Nurse-led medication management as a critical component of transitional care for preventing drug-related problems.

Drug-related problems (DRPs) are critical medical issues during transition from hospital to home with high prevalence. The application of a variety of interventional strategies as part of the transitional care has been studied for preventing DRPs. However, it remains challenging for minimizing DRPs in patients, especially in older adults and those with high risk of medication discrepancies after hospital discharge. In this narrative review, we demonstrated that age, specific medications and polypharmacy, as well as some patient-related and system-related factors all contribute to a higher prevalence of transitional DPRs, most of which could be largely prevented by enhancing nurse-led multidisciplinary medication reconciliation. Nurses' contributions during transitional period for preventing DRPs include information collection and evaluation, communication and education, enhancement of medication adherence, as well as coordination among healthcare professionals. We concluded that nurse-led strategies for medication management can be implemented to prevent or solve DRPs during the high-risk transitional period, and subsequently improve patients' satisfaction and health-related outcomes, prevent the unnecessary loss and waste of medical expenditure and resources, and increase the efficiency of the multidisciplinary teamwork during transitional care.

Is negative e-WOM more powerful? Multimodal data analysis on air passengers' perception of COVID-19 safety measures.

During the normalization stage of the COVID-19 epidemic prevention and control, the safety threats caused by improper epidemic prevention measures of airlines have become the primary concern for air passengers. Negative e-WOM related to safety perception obtained based on online multimodal reviews of travel websites has become an important decision-making basis for potential air passengers when making airline choices. This study aims to examine the relationship between potential air passengers' negative safety perception and the usefulness of online reviews, as well as to test the moderating effect of review modality and airline type. It also further explores the effectiveness and feasibility of applying big data sentiment analysis to e-WOM management. To this end, the theoretical model of negative safety perception, review modality, and airline type affecting review usefulness was constructed. Then we select 10 low-cost airlines and 10 full-service airlines, respectively, according to the number of reviews sorted by the TripAdvisor website, and use crawling techniques to obtain 10,485 reviews related to COVID-19 safety of the above companies from December 2019 to date, and conduct safety perception sentiment analysis based on Python's Textblob library. Finally, to avoid data overdispersion, the model is empirically analyzed by negative binomial regression using R software. The results indicate that (1) Negative safety perception significantly and negatively affects review usefulness, that is, extreme negative safety perception can provide higher review usefulness for potential air passengers. (2) Review modality and airline type have a significant moderating effect on the relationship between negative safety perception and review usefulness, in which multimodal reviews and full-service airlines both weakened the negative impact of negative safety perception on review usefulness. The theoretical model in this paper is both an extension of the application of big data sentiment analysis techniques and a beneficial supplement to current research findings of e-WOM, providing an important reference for potential air passengers to identify useful reviews accurately and thus reduce safety risks in online decision-making.

Dynamic Digital Twin: Diagnosis, Treatment, Prediction, and Prevention of Disease During the Life Course.

A digital twin (DT), originally defined as a virtual representation of a physical asset, system, or process, is a new concept in health care. A DT in health care is not a single technology but a domain-adapted multimodal modeling approach incorporating the acquisition, management, analysis, prediction, and interpretation of data, aiming to improve medical decision-making. However, there are many challenges and barriers that must be overcome before a DT can be used in health care. In this viewpoint paper, we build on the current literature, address these challenges, and describe a dynamic DT in health care for optimizing individual patient health care journeys, specifically for women at risk for cardiovascular complications in the preconception and pregnancy periods and across the life course. We describe how we can commit multiple domains to developing this DT. With our cross-domain definition of the DT, we aim to define future goals, trade-offs, and methods that will guide the development of the dynamic DT and implementation strategies in health care.

Ethical Issues of Digital Twins for Personalized Health Care Service: Preliminary Mapping Study.

BACKGROUND: The concept of digital twins has great potential for transforming the existing health care system by making it more personalized. As a convergence of health care, artificial intelligence, and information and communication technologies, personalized health care services that are developed under the concept of digital twins raise a myriad of ethical issues. Although some of the ethical issues are known to researchers working on digital health and personalized medicine, currently, there is no comprehensive review that maps the major ethical risks of digital twins for personalized health care services. OBJECTIVE: This study aims to fill the research gap by identifying the major ethical risks of digital twins for personalized health care services. We first propose a working definition for digital twins for personalized health care services to facilitate future discussions on the ethical issues related to these emerging digital health services. We then develop a process-oriented ethical map to identify the major ethical risks in each of the different data processing phases. METHODS: We resorted to the literature on eHealth, personalized medicine, precision medicine, and information engineering to identify potential issues and developed a process-oriented ethical map to structure the inquiry in a more systematic way. The ethical map allows us to see how each of the major ethical concerns emerges during the process of transforming raw data into valuable information. Developers of a digital twin for personalized health care service may use this map to identify ethical risks during the development stage in a more systematic way and can proactively address them. RESULTS: This paper provides a working definition of digital twins for personalized health care services by identifying 3 features that distinguish the new application from other eHealth services. On the basis of the working definition, this paper further layouts 10 major operational problems and the corresponding ethical risks. CONCLUSIONS: It is challenging to address all the major ethical risks that a digital twin for a personalized health care service might encounter proactively without a conceptual map at hand. The process-oriented ethical map we propose here can assist the developers of digital twins for personalized health care services in analyzing ethical risks in a more systematic manner.

