Social determinants of health and sepsis: a case-control study.

PURPOSE: We aimed to identify whether social determinants of health (SDoH) are associated with the development of sepsis and assess the differences between individuals living within systematically disadvantaged neighbourhoods compared with those living outside these neighbourhoods. METHODS: We conducted a single-centre case-control study including 300 randomly selected adult patients (100 patients with sepsis and 200 patients without sepsis) admitted to the emergency department of a large academic tertiary care hospital in Hamilton, ON, Canada. We collected data on demographics and a limited set of SDoH variables, including neighbourhood household income, smoking history, social support, and history of alcohol disorder. We analyzed study data using multivariate logistic regression models. RESULTS: The study included 100 patients with sepsis with a median [interquartile range (IQR)] age of 75 [58-84] yr and 200 patients without sepsis with a median [IQR] age of 72 [60-83] yr. Factors significantly associated with sepsis included arrival by ambulance, absence of a family physician, higher Hamilton Early Warning Score, and a recorded history of dyslipidemia. Important SDoH variables, such as individual or household income and race, were not available in the medical chart. In patients with SDoH available in their medical records, no SDoH was significantly associated with sepsis. Nevertheless, compared with their proportion of the Hamilton population, the rate of sepsis cases and sepsis deaths was approximately two times higher among patients living in systematically disadvantaged neighbourhoods. CONCLUSIONS: This study revealed the lack of available SDoH data in electronic health records. Despite no association between the SDoH variables available and sepsis, we found a higher rate of sepsis cases and sepsis deaths among individuals living in systematically disadvantaged neighbourhoods. Including SDoH in electronic health records is crucial to study their effect on the risk of sepsis and to provide equitable care.

RéSUMé: OBJECTIF: Nous avons cherché à déterminer si les déterminants sociaux de la santé (DSS) étaient associés à l'apparition de sepsis et à évaluer les différences entre les personnes vivant dans des quartiers systématiquement défavorisés et celles vivant à l'extérieur de ces quartiers. MéTHODE: Nous avons mené une étude cas témoins monocentrique portant sur 300 patient·es adultes sélectionné·es au hasard (100 personnes atteintes de sepsis et 200 témoins sans sepsis) admis·es au service des urgences d'un grand hôpital universitaire de soins tertiaires à Hamilton, ON, Canada. Nous avons recueilli des données démographiques et un ensemble limité de variables de DSS, y compris le revenu des ménages du quartier, les antécédents de tabagisme, le soutien social et les antécédents de troubles liés à l'alcool. Nous avons analysé les données de l'étude à l'aide de modèles de régression logistique multivariés. RéSULTATS: L'étude a inclus 100 patient·es atteint·es de sepsis avec un âge médian [écart interquartile (ÉIQ)] de 75 [58-84] ans et 200 patient·es sans sepsis avec un âge médian [ÉIQ] de 72 [60-83] ans. Les facteurs significativement associés au sepsis comprenaient l'arrivée en ambulance, l'absence de médecin de famille, un score Hamilton Early Warning Score plus élevé et des antécédents enregistrés de dyslipidémie. D'importantes variables de DSS, telles que le revenu individuel et du ménage et la race, n'étaient pas disponibles dans le dossier médical. Chez les personnes dont les DSS étaient disponibles dans leur dossier médical, aucun DSS n'était significativement associé au sepsis. Néanmoins, comparativement à leur proportion dans la population de Hamilton, le taux de cas de sepsis et de décès dus au sepsis était environ deux fois plus élevé chez les personnes vivant dans des quartiers systématiquement défavorisés. CONCLUSION: Cette étude a révélé le manque de données disponibles sur les DSS dans les dossiers de santé électroniques. Bien qu'il n'y ait pas d'association entre les variables disponibles et le sepsis, nous avons constaté un taux plus élevé de cas de sepsis et de décès dus à la septicémie chez les personnes vivant dans des quartiers systématiquement défavorisés. L'inclusion des DSS dans les dossiers de santé électroniques est cruciale pour étudier leur effet sur le risque de sepsis et pour dispenser des soins équitables.

