The digital revolution is disrupting the ways in which health research is conducted, and subsequently, changing healthcare. Direct-to-consumer wellness products and mobile apps, pervasive sensor ...technologies and access to social network data offer exciting opportunities for researchers to passively observe and/or track patients 'in the wild' and 24/7. The volume of granular personal health data gathered using these technologies is unprecedented, and is increasingly leveraged to inform personalized health promotion and disease treatment interventions. The use of artificial intelligence in the health sector is also increasing. Although rich with potential, the digital health ecosystem presents new ethical challenges for those making decisions about the selection, testing, implementation and evaluation of technologies for use in healthcare. As the 'Wild West' of digital health research unfolds, it is important to recognize who is involved, and identify how each party can and should take responsibility to advance the ethical practices of this work. While not a comprehensive review, we describe the landscape, identify gaps to be addressed, and offer recommendations as to how stakeholders can and should take responsibility to advance socially responsible digital health research.
A central goal of behavioral medicine is the creation of evidence-based interventions for promoting behavior change. Scientific knowledge about behavior change could be more effectively accumulated ...using “ontologies.” In information science, an ontology is a systematic method for articulating a “controlled vocabulary” of agreed-upon terms and their inter-relationships. It involves three core elements: (1) a controlled vocabulary specifying and defining existing classes; (2) specification of the inter-relationships between classes; and (3) codification in a computer-readable format to enable knowledge generation, organization, reuse, integration, and analysis. This paper introduces ontologies, provides a review of current efforts to create ontologies related to behavior change interventions and suggests future work. This paper was written by behavioral medicine and information science experts and was developed in partnership between the Society of Behavioral Medicine’s Technology Special Interest Group (SIG) and the Theories and Techniques of Behavior Change Interventions SIG. In recent years significant progress has been made in the foundational work needed to develop ontologies of behavior change. Ontologies of behavior change could facilitate a transformation of behavioral science from a field in which data from different experiments are siloed into one in which data across experiments could be compared and/or integrated. This could facilitate new approaches to hypothesis generation and knowledge discovery in behavioral science.
Background: Recent systematic reviews have questioned the ability of psychosocial intervention to add substantive benefit to buprenorphine therapy.
Objectives: The purpose of the present ...meta-analysis was to test the random effects model (REM) null hypothesis that, for opioid use disorder (OUD) and opioid biological sample outcomes, the summary effect of cognitive-behavioral therapy (CBT) + buprenorphine randomized controlled trials (RCTs) = 0.
Methods: A systematic review was conducted searching electronic databases and the reference lists of included studies. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) criteria were used to guide this review and the REM meta-analysis.
Results: The initial meta-analytic model (k = 4) was insignificant (REM Hedges' g =.22, Z = 1.27, p =.206, 95% CI: −0.12-0.56) and heterogeneous (I2 = 53.47). A pre-specified categorical moderator analysis explained the heterogeneity via CBT modality. Categorical moderator analysis (k = 4) showed non-individual CBT RCTs (k = 2) to have a REM Hedges' g summary effect of.598 (p =.006) and individual-CBT RCTs (k = 2) to have a REM Hedges' g summary effect of −0.010 (p = .936). The difference between these two subgroups was significant (Q = 5.85, df = 1, p = .016).
Conclusion: The evidence cautiously suggests that for OUD, there may be some benefit to adding non-individual CBT to buprenorphine therapy.
Other fast lanes, while forming below the cell surface, push released particles to “surf” towards noninfected cells 7. ...some viruses take advantage of structures built by circulating cells to ...communicate, such as the immunological synapse, to spread more rapidly 2. ...the lowest portion of the tract that lacks cilia and mucus is safeguarded by macrophages that destroy particles. ...mechanisms that allow viral spread within the airway epithelia without particle release would be highly advantageous, and recent studies suggest that some respiratory viruses have indeed developed alternative means of spread. ...the complete assembly of virions is not needed, and direct cell-to-cell transfer of viral genetic material, proteins, nucleocapsids, or replication bodies is most likely occurring. ...disruption of intercellular extensions or intercellular pores by different means leads to reduced and/or less efficient viral spread.
