Semi-supervised super-resolution of diffusion-weighted images based on multiple references.

Spatial resolution of diffusion tensor images is usually compromised to accelerate the acquisitions, and the state-of-the-art (SOTA) image super-resolution (SR) reconstruction methods are commonly based on supervised learning models. Considering that matched low-resolution (LR) and high-resolution (HR) diffusion-weighted (DW) image pairs are not readily available, we propose a semi-supervised DW image SR reconstruction method based on multiple references (MRSR) extracted from other subjects. In MRSR, the prior information of multiple HR reference images is migrated into a residual-like network to assist SR reconstruction of DW images, and a CycleGAN-based semi-supervised strategy is used to train the network with 30% matched and 70% unmatched LR-HR image pairs. We evaluate the performance of the MRSR by comparing against SOTA methods on an HCP dataset in terms of the quality of reconstructed DW images and diffusion metrics. MRSR achieves the best performance, with the mean PSNR/SSIM of DW images being improved by at least 14.3%/28.8% and 1%/1.4% respectively relative to SOTA unsupervised and supervised learning methods, and with the fiber orientations deviating from the ground truth by about 6.28° on average, the RMSEs of fractional anisotropy, mean diffusivity, axial diffusivity and radial diffusivity being 3.0%, 4.6%, 5.7% and 4.5% respectively relative to the ground truth. We validate the effectiveness of the proposed network structure, multiple-reference and CycleGAN-based semi-supervised learning strategies for SR reconstruction of diffusion tensor images through the ablation studies. The proposed method allows us to achieve SR reconstruction for diffusion tensor images with a limited number of matched image pairs.

Use of Consumer Wearables in Health Research: Issues and Considerations.

As wearable devices, which allow individuals to track and self-manage their health, become more ubiquitous, the opportunities are growing for researchers to use these sensors within interventions and for data collection. They offer access to data that are captured continuously, passively, and pragmatically with minimal user burden, providing huge advantages for health research. However, the growth in their use must be coupled with consideration of their potential limitations, in particular, digital inclusion, data availability, privacy, ethics of third-party involvement, data quality, and potential for adverse consequences. In this paper, we discuss these issues and strategies used to prevent or mitigate them and recommendations for researchers using wearables as part of interventions or for data collection.

The Content and Principle of the Rare Ginsenosides Produced from Gynostemma pentaphyllum after Heat Treatment.

Ginsenoside Rg3, Rk1, and Rg5, rare ginsenosides from Panax ginseng, have many pharmacological effects, which have attracted extensive attention. They can be obtained through the heat treatment of Gynostemma pentaphyllum. In this study, scanning electron microscopy (SEM) and thermal gravity-differential thermal gravity (TG-DTG) were employed to investigate this process and the content change in ginsenosides was analyzed using liquid chromatography-mass spectrometry (LC-MS). SEM and TG-DTG were used to compare the changes in the ginsenosides before and after treatment. In SEM, the presence of hydrogen bond rearrangement was indicated by the observed deformation of vascular bundles and ducts. The before-and-after changes in the peak patterns and peaks values in TG-DTG indicated that the content of different kinds of compounds produced changes, which all revealed that the formation of new saponins before and after the heat treatment was due to the breakage or rearrangement of chemical bonds. Additionally, the deformation of vascular bundles and vessels indicated the presence of hydrogen bond rearrangement. The glycosidic bond at the 20 positions could be cleaved by ginsenoside Rb3 to form ginsenoside Rd, which, in turn, gave rise to ginsenoside Rg3(S) and Rg3(R). They were further dehydrated to form ginsenoside Rk1 and Rg5. This transformation process occurs in a weak acidic environment provided by G. pentaphyllum itself, without the involvement of endogenous enzymes. In addition, the LC-MS analysis results showed that the content of ginsenoside Rb3 decreased from 2.25 mg/g to 1.80 mg/g, while the contents of ginsenoside Rk1 and Rg5 increased from 0.08 and 0.01 mg/g to 3.36 and 3.35 mg/g, respectively. Ginsenoside Rg3(S) and Rg3(R) were almost not detected in G. pentaphyllum, and the contents of them increased to 0.035 and 0.23 mg/g after heat treatment. Therefore, the rare ginsenosides Rg3(S), Rg3(R), Rk1, and Rg5 can be obtained from G. pentaphyllum via heat treatment.