Cognitive Decline After Divorce and Widowhood: Is Marital Loss Always a Loss?

Background and Objectives: We used longitudinal data to determine whether the type of marital loss is associated with the rate of cognitive change before and after divorce or widowhood. Previous research found that relationship status was associated with older adults' cognitive performance: married persons performed better on memory assessments and had lower dementia risk than unmarried-cohabitating, never-married, divorced, and widowed persons. However, the end of a marriage may cause distress or reduce distress because a stressor disappears. Questions thus remain about the mechanisms by which marital change affects cognitive outcomes and, specifically, whether termination of marriage can improve cognitive performance for some. Research Design and Methods: Using data from the 1998-2016 waves of the Health and Retirement Study (N = 23,393), we conducted two analyses. First, we used trajectory analysis to create clusters of participants with similar cognitive trajectories and tested the association between participants' cluster membership and marital loss type. Second, we used multilevel modeling to analyze the relationship between participants' cognitive scores while married and following divorce or widowhood and linked these to marital features. Results: Participants who divorced showed no difference in trajectory distribution; widowed participants were more likely to be in the lower-performing and more quickly declining groups. Participants had lower rates of decline following divorce (ß = .136, p < .001), while widowed participants had accelerated decline following spousal death (ß = -0.183, p < .001) and an immediate decline following spousal death (ß = -0.113, p = .028). Discussion and Implications: We found that the type of marital loss was important, and predicted improvements in cognition for some and decrements for others, with individuals who were divorced performing best while those who were widowed or separated but not divorced performing worse.

Quantifying Healthy Aging in Older Veterans Using Computational Audio Analysis.

BACKGROUND: Researchers are increasingly interested in better methods for assessing the pace of aging in older adults, including vocal analysis. The present study sought to determine whether paralinguistic vocal attributes improve estimates of the age and risk of mortality in older adults. METHODS: To measure vocal age, we curated interviews provided by male U.S. World War II Veterans in the Library of Congress collection. We used diarization to identify speakers and measure vocal features and matched recording data to mortality information. Veterans (N = 2 447) were randomly split into testing (n = 1 467) and validation (n = 980) subsets to generate estimations of vocal age and years of life remaining. Results were replicated to examine out-of-sample utility using Korean War Veterans (N = 352). RESULTS: World War II Veterans' average age was 86.08 at the time of recording and 91.28 at the time of death. Overall, 7.4% were prisoners of war, 43.3% were Army Veterans, and 29.3% were drafted. Vocal age estimates (mean absolute error = 3.255) were within 5 years of chronological age, 78.5% of the time. With chronological age held constant, older vocal age estimation was correlated with shorter life expectancy (aHR = 1.10; 95% confidence interval: 1.06-1.15; p < .001), even when adjusting for age at vocal assessment. CONCLUSIONS: Computational analyses reduced estimation error by 71.94% (approximately 8 years) and produced vocal age estimates that were correlated with both age and predicted time until death when age was held constant. Paralinguistic analyses augment other assessments for individuals when oral patient histories are recorded.

Genome-wide identification and spatiotemporal expression analysis of cadherin superfamily members in echinoderms.