Abstract
The Paramyxoviridae family includes established human pathogens such as measles virus, mumps virus, and the human parainfluenza viruses; highly lethal zoonotic pathogens such as Nipah virus; ...and a number of recently identified agents, such as Sosuga virus, which remain poorly understood. The high human-to-human transmission rate of paramyxoviruses such as measles virus, high case fatality rate associated with other family members such as Nipah virus, and the existence of poorly characterized zoonotic pathogens raise concern that known and unknown paramyxoviruses have significant pandemic potential. In this review, the general life cycle, taxonomic relationships, and viral pathogenesis are described for paramyxoviruses that cause both systemic and respiratory system–restricted infections. Next, key gaps in critical areas are presented, following detailed conversations with subject matter experts and based on the current literature. Finally, we present an assessment of potential prototype pathogen candidates that could be used as models to study this important virus family, including assessment of the strengths and weaknesses of each potential prototype.
This review examines Frontline Farmers: How the National Farmers Union Resists Agribusiness and Creates Our New Food Future, a new book about the activism of the National Farmers Union (NFU) over the ...past five decades. In this review I highlight the impact of the NFU in campaigns against the corporatization of the food system, their commitment to international and Indigenous solidarity, and the struggles faced by women within the organization. I also question the lack of discussion about solidarity with migrant farmworkers. Overall, this is an important book that is useful for food system activists, students and scholars.
Background:
Managing medications for Alzheimer’s disease and related dementias is challenging for caregivers. Information about caregivers’ strategies to manage these challenges is needed to inform ...intervention development.
Objective:
This study aimed to understand caregivers’ medication management experiences by analyzing online community discussions.
Methods:
Posts were extracted from the ALZConnected® Forum using keywords “medication” and “drug” via web scraping. The researchers applied thematic analysis.
Results:
Four major themes emerged: (1) role transition of medication management responsibilities, (2) caregivers’ uncertainty about medication purpose and values, (3) conflicts between the care recipients and caregivers, and (4) difficulty accessing and affording medications.
Conclusions:
The experiences shared on a non-moderated, unstructured online forum indicate that medication management is challenging and overwhelming for caregivers of people living with Alzheimer’s disease and related dementias. Since this is a progressive disease with various stages and changing needs, caregivers’ strategies vary and are often limited by available resources and support. Health care providers should offer training and support for caregivers to navigate the transfer of medication management responsibilities and changing care needs as the disease progresses.
Background. Increased gastric content from enteral nutrition intolerance is thought to place patients at risk for pulmonary aspiration. Although considered a questionable practice, blind gastric tube ...aspiration is the most common approach to measure gastric content. This simulated study evaluated the accuracy of residual volume (RV) assessment via tube aspirations made from known volumes by controlling the syringe pull technique, feeding tube properties, fluid viscosity, and placement of tubes in the fluid. Materials and Methods. This study was conducted in a metrology laboratory. Aspirates were obtained using a force measurement test system to control force of the syringe pull technique using 3 different procedures (slow 10 inches per minute ipm, intermittent 10 ipm, and fast 40 ipm). Four different feeding tubes, 10 Fr and 18 Fr, each made of polyurethane and polyvinyl chloride, were placed in varying depths of 100 mL of either water or formula. The effect of fluid viscosity was also examined. Results. Overall, 108 RVs were analyzed using a force measurement test system. Actual content of RV was underestimated 19% on average and varied across tube size and viscosity. Intermittent and slow syringe pull techniques yielded greater aspirate quantities, although neither technique aspirated the full amount of volume available. The 10 Fr feeding tubes yielded larger RVs in more viscous fluid, yet the 18 Fr tubes performed better with fluids of lower viscosity. Conclusions. Based on this simulation, RV assessment does not accurately reflect the total volume of the contents available and, therefore, the clinical utility of this assessment should be further investigated.