Effective use of online depression information and associated literacies among US college students.

Mental health issues, such as depression, are rising among young people, who may benefit from online depression-related information. However, the competencies required to search for health information on the Internet and evaluate it before use may be poor among this population. This research aimed to investigate how college students use the Internet for solving problems in realistic case scenarios relevant to depression and to understand whether various literature-indicated literacies and factors may predict effective utilization of relevant online resources. We designed a web-based questionnaire survey including four depression-related case scenarios. A total of 218 undergraduate students who were enrolled in a Northeastern public US university were invited to participate in the survey in 2016, with 192 completed responses being included in this analysis (response rate = 88%; the participants' median age = 20; 79% female). Approximately half of the participants (47%) answered the depression-related questions in the case scenarios with 90% or higher accuracy. In a multiple linear regression model, prior depression knowledge and eHealth information literacy significantly predicted the effective use of online depression information. However, medical literacy and critical health literacy were not significant predictors. A few additional demographic and experience related factors were positively associated with the effective Internet use (e.g. female, non-Hispanic, psychology or health science major and prior experience with depression). These findings identify a need for college students to develop domain-specific knowledge and literacies in order to facilitate effective use of online information about depression.

Mobile phone text messaging and app-based interventions for smoking cessation.

BACKGROUND: Mobile phone-based smoking cessation support (mCessation) offers the opportunity to provide behavioural support to those who cannot or do not want face-to-face support. In addition, mCessation can be automated and therefore provided affordably even in resource-poor settings. This is an update of a Cochrane Review first published in 2006, and previously updated in 2009 and 2012. OBJECTIVES: To determine whether mobile phone-based smoking cessation interventions increase smoking cessation rates in people who smoke. SEARCH METHODS: For this update, we searched the Cochrane Tobacco Addiction Group's Specialised Register, along with clinicaltrials.gov and the ICTRP. The date of the most recent searches was 29 October 2018. SELECTION CRITERIA: Participants were smokers of any age. Eligible interventions were those testing any type of predominantly mobile phone-based programme (such as text messages (or smartphone app) for smoking cessation. We included randomised controlled trials with smoking cessation outcomes reported at at least six-month follow-up. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures described in the Cochrane Handbook for Systematic Reviews of Interventions. We performed both study eligibility checks and data extraction in duplicate. We performed meta-analyses of the most stringent measures of abstinence at six months' follow-up or longer, using a Mantel-Haenszel random-effects method, pooling studies with similar interventions and similar comparators to calculate risk ratios (RR) and their corresponding 95% confidence intervals (CI). We conducted analyses including all randomised (with dropouts counted as still smoking) and complete cases only. MAIN RESULTS: This review includes 26 studies (33,849 participants). Overall, we judged 13 studies to be at low risk of bias, three at high risk, and the remainder at unclear risk. Settings and recruitment procedures varied across studies, but most studies were conducted in high-income countries. There was moderate-certainty evidence, limited by inconsistency, that automated text messaging interventions were more effective than minimal smoking cessation support (RR 1.54, 95% CI 1.19 to 2.00; I2 = 71%; 13 studies, 14,133 participants). There was also moderate-certainty evidence, limited by imprecision, that text messaging added to other smoking cessation interventions was more effective than the other smoking cessation interventions alone (RR 1.59, 95% CI 1.09 to 2.33; I2 = 0%, 4 studies, 997 participants). Two studies comparing text messaging with other smoking cessation interventions, and three studies comparing high- and low-intensity messaging, did not show significant differences between groups (RR 0.92 95% CI 0.61 to 1.40; I2 = 27%; 2 studies, 2238 participants; and RR 1.00, 95% CI 0.95 to 1.06; I2 = 0%, 3 studies, 12,985 participants, respectively) but confidence intervals were wide in the former comparison. Five studies compared a smoking cessation smartphone app with lower-intensity smoking cessation support (either a lower-intensity app or non-app minimal support). We pooled the evidence and deemed it to be of very low certainty due to inconsistency and serious imprecision. It provided no evidence that smartphone apps improved the likelihood of smoking cessation (RR 1.00, 95% CI 0.66 to 1.52; I2 = 59%; 5 studies, 3079 participants). Other smartphone apps tested differed from the apps included in the analysis, as two used contingency management and one combined text messaging with an app, and so we did not pool them. Using complete case data as opposed to using data from all participants randomised did not substantially alter the findings. AUTHORS' CONCLUSIONS: There is moderate-certainty evidence that automated text message-based smoking cessation interventions result in greater quit rates than minimal smoking cessation support. There is moderate-certainty evidence of the benefit of text messaging interventions in addition to other smoking cessation support in comparison with that smoking cessation support alone. The evidence comparing smartphone apps with less intensive support was of very low certainty, and more randomised controlled trials are needed to test these interventions.