BACKGROUND: Cadherins are calcium-dependent transmembrane cell-cell adhesion proteins that are essential for metazoan development. They consist of three subfamilies: classical cadherins, which bind catenin, protocadherins, which contain 6-7 calcium-binding repeat domains, and atypical cadherins. Their functions include forming adherens junctions, establishing planar cell polarity (PCP), and regulating cell shape, proliferation, and migration. Because they are basal deuterostomes, echinoderms provide important insights into bilaterian evolution, but their only well-characterized cadherin is G-cadherin, a classical cadherin that is expressed by many embryonic epithelia. We aimed to better characterize echinoderm cadherins by conducting phylogenetic analyses and examining the spatiotemporal expression patterns of cadherin-encoding genes during Strongylocentrotus purpuratus development. RESULTS: Our phylogenetic analyses conducted on two echinoid, three asteroid, and one crinoid species identified ten echinoderm cadherins, including one deuterostome-specific ortholog, cadherin-23, and an echinoderm-specific atypical cadherin that possibly arose in an echinoid-asteroid ancestor. Catenin-binding domains in dachsous-2 orthologs were found to be a deuterostome-specific innovation that was selectively lost in mouse, while those in Fat4 orthologs appeared to be Ambulacraria-specific and were selectively lost in non-crinoid echinoderms. The identified suite of echinoderm cadherins lacks vertebrate-specific innovations but contains two proteins that are present in protostomes and absent from mouse. The spatiotemporal expression patterns of four embryonically expressed cadherins (fat atypical cadherins 1 and 4, dachsous-2, and protocadherin-9) were dynamic and mirrored the expression pattern of Frizzled 5/8, a non-canonical Wnt PCP pathway receptor protein essential for archenteron morphogenesis. CONCLUSIONS: The echinoderm cadherin toolkit is more similar to that of an ancient bilaterian predating protostomes and deuterostomes than it is to the suite of cadherins found in extant vertebrates. However, it also appears that deuterostomes underwent several cadherin-related innovations. Based on their similar spatiotemporal expression patterns and orthologous relationships to PCP-related and tumor-suppressing proteins, we hypothesize that sea urchin cadherins may play a role in regulating the shape and growth of embryonic epithelia and organs. Future experiments will examine cadherin expression in non-echinoid echinoderms and explore the functions of cadherins during echinoderm development.

Obesity in Late-Life as a Protective Factor Against Dementia and Dementia-Related Mortality.

OBJECTIVE: We estimated the conversion from cognitively normal to mild cognitive impairment (MCI) to probable dementia and death for underweight, normal, overweight, and obese older adults, where the timing of examinations is associated with the severity of dementia. METHODS: We analyzed six waves of the National Health and Aging Trends Study (NHATS). Body mass (BMI) was computed from height and weight. Multi-state survival models (MSMs) examined misclassification probability, time-to-event ratios, and cognitive decline. RESULTS: Participants (n = 6078) were 77 years old, 62% had overweight and/or obese BMI. After adjusting for the effects of cardiometabolic factors, age, sex, and race, obesity was protective against developing dementia (aHR=.44; 95%CI [.29-.67]) and dementia-related mortality (aHR=.63; 95%CI [.42-.95]). DISCUSSION: We found a negative relationship between obesity and dementia and dementia-related mortality, a finding that has been underreported in the literature. The continuing obesity epidemic might complicate the diagnosis and treatment of dementia.

Paper I: Heterogeneous use of registry data for participant identification and primary outcome ascertainment is found in registry-based randomized controlled trials: A scoping review.

OBJECTIVES: Registry-based randomized controlled trials (RRCTs) have potential to address limitations of traditional clinical trials. To describe their current use, information on planned and published RRCTs was identified and synthesized. STUDY DESIGN AND SETTING: A scoping review of published RRCT protocols and reports was conducted. Articles published between 2010 and 2021 identified from electronic database searching, a recent review of RRCTs, and targeted searching for recent RRCT protocols (2018-2021) were screened. Data on trial data sources, types of primary outcomes, and how these primary outcomes were described, selected, and reported were extracted. RESULTS: Ninety RRCT articles (77 reports; 13 protocols) were included. Forty nine (54%) used or planned to rely on registry data for their trial, 26 (29%) used both registry and additional data, and 15 (17%) used the registry solely for recruitment. Primary outcomes were routinely collected from the registry for 66 articles (73%). Only 28 articles (31%) described any methods to promote outcome data quality during or after data collection. Core outcome sets were not used in any of the trials. CONCLUSION: With improvements in registry design, outcome selection, measurement, and reporting, future RRCTs may deliver on promises of efficient, high-quality trials that address clinically relevant questions.

Paper II: thematic framework analysis of registry-based randomized controlled trials provided insights for designing trial ready registries.