COVID-19 vaccination and the right to take risks.

The rare but severe cerebral venous thrombosis occurring in some AstraZeneca vaccine recipients has prompted some governments to suspend part of their COVID-19 vaccination programmes. Such suspensions have faced various challenges from both scientific and ethical angles. Most of the criticisms against such suspensions follow a consequentialist approach, arguing that the suspension will lead to more harm than benefits. In this paper, I propose a rights-based argument against the suspension of the vaccine rollouts amid this highly time-sensitive combat of COVID-19. I argue that by suspending a vaccine rollout, a government infringes people's right to take the risks they deem worth taking for their health. I also consider four potential objections to my argument and explain why none of them undermines my argument.

Who's afraid of perfectionist moral enhancement? A reply to Sparrow.

Robert Sparrow recently argued that state-driven moral bioenhancement is morally problematic because it inevitably invites moral perfectionism. While sharing Sparrow's worry about state-driven moral bioenhancement, I argue that his anti-perfectionism argument is too strong to offer useful normative guidance. That is, if we reject state-driven moral bioenhancement because it cannot remain neutral between different conceptions of the good, we might have to conclude that all forms of moral enhancement programs ought not be made compulsory, including the least controversial and most popular state-driven program: compulsory (moral) education. In this paper, I argue that, instead, the spirit of Sparrow's worry should be recast in the language of the capability approach-an approach that strives to enhance people's capabilities to develop their own conceptions of the good by restricting itself from endorsing thick conceptions of the good. The distinction made regarding thick and thin conceptions of the good helps to capture sentiments against state-driven bioenhancement programs without falling prey to the issues I raise against Sparrow's anti-perfectionist arguments.

Moral Enhancement, Self-Governance, and Resistance.

John Harris recently argued that the moral bioenhancement proposed by Persson and Savulescu can damage moral agency by depriving recipients of their freedom to fall (freedom to make wrongful choices) and therefore should not be pursued. The link Harris makes between moral agency and the freedom to fall, however, implies that all forms of moral enhancement that aim to make the enhancement recipients less likely to "fall," including moral education, are detrimental to moral agency. In this article, I present a new moral agency-based critique against the moral bioenhancement program envisaged by Persson and Savulescu. I argue that the irresistible influences exerted by the bioenhancement program harm our capabilities for conducting accurate self-reflection and forming decisions that truly express our will, subsequently undermining our moral agency.

Climate change, cooperation and moral bioenhancement.

The human faculty of moral judgement is not well suited to address problems, like climate change, that are global in scope and remote in time. Advocates of 'moral bioenhancement' have proposed that we should investigate the use of medical technologies to make human beings more trusting and altruistic and hence more willing to cooperate in efforts to mitigate the impacts of climate change. We survey recent accounts of the proximate and ultimate causes of human cooperation in order to assess the prospects for bioenhancement. We identify a number of issues that are likely to be significant obstacles to effective bioenhancement, as well as areas for future research.

Assembly and in vitro functional analysis of zinc finger nuclease specific to the 3' untranslated region of chicken ovalbumin gene.

Synthetic zinc finger nucleases (ZFNs) are useful for the improvement of site directed integration of foreign gene into vertebrate chromosomes. To facilitate site-directed integration of foreign genes into the 3'-untranslated region of the chicken ovalbumin gene, we have constructed ZFN expression vectors using Zinc Finger Consortium Vector Kits and tested the functionality of these ZFN constructs. Coding sequences for 6 zinc fingers were assembled following the modular assembly method. The zinc finger assembly was fused to two FokI catalytic domains. Various configurations of linker regions between domains were tested for their influence on enzymatic activity, using plasmid substrate containing the target sequence. Results indicated that ZFN with an elongated linker between two nuclease domains had a high catalytic activity.

Ultrahigh-power micrometre-sized supercapacitors based on onion-like carbon.

Electrochemical capacitors, also called supercapacitors, store energy in two closely spaced layers with opposing charges, and are used to power hybrid electric vehicles, portable electronic equipment and other devices. By offering fast charging and discharging rates, and the ability to sustain millions of cycles, electrochemical capacitors bridge the gap between batteries, which offer high energy densities but are slow, and conventional electrolytic capacitors, which are fast but have low energy densities. Here, we demonstrate microsupercapacitors with powers per volume that are comparable to electrolytic capacitors, capacitances that are four orders of magnitude higher, and energies per volume that are an order of magnitude higher. We also measured discharge rates of up to 200 V s(-1), which is three orders of magnitude higher than conventional supercapacitors. The microsupercapacitors are produced by the electrophoretic deposition of a several-micrometre-thick layer of nanostructured carbon onions with diameters of 6-7 nm. Integration of these nanoparticles in a microdevice with a high surface-to-volume ratio, without the use of organic binders and polymer separators, improves performance because of the ease with which ions can access the active material. Increasing the energy density and discharge rates of supercapacitors will enable them to compete with batteries and conventional electrolytic capacitors in a number of applications.