Burden of atrial fibrillation in Maori and Pacific people in New Zealand: a cohort study.

BACKGROUND: Atrial fibrillation (AF) is a major risk factor for ischaemic stroke and cardiovascular events. In New Zealand (NZ), Maori (indigenous New Zealanders) and Pacific people experience higher rates of AF compared with non-Maori/non-Pacific people. AIM: To describe a primary care population with AF in NZ. Stroke risk and medication adherence according to ethnicity are also detailed. METHODS: Electronic medical records for adults (≥20 years, n = 135 840, including 19 918 Maori and 43 634 Pacific people) enrolled at 37 NZ general practices were analysed for AF diagnosis and associated medication prescription information. RESULTS: The overall prevalence of non-valvular AF (NVAF) in this population was 1.3% (1769), and increased with age (4.4% in people ≥55 years). Maori aged ≥55 years were more likely to be diagnosed with NVAF (7.3%) than Pacific (4.0%) and non-Maori/non-Pacific people (4.1%, P < 0.001). Maori and Pacific NVAF patients were diagnosed with AF 10 years earlier than non-Maori/non-Pacific patients (median age of diagnosis: Maori = 60 years, Pacific = 61 years, non-Maori/non-Pacific = 71 years, P < 0.001). Overall, 67% of NVAF patients were at high risk for stroke (CHA2 DS2 -VASc ≥ 2) at the time of AF diagnosis. Almost half (48%) of Maori and Pacific NVAF patients aged <65 years were at high risk for stroke, compared with 22% of non-Maori/non-Pacific (P < 0.001). Irrespective of ethnic group, adherence to AF medication was suboptimal in those NVAF patients with a high risk of stroke or with stroke history. CONCLUSION: AF screening and stroke thromboprophylaxis in Maori and Pacific people could start below the age of 65 years in NZ.

Innovative method for the enrichment of high-polarity bioactive molecules present at low concentrations in complex matrices.

Ginsenoside Rg1 is a valuable bioactive molecule but its high polarity and low concentration in complex mixtures makes it a challenge to separate Ginsenoside Rg1 from other saponins with similar structures, resulting in low extraction efficiency. The successful development of effective Rg1 molecularly imprinted polymers that exhibit high selectivity and adsorption may offer an improved method for the enrichment of active compounds. In this work, molecularly imprinted polymers were prepared with two different methods, precipitation polymerization or surface imprinted polymerization. Comparison of the adsorption abilities showed higher adsorption of the surface molecularly imprinted polymers prepared by surface imprinted polymerization, 46.80 mg/g, compared to the 27.74 mg/g observed for the molecularly imprinted polymers prepared by precipitation polymerization. Therefore, for higher adsorption of the highly polar Rg1, surface imprinted polymerization is a superior technique to make Rg1 molecularly imprinted polymers. The prepared surface molecularly imprinted polymers were tested as a solid-phase extraction column to directionally enrich Rg1 and its analogues from ginseng tea and total ginseng extracts. The column with surface molecularly imprinted polymers showed higher enrichment efficiency and better selectivity than a C18 solid-phase extraction column. Overall, a new, innovative method was developed to efficiently enrich high-polarity bioactive molecules present at low concentrations in complex matrices.