OBJECTIVES: Registry-based randomized controlled trials (RRCTs) are increasingly used, promising to address challenges associated with traditional randomized controlled trials. We identified strengths and limitations reported in planned and completed RRCTs to inform future RRCTs. STUDY DESIGN AND SETTING: We conducted an environmental scan of literature discussing conceptual or methodological strengths and limitations of using registries for trial design and conduct (n = 12), followed by an analysis of RRCT protocols (n = 13) and reports (n = 77) identified from a scoping review. Using framework analysis, we developed and refined a conceptual framework of RRCT-specific strengths and limitations. We mapped and interpreted strengths and limitations discussed by authors of RRCT articles using framework codes and quantified the frequencies at which these were mentioned. RESULTS: Our conceptual framework identified six main RRCT strengths and four main RRCT limitations. Considering implications for RRCT conduct and design, we formulated ten recommendations for registry designers, administrators, and trialists planning future RRCTs. CONCLUSION: Consideration and application of empirically underpinned recommendations for future registry design and trial conduct may help trialists utilize registries and RRCTs to their full potential.

Cognitive Aging in Same- and Different-Sex Relationships: Comparing Age of Diagnosis and Rate of Cognitive Decline in the Health and Retirement Study.

INTRODUCTION: The ongoing marginalization of lesbian, gay, and bisexual people has been hypothesized to produce poorer late-in-life cognitive outcomes, according to mechanisms posited by minority stress and allostatic load theories. Yet the existence of those outcomes remains understudied, and results of existing studies have been contradictory. Using a population-based longitudinal aging study, this paper will compare age at diagnosis of Alzheimer's disease (AD) or a related dementia and rates of cognitive decline between participants in same-sex relationships (SSRs) and different-sex relationships (DSRs). METHODS: The study used longitudinal cognitive-health data from the Health and Retirement Study (HRS; 1998-2018; N = 26,344) to analyze the onset of cognitive impairment and AD/dementia and the rates of cognitive change between participants in SSRs and those in DSRs. We hypothesized that SSR participants would have worse overall cognitive functioning in old age and would experience earlier onset of cognitive impairment. Using multiple regression, we compared the ages at which participants in SSRs and DSRs first reported AD or dementia diagnoses and the ages at which they first scored below cutoffs for cognitive impairment, not dementia (CIND) and possible dementia as determined using the cognitive assessment. The study then compared rates of cognitive decline over time across the SSR and DSR groups, including stratified analyses by education, race/ethnicity, wealth, and sex/gender. RESULTS: Participants in SSRs reported dementia diagnoses (ß = -12.346; p = 0.001), crossed the threshold into CIND (ß = -8.815; p < 0.001) and possible dementia (ß = -13.388; p < 0.001) at a younger age than participants in DSRs. When adjusted for covariates, participants in SSRs also had lower cognition at baseline (ß = 0.745; p = 0.003), though having slower rates of cognitive decline when SSR was interacted with time (ß = 0.066; p = 0.003). In separate analyses, cognitive differences for SSR participants were only found in participants without undergraduate degrees, with below-median household incomes, and women. CONCLUSION: Our findings support theories suggesting that marginalization and stigma cause premature cognitive impairment. Findings also suggest that higher education might mitigate the adverse effects of sexuality-minority status on cognitive aging. Results do not support these theories' claims of more rapid cognitive decline; the lower slopes of cognitive decline with time are compatible with the possibility of slower rates of decline for aging individuals in SSRs.

Permanent Hydrophobic Surface Treatment Combined with Solvent Vapor-Assisted Thermal Bonding for Mass Production of Cyclic Olefin Copolymer Microfluidic Chips.

