initial state does not contribute to surface temperature prediction skill in weeks 3–6 and climatological land conditions lead to higher skill, disagreeing with our current understanding. However, land-atmosphere coupling is important in week 1. Subseasonal precipitation prediction skill also comes primarily from the atmospheric initial condition, except for the Tropics, where after week 4 the ocean state is more important.
Abstract
Background
Escherichia coli (E. coli) is a frequent cause of blood stream infection (BSI) with associated morbidity and mortality. We evaluated the costs of susceptible and resistant E. coli ...BSI in children and adults. There is a paucity of studies examining E. coli BSI using micro-costing data within North America.
Methods
Population-based cohort of all blood cultures from 2011 to 2018 in Calgary, Canada, linked to micro- and gross costing data using administrative databases. Compared no BSI to any E. coli infection, classified as resistant to any antimicrobial agent or susceptible, over 90 days. Propensity score matching was done 4:1 by age, sex, and comorbidities. The primary outcome was mean costs, using multivariable linear regression models in R version 4.1.0. Secondary outcomes were length of stay (LOS), readmissions and 90-day all-cause mortality. Comparative analyses were reported using odds ratios (OR) and 95% CIs.
Results
A total of 37,482 children and 89,673 adults were included: 225 susceptible and 21 resistant BSI in children, and 3,870 and 711, in adults. Mean and standard deviation (SD) costs of an E. coli BSI including ED visits and hospitalizations for 90 days in children were $99,214 ($152,809) for susceptible, and $94,628 ($113,281) for resistant infections, and $36,104 ($74,274), and $57,162 ($176,019) in adults. The greatest cost difference in adults was resistant E. coli BSI compared to no BSI ($24,265, 95% CI $11,308-37,223, p< 0.001), with higher odds of readmission (OR 1.54, 95% CI 1.26-1.88, p< 0.001) and increased LOS (4.17 days, 95% CI 1.04-7.30, p=0.009). In children, cost differences were greatest for susceptible infections compared to no BSI ($45,186, 95% CI 27,965-62,406, p< 0.001), with the longest initial hospitalization (17.1 days, 95% CI 10.3-23.9, p< 0.001), and higher readmissions at 90 days (OR 1.65, 95% CI 1.17-2.31, p=0.004). E. coli BSI did not impact mortality for children or adults compared to those with no BSI.
Conclusion
E. coli BSI is associated with substantial morbidity, mortality, and costs. Total cost differences were highest among adults with resistant, and children with susceptible infections compared to no BSI. Further research into cost-effectiveness of BSI diagnosis, treatment and prevention is warranted.
Disclosures
Ranjani Somayaji, M.D, CF Foundation: Grant/Research Support|CIHR: Grant/Research Support|Oncovir: Data and Safety Monitoring Board Fees|Vertex Pharmaceuticals: Advisor/Consultant|Vertex Pharmaceuticals: Grant/Research Support|Vertex Pharmaceuticals: Honoraria Dan Gregson, MD, BioMerieux Canada: Advisor/Consultant
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