Mobile phone-based interventions for smoking cessation.

BACKGROUND: Access to mobile phones continues to increase exponentially globally, outstripping access to fixed telephone lines, fixed computers and the Internet. Mobile phones are an appropriate and effective option for the delivery of smoking cessation support in some contexts. This review updates the evidence on the effectiveness of mobile phone-based smoking cessation interventions. OBJECTIVES: To determine whether mobile phone-based smoking cessation interventions increase smoking cessation in people who smoke and want to quit. SEARCH METHODS: For the most recent update, we searched the Cochrane Tobacco Addiction Group Specialised Register in April 2015. We also searched the UK Clinical Research Network Portfolio for current projects in the UK, and the ClinicalTrials.gov register for ongoing or recently completed studies. We searched through the reference lists of identified studies and attempted to contact the authors of ongoing studies. We applied no restrictions on language or publication date. SELECTION CRITERIA: We included randomised or quasi-randomised trials. Participants were smokers of any age who wanted to quit. Studies were those examining any type of mobile phone-based intervention for smoking cessation. This included any intervention aimed at mobile phone users, based around delivery via mobile phone, and using any functions or applications that can be used or sent via a mobile phone. DATA COLLECTION AND ANALYSIS: Review authors extracted information on risk of bias and methodological details using a standardised form. We considered participants who dropped out of the trials or were lost to follow-up to be smoking. We calculated risk ratios (RR) and 95% confidence intervals (CI) for each included study. Meta-analysis of the included studies used the Mantel-Haenszel fixed-effect method. Where meta-analysis was not possible, we presented a narrative summary and descriptive statistics. MAIN RESULTS: This updated search identified 12 studies with six-month smoking cessation outcomes, including seven studies completed since the previous review. The interventions were predominantly text messaging-based, although several paired text messaging with in-person visits or initial assessments. Two studies gave pre-paid mobile phones to low-income human immunodeficiency virus (HIV)-positive populations - one solely for phone counselling, the other also included text messaging. One study used text messages to link to video messages. Control programmes varied widely. Studies were pooled according to outcomes - some providing measures of continuous abstinence or repeated measures of point prevalence; others only providing 7-day point prevalence abstinence. All 12 studies pooled using their most rigorous 26-week measures of abstinence provided an RR of 1.67 (95% CI 1.46 to 1.90; I(2) = 59%). Six studies verified quitting biochemically at six months (RR 1.83; 95% CI 1.54 to 2.19). AUTHORS' CONCLUSIONS: The current evidence supports a beneficial impact of mobile phone-based smoking cessation interventions on six-month cessation outcomes. While all studies were good quality, the fact that those studies with biochemical verification of quitting status demonstrated an even higher chance of quitting further supports the positive findings. However, it should be noted that most included studies were of text message interventions in high-income countries with good tobacco control policies. Therefore, caution should be taken in generalising these results outside of this type of intervention and context.

Construction of antibacterial bone implants and their application in bone regeneration.

Bacterial infection represents a prevalent challenge during the bone repair process, often resulting in implant failure. However, the extensive use of antibiotics has limited local antibacterial effects at the infection site and is prone to side effects. In order to address the issue of bacterial infection during the transplantation of bone implants, four types of bone scaffold implants with long-term antimicrobial functionality have been constructed, including direct contact antimicrobial scaffold, dissolution-penetration antimicrobial scaffold, photocatalytic antimicrobial scaffold, and multimodal synergistic antimicrobial scaffold. The direct contact antimicrobial scaffold involves the physical penetration or disruption of bacterial cell membranes by the scaffold surface or hindrance of bacterial adhesion through surface charge, microstructure, and other factors. The dissolution-penetration antimicrobial scaffold releases antimicrobial substances from the scaffold's interior through degradation and other means to achieve local antimicrobial effects. The photocatalytic antimicrobial scaffold utilizes the absorption of light to generate reactive oxygen species (ROS) with enhanced chemical reactivity for antimicrobial activity. ROS can cause damage to bacterial cell membranes, deoxyribonucleic acid (DNA), proteins, and other components. The multimodal synergistic antimicrobial scaffold involves the combined use of multiple antimicrobial methods to achieve synergistic effects and effectively overcome the limitations of individual antimicrobial approaches. Additionally, the biocompatibility issues of the antimicrobial bone scaffold are also discussed, including in vitro cell adhesion, proliferation, and osteogenic differentiation, as well as in vivo bone repair and vascularization. Finally, the challenges and prospects of antimicrobial bone implants are summarized. The development of antimicrobial bone implants can provide effective solutions to bacterial infection issues in bone defect repair in the foreseeable future.