A hydrophobic surface modification followed by solvent vapor-assisted thermal bonding was developed for the fabrication of cyclic olefin copolymer (COC) microfluidic chips. The modifier species 1H,1H,2H,2H-perfluorooctyl trichlorosilane (FOTS) was used to achieve the entrapment functionalization on the COC surface, and a hydrophobic surface was developed through the formation of a Si-O-Si crosslink network. The COC surface coated with 40 vol % cyclohexane, 59 vol % acetone, and 1 vol % FOTS by ultrasonic spray 10 and 20 times maintained its hydrophobicity with the water contact angle increasing from ∼86 to ∼115° after storage for 3 weeks. The solvent vapor-assisted thermal bonding was optimized to achieve high bond strength and good channel integrity. The results revealed that the COC chips exposed to 60 vol % cyclohexane and 40 vol % acetone for 120 s have the highest bond strength, with a burst pressure of ∼17 bar, which is sufficient for microfluidics applications such as droplet generation. After bonding, the channel maintained its integrity without any channel collapse. The hydrophobicity was also maintained, proved by the water contact angle of ∼115° on the bonded film, as well as the curved shape of water flow in the chip channel by capillary test. The combined hydrophobic treatment and solvent bonding process show significant benefits for scale-up production compared to conventional hydrophilic treatment for bonding and hydrophobic treatment using surface grafting or chemical vapor deposition since it does not require nasty chemistry, long-term treatment, vacuum chamber, and can be integrated into production line easily. Such a process can also be extended to permanent hydrophilic treatment combined with the bonding process and will lay a foundation for low-cost mass production of plastic microfluidic cartridges.

Social Determinants of Health Associated With the Development of Sepsis in Adults: A Scoping Review.

Evaluating risk for sepsis is complicated due to limited understanding of how social determinants of health (SDoH) influence the occurence of the disease. This scoping review aims to identify gaps and summarize the existing literature on SDoH and the development of sepsis in adults. DATA SOURCES: A literature search using key terms related to sepsis and SDoH was conducted using Medline and PubMed. STUDY SELECTION: Studies were screened by title and abstract and then full text in duplicate. Articles were eligible for inclusion if they: 1) evaluated at least one SDoH on the development of sepsis, 2) participants were 18 years or older, and 3) the studies were written in English between January 1970 and January 2022. Systematic reviews, meta-analyses, editorials, letters, commentaries, and studies with nonhuman participants were excluded. DATA EXTRACTION: Data were extracted in duplicate using a standardized data extraction form. Studies were grouped into five categories according to the SDoH they evaluated (race, socioeconomic status [SES], old age and frailty, health behaviors, and social support). The study characteristics, key outcomes related to incidence of sepsis, mortality, and summary statements were included in tables. DATA SYNTHESIS: The search identified 637 abstracts, 20 of which were included after full-text screening. Studies evaluating SES, old age, frailty, and gender demonstrated an association between sepsis incidence and the SDoH. Studies that examined race demonstrated conflicting conclusions as to whether Black or White patients were at increased risk of sepsis. Overall, a major limitation of this analysis was the methodological heterogeneity between studies. CONCLUSIONS: There is evidence to suggest that SDoH impacts sepsis incidence, particularly SES, gender, old age, and frailty. Future prospective cohort studies that use standardized methods to collect SDoH data, particularly race-based data, are needed to inform public health efforts to reduce the incidence of sepsis and help clinicians identify the populations most at risk.

Titanium Substratum Roughness as a Determinant of Human Gingival Fibroblast Fibronectin and α-Smooth Muscle Actin Expression.

The most appropriate surface treatment to enhance gingival connective tissue formation on the abutment of dental implants remains undefined, with healing associated with a scar-like response. We have previously shown that topographies with an arithmetic average of the absolute profile height deviations (Ra) = 4.0 induces an anti-fibrotic phenotype in human gingival fibroblasts (HGFs) by causing nascent adhesion formation. With bacterial colonization considerations, we hypothesized that a lower Ra could be identified that would alter adhesion stability and promote a matrix remodeling phenotype. Focal adhesions (FAs) area decreased with increasing roughness, although no differences in cell attachment or proliferation were observed. Alpha smooth muscle actin (α-SMA) protein levels were significantly reduced on Ra = 3.0 and 4.0 vs. 0.1 (p < 0.05), with incorporation of α-SMA into stress fibers most prominent on Ra = 0.1. Fibronectin protein levels were reduced on 3.0 and 4.0 vs. 0.1 (p < 0.05), and Ra = 1.5 and deeper significantly altered fibronectin deposition. Addition of exogenous TGF-ß3 increased HGF adhesion size on 0.1 surfaces, but not on any other topography. We conclude that Ra = 1.5 is sufficient to reduce adhesion size and inhibit α-SMA incorporation into stress fibers in HGFs, but 3.0 is required in the presence of exogenous TGF-ß3. Our findings have implications for inhibiting fibrotic tissue formation surrounding percutaneous devices such as dental implants.