Smokers are a stigmatized population, but an important population to reach for the purpose of research. Therefore, innovative recruitment methods are needed that are both cost-effective and ...efficacious in recruiting this population.
The aim of the present article was to evaluate the feasibility of Facebook-targeted advertisement to recruit long-term smokers eligible for lung cancer screening for a descriptive, cross-sectional survey.
A social media recruitment campaign was launched using Facebook-targeted advertisement to target age and keywords related to tobacco smoking in the Facebook users profile, interests, and likes. A 3-day newspaper advertisement recruitment campaign was used as a comparison. The study that used both recruitment methods aimed to test the psychometric properties of 4 newly developed lung cancer screening health belief scales. Data were collected via cross-sectional survey methodology using an Web-based survey platform.
The Facebook-targeted advertisements were viewed 56,621 times over an 18-day campaign in 2015 in the United States. The advertisement campaign yielded 1121 unique clicks to the Web-based survey platform at a cost of $1.51 per completed survey. Of those who clicked through to the study survey platform, 423 (37.7%) consented to participate; 92 (8.2%) dropped out during completion of the survey yielding a final study pool of 331 completed surveys. Recruitment by newspaper advertisement yielded a total of 30 participants in response to a 3-day advertisement campaign; recruitment efficacy resulted in 10 participants/day at $40.80 per completed survey. Participants represented current (n=182; 51%) and former smokers (n=178; 49%) with a mean age of 63.4 years (SD 6.0). Cost of the advertisement campaign was $500 total for the 18-day campaign.
Recruitment by Facebook was more efficacious and cost-effective compared with newspaper advertisement. Facebook offers a new venue for recruitment into research studies that offer the potential for wider reach at a lower cost while providing privacy and flexibility for potential study participants. The study's findings extend recent work of other researchers who have demonstrated Facebook's utility with younger smokers, and Facebook is an effective tool to recruit older smokers. Furthermore, Facebook is a cost-effective alternative to traditional newspaper advertisement offering a new, affordable venue to recruit large numbers of older smokers efficiently.
Background Autism is a normal part of cognitive diversity, resulting in communication and sensory processing differences, which can become disabling in a neurotypical world. Autistic people have an ...increased likelihood of physical and mental co-occurring conditions and die earlier than neurotypical peers. Inaccessible healthcare may contribute to this. Autism Health Passports (AHPs) are paper-based or digital tools which can be used to describe healthcare accessibility needs; they are recommended in UK clinical guidance. However, questions remained as to the theoretical underpinnings and effectiveness of AHPs. Methods We undertook a systematic literature search identifying studies focused on AHPs for adults (aged over 16 years) from five databases. Included literature was subjected to realist evaluation. Data were extracted using a standardised form, developed by the research team, which considered research design, study quality for realist review and the Context, Mechanisms and Outcomes (CMOs) associated with each AHP tool. Findings 162 unique records were identified, and 13 items were included in the review. Only one item was considered high quality. Contextual factors focused on the inaccessibility of healthcare to Autistic patients and staff lack of confidence and training in supporting Autistic needs. Interventions were heterogeneous, with most sources reporting few details as to how they had been developed. The most frequently included contents were communication preferences. Mechanisms were often not stated or were inferred by the reviewers and lacked specificity. Outcomes were included in four studies and were primarily focused on AHP uptake, rather than Outcomes which measured impact. Conclusion There is insufficient evidence to conclude that AHPs reduce the health inequalities experienced by Autistic people. Using an AHP tool alone in a healthcare Context that does not meet Autistic needs, without the inclusion of the local Autistic community developing the tool, and a wider intervention to reduce known barriers to health inequality, may mean that AHPs do not trigger any Mechanisms, and thus cannot affect Outcomes.
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