Gender differences in cardiovascular disease risk management for Pacific Islanders in primary care.

OBJECTIVES: To assess gender differences in cardiovascular disease risk (CVR) assessment and management for Pacific people in New Zealand. METHODS: New Zealand guidelines indicate CVR assessment from age 35 years for Pacific men and from age 45 years for Pacific women. Using general practice electronic medical records from 16 practices in New Zealand, the rate of CVR screening, treatment patterns and physiological measures for high-CVR (≥15% five-year) patients were assessed for Pacific patients ≥20 years of age by gender. RESULTS: Records for 10 863 Pacific patients showed a higher proportion of indicated women screened for CVR (65 vs 56%), but a lower proportion of assessed women with high CVR (28% for Pacific women vs 40% for Pacific men). Many of these high-CVR patients had physiological measures well above desirable levels based on their most recent readings. In the high-CVR group, women had similar CVR levels to men, but higher systolic blood pressure and HbA1c level, and a higher proportion of women were treated with antihypertensive and oral antidiabetic medication. There were substantial levels of poor medication adherence, particularly for cholesterol-lowering medication. Women and men were equally likely to adhere to treatment. Those adhering to relevant medications had lower blood pressure, total-to-HDL cholesterol ratio and HbA1c than non-adherers. CONCLUSIONS: Pacific men were less likely than Pacific women to have their CVR assessed when indicated, more likely once assessed to have high CVR and equally likely to adhere to treatment. Medication adherence was associated with better control of risk factors and should be further promoted in this population.

Quantitative Survey on Prevalence of Prescription Pain Medications and Stimulants Use in Young Adults.

Background: Prescription drug use including pain relievers and stimulants has been a growing problem in young adults and the issue has been a public health concern for years. Methods: This Quantitative Cross-sectional study aimed to collect preliminary data regarding prescription opioid use, prescription stimulant drug use and overdose treatment knowledge in young adults between 18 and 24 years old in a southern New Jersey university through administering an online survey. Results: Of the 1663 students who completed the survey, 33% reported using prescription pain relievers and 15% reported using prescription stimulant drugs. Stimulant drug users were found to be more likely to use prescription pain relievers (49%) as compared to non-stimulant users (30%). Furthermore, students with overdose treatment knowledge of opioids were more likely to report misuse of prescription drugs (15%) than students with less knowledge (8%). Conclusions: This study reiterates the increasing usage of prescription drugs and stimulant use among college students. There is a need for effective education strategies to inform students about the prescription medication uses and misuse to reduce nonmedical use of prescription medications.

Development and pilot testing of an online training program for better use of internet to learn about depression and anxiety (BUILDA).

BACKGROUND: Depression and anxiety are common issues among college students in the United States. Although college students routinely use the Internet for information regarding their mental health, they might lack the digital health literacy required to search, evaluate, and use Internet resources. MATERIALS AND METHODS: A web-based short training program with four modules aimed to improve mental health literacy and digital health literacy for Better Use of Internet to Learn about Depression and Anxiety (BUILDA). BUILDA was tested in a pilot study with 10 undergraduate students who completed the program and provided feedback via online surveys and exit interviews. Participants completed a pretest and a post-test, which included health literacy instruments and realistic case scenarios to assess student knowledge and ability to search and use Internet information on mental health topics. Descriptive analyses and paired t-tests were used. RESULTS: Increased knowledge about mental health topics was observed in pilot participants, with improvement in mean values of depression literacy (P =. 01) and anxiety literacy (P =. 019) from pretest to post-test. Better Internet search performance was also observed as the number of participants who scored >90% in case scenarios increased from two pretest to five post-test. Students used more valid and reliable Internet resources after training, citing more government health agency websites (20% in the pretest and 25% in the post-test) and scholarly resources (6% in the pretest and 30% in the post-test). The pilot participants reported the BUILDA program was useful and provided minor suggestions regarding program improvement. CONCLUSIONS: It was feasible to deliver a short training program via a simple website to help students develop mental health literacy and digital health skills.