Artificial intelligence application versus physical therapist for squat evaluation: a randomized controlled trial.

Artificial intelligence technology is becoming more prevalent in health care as a tool to improve practice patterns and patient outcomes. This study assessed ability of a commercialized artificial intelligence (AI) mobile application to identify and improve bodyweight squat form in adult participants when compared to a physical therapist (PT). Participants randomized to AI group (n = 15) performed 3 squat sets: 10 unassisted control squats, 10 squats with performance feedback from AI, and 10 additional unassisted test squats. Participants randomized to PT group (n = 15) also performed 3 identical sets, but instead received performance feedback from PT. AI group intervention did not differ from PT group (log ratio of two odds ratios = - 0.462, 95% confidence interval (CI) (- 1.394, 0.471), p = 0.332). AI ability to identify a correct squat generated sensitivity 0.840 (95% CI (0.753, 0.901)), specificity 0.276 (95% CI (0.191, 0.382)), PPV 0.549 (95% CI (0.423, 0.669)), NPV 0.623 (95% CI (0.436, 0.780)), and accuracy 0.565 95% CI (0.477, 0.649)). There was no statistically significant association between group allocation and improved squat performance. Current AI had satisfactory ability to identify correct squat form and limited ability to identify incorrect squat form, which reduced diagnostic capabilities.Trial Registration NCT04624594, 12/11/2020, retrospectively registered.

Global patterns of enhancer activity during sea urchin embryogenesis assessed by eRNA profiling.

We used capped analysis of gene expression with sequencing (CAGE-seq) to profile eRNA expression and enhancer activity during embryogenesis of a model echinoderm: the sea urchin, Strongylocentrotus purpuratus We identified more than 18,000 enhancers that were active in mature oocytes and developing embryos and documented a burst of enhancer activation during cleavage and early blastula stages. We found that a large fraction (73.8%) of all enhancers active during the first 48 h of embryogenesis were hyperaccessible no later than the 128-cell stage and possibly even earlier. Most enhancers were located near gene bodies, and temporal patterns of eRNA expression tended to parallel those of nearby genes. Furthermore, enhancers near lineage-specific genes contained signatures of inputs from developmental gene regulatory networks deployed in those lineages. A large fraction (60%) of sea urchin enhancers previously shown to be active in transgenic reporter assays was associated with eRNA expression. Moreover, a large fraction (50%) of a representative subset of enhancers identified by eRNA profiling drove tissue-specific gene expression in isolation when tested by reporter assays. Our findings provide an atlas of developmental enhancers in a model sea urchin and support the utility of eRNA profiling as a tool for enhancer discovery and regulatory biology. The data generated in this study are available at Echinobase, the public database of information related to echinoderm genomics.

Fast-forward approach of time-domain NMR relaxometry for solid-state chemistry of chitosan.

Chitosans with different average degrees of acetylation and weight molecular weight were analyzed by time-domain NMR relaxometry using the recently proposed pulse sequence named Rhim and Kessemeier - Radiofrequency Optimized Solid-Echo (RK-ROSE) to acquire 1H NMR signal of solid-state materials. The NMR signal decay was composed of faster (tenths of µs) and longer components, where the mobile-part fraction exhibited an effective relaxation transverse time assigned to methyl hydrogens from N-acetyl-d-glucosamine (GlcNAc) units. The higher intrinsic mobility of methyl groups was confirmed via DIPSHIFT experiments by probing the 1H-13C dipolar interaction. RK-ROSE data were modeled by using Partial Least Square (PLS) multivariate regression, which showed a high coefficient of determination (R2 > 0.93) between RK-ROSE signal profile and average degrees of acetylation and crystallinity index, thus indicating that time-domain NMR consists in a promising tool for structural and morphological characterization of chitosan.

Ask Again: Including Gender Identity in Longitudinal Studies of Aging.