Gypenosides suppress hepatocellular carcinoma cells by blocking cholesterol biosynthesis through inhibition of MVA pathway enzyme HMGCS1.

Hepatocellular carcinoma (HCC) is one of the most common malignant tumors with high morbidity and mortality. Targeting abnormal cholesterol metabolism is a potential therapeutic direction. Therefore, more natural drugs targeting cholesterol in HCC need to be developed. Gypenosides (Gyp), the major constituent of Gynostemma pentaphyllum, has been demonstrated to have pharmacological properties on anti-cancer, anti-obesity, and hepatoprotective. We investigated whether Gyp, isolated and purified by our lab, could inhibit HCC progression by inhibiting cholesterol synthesis. The present research showed that Gyp inhibited proliferation and migration, and induced apoptosis in Huh-7 and Hep3B cells. Metabolomics, transcriptomics, and target prediction all suggested that lipid metabolism and cholesterol biosynthesis were the mechanisms of Gyp. Gyp could limit the production of cholesterol and target HMGCS1, the cholesterol synthesis-related protein. Downregulation of HMGCS1 could suppress the progression and abnormal cholesterol metabolism of HCC. In terms of mechanism, Gyp suppressed mevalonate (MVA) pathway mediated cholesterol synthesis by inhibiting HMGCS1 transcription factor SREBP2. And the high expression of HMGCS1 in HCC human specimens was correlated with poor clinical prognosis. The data suggested that Gyp could be a promising cholesterol-lowering drug for the prevention and treatment of HCC. And targeting SREBP2-HMGCS1 axis in MVA pathway might be an effective HCC therapeutic strategy.

Protective effect of heat-processed Gynostemma pentaphyllum on high fat diet-induced glucose metabolic disorders mice.

Glucose metabolic disorders (GMD) can promote insulin resistance (IR) and diabetes, and damage liver and kidney. Gynostemma pentaphyllum is commonly used in the clinical treatment of diabetes, but the research on its main active constituents and GMD has not been reported yet. This study explores the therapeutic potential of gypenosides of heat-processed Gynostemma pentaphyllum (HGyp) on high-fat diet-induced GMD in mice. HGyp was administered at different doses for 12 weeks. The investigation encompassed an array of parameters, including body weight, blood lipids, blood glucose, and liver tissue components. Metabolomic and network analyses were conducted to uncover potential targets and pathways associated with HGyp treatment. The results revealed that HGyp alleviated GMD by reducing body weight, blood glucose, and improving blood lipids levels, while increasing liver glycogen and antioxidant enzyme levels. Additionally, HGyp exhibited protective effects on liver and kidney health by reducing tissue damage. Fourteen blood components were detected by LC-MS. Metabolomic and network analyses indicated the potential engagement of the AGE-RAGE signaling pathway in the therapeutic effects of HGyp.Furthermore, Western blot and ELISA assays confirmed that HGyp upregulated GLO1 and GLUT4 while down-regulating AGEs and RAGE expression in liver tissue. In light of these findings, HGyp demonstrates promise as a potential therapeutic candidate for combating GMD, warranting further exploration in the development of therapeutic strategies or functional products.

Mobile phone-based interventions for smoking cessation.