Information on transgender people's health, and especially their experiences of aging, is lacking, including from major longitudinal studies of aging like the Health and Retirement Study and its sister studies in the Gateway to Global Aging Data project. This paper surveys the state of gender data collection among major longitudinal studies and finds that all but one fail to collect adequate information on participants' gender to determine participants' gender identities. It identifies the unique challenges that population-wide longitudinal data collection poses to current best practices for identifying transgender survey participants and proposes a modified "two-question model": one question for sex assigned at birth and a second for gender identity, both of which offer 3 responses.

Cannabis Use and Low-Back Pain: A Systematic Review.

Introduction: The potential use of cannabis and cannabinoid products for the treatment of low-back pain is an important area for investigation. As one of the leading reasons to visit a primary care provider, low-back pain results in a significant burden of disease in both the United States' economic and health care systems. Given the current opioid epidemic, it is important to seek novel analgesics and understand their efficacy for myriad pain conditions, including low-back pain. Materials and Methods: A systematic review was performed using multiple online databases to assess the association of cannabis use and low-back pain in the literature. Results: A total of 124 articles were produced via our search methods, 73 abstracts in total were screened, 16 articles underwent full-text review, and 6 articles were included in qualitative synthesis. Discussion: This systematic literature review reveals a lack of primary research investigating cannabis as a potential treatment of low-back pain and highlights the need for further investigation with well-designed clinical trials. There remain substantial political and legal barriers to performing such research. Conclusion: Although there is a considerable body of work on the usage of cannabinoid products for many medical conditions, including the treatment of chronic pain, more directed clinical research into their utility as an analgesic for low-back pain and related symptoms needs to be addressed.

A Novel Educational Prescription Web-Based Application to Support Education for Caregivers of People Living With Dementia: Development and Usability Study With Clinicians.

BACKGROUND: It is estimated that 564,000 Canadians are currently living with dementia and there are approximately 486,000 to 1.1 million informal family/friend caregivers. Family/friend caregivers often receive little to no education or training about dementia but are expected to provide ongoing support for a complex condition. Web-based family/friend caregiver interventions may be helpful, but little is known about how best to implement them. OBJECTIVE: The objectives of this study were to 1) design and develop a novel education prescription application to help scale and spread web-based dementia education to family/friend caregivers, 2) conduct user testing, and 3) conduct a larger-scale field trial. METHODS: A novel education prescription web-based application was designed and developed. Initial user testing used task completion and the "think aloud" technique with a small sample of representative clinicians who work with people living with dementia and family/friend caregivers. Following iterative incorporation of feedback, a larger field trial was conducted with a convenience sample of clinicians. Account invitations were sent to 55 clinicians and, following a 2-month trial period, surveys were administered to participants including the System Usability Scale and the Net Promoter Score. RESULTS: During the initial user testing phase, participants (N=7) from representative disciplines easily completed associated tasks, and had very positive feedback with respect to the usability of the application. The System Usability Scale score during this phase was 91.4. Suggestions from feedback were incorporated into the application. During the larger field trial phase, participants (total N=55; activated account n=17; did not activate account n=38) were given access to the iGeriCare education prescription application. During this period, 2 participants created educational prescriptions; a total of 3 educational prescriptions were sent. Survey completers who did not activate their account (n=5) identified that their lack of use was due to time constraints, competing priorities, or forgetting to use the application. Survey completers who activated their account (n=5) identified their lower use was due to lack of time, lack of eligible family/friend caregivers during trial period, and competing priorities due to the COVID-19 pandemic. The System Usability Scale score during this phase was 78.75, and the Net Promoter Score was 50. CONCLUSIONS: Study findings indicate a generally positive response for the usability of a web-based application for clinicians to prescribe dementia education to family/friend caregivers. The dissonance between the promising data and widespread enthusiasm for the design and purpose of the education prescription application found in the initial user testing phase and subsequent lack of significant adoption in the field trial represents both an important lesson for other novel health technologies and a potential area for further investigation. Further research is required to better understand factors associated with implementation of this type of intervention and impact on dissemination of education to family/friend caregivers.