BACKGROUND: Innovative and effective smoking cessation interventions are required to appeal to those who are not accessing traditional cessation services. Mobile phones are widely used and are now well-integrated into the daily lives of many, particularly young adults. Mobile phones are a potential medium for the delivery of health programmes such as smoking cessation. OBJECTIVES: To determine whether mobile phone-based interventions are effective at helping people who smoke, to quit. SEARCH METHODS: For the most recent update, we searched the Cochrane Tobacco Addiction Group Specialised Register in May 2012. We also searched UK Clinical Research Network Portfolio for current projects in the UK and the ClinicalTrials register for on-going or recently completed studies. We searched through the reference lists of identified studies and attempted to contact the authors of ongoing studies, with no restrictions placed on language or publication date. SELECTION CRITERIA: We included randomized or quasi-randomized trials. Participants were smokers of any age who wanted to quit. Studies were those examining any type of mobile phone-based intervention. This included any intervention aimed at mobile phone users, based around delivery via mobile phone, and using any functions or applications that can be used or sent via a mobile phone. DATA COLLECTION AND ANALYSIS: Information on risk of bias and methodological details was extracted using a standardised form. Participants who dropped out of the trials or were lost to follow-up were considered to be smoking. We calculated risk ratios (RR) for each included study. Meta-analysis of the included studies was undertaken using the Mantel-Haenszel fixed-effect method. Where meta-analysis was not possible, summary and descriptive statistics are presented. MAIN RESULTS: Five studies with at least six month cessation outcomes were included in this review. Three studies involve a purely text messaging intervention that has been adapted over the course of these three studies for different populations and contexts. One study is a multi-arm study of a text messaging intervention and an internet QuitCoach separately and in combination. The final study involves a video messaging intervention delivered via the mobile phone. When all five studies were pooled, mobile phone interventions were shown to increase the long term quit rates compared with control programmes (RR 1.71, 95% CI 1.47 to 1.99, over 9000 participants), using a definition of abstinence of no smoking at six months since quit day but allowing up to three lapses or up to five cigarettes. Statistical heterogeneity was substantial as indicated by the I² statistic (I² = 79%), but as all included studies were similar in design, intervention and primary outcome measure, we have presented the meta-analysis in this review. AUTHORS' CONCLUSIONS: The current evidence shows a benefit of mobile phone-based smoking cessation interventions on long-term outcomes, though results were heterogenous with findings from three of five included studies crossing the line of no effect. The studies included were predominantly of text messaging interventions. More research is required into other forms of mobile phone-based interventions for smoking cessation, other contexts such as low income countries, and cost-effectiveness.

Influencing factors for adopting personal health record (PHR).

BACKGROUND: This paper reports on a small study in which we investigated factors influencing the adoption of Personal Health Records (PHRs), with specific reference to those linked to Electronic Health Records. Long term conditions are a growing concern in healthcare delivery, especially as the need for services outstrips resources. PHRs could be useful in supporting self-care of people with long term conditions, e.g. diabetes. METHOD: We used a Grounded Theory approach to gather initial data to inform future research. This meant that we were guided and informed by data collected.[1] The aim was to find a baseline for PHR research using the Technology Acceptance Model [2], after which emerging topics will be pursued with constant comparison to this first study and subsequent studies. We interviewed ten patients from a Wellington primary care practice who had been using a PHR linked to their doctor's Practice Management System, and observed them using and navigating the software at home. RESULTS: Three groups of factors appeared to influence the participants' use of the PHR. (1) Their perception that convenience, time saving (for them, their GP's practice personnel and their GP), efficiency and effectiveness of care is a result of using the PHR. (2) Computer and health literacy contribute to being able to effectively use the PHR. PHR usage impacts positively on the relationship with their doctor and vice versa, and improves their ability to navigate the health system. (3) It is not clear how PHR-related services are paid for, who pays and under what circumstances. DISCUSSION: These findings are in keeping with those of Santana et al[3] who indicate that patients are interested in viewing and using laboratory results, medicines and diagnosis lists, and ordering repeat prescriptions and corresponding with their clinicians. Literacy does matter, especially in terms of PHRs providing a transparent 'source of truth' and memory aid about medications, laboratory results and diagnoses. The combination of computer and health literacy requires further research. The cost of incorporating PHRs into healthcare services needs to be articulated so that it makes sense in the current capitation funding model. LIMITATIONS of this research include the small sample size, bias based on small context and self-selection into the interview cohort. IN CONCLUSION: three groups of influencing factors have been elicited from the interviews and observations to indicate potential acceptance and adoption of PHRs in self-care of long term conditions. The next step is to examine the social situatedness of long term conditions and how PHRs support self-care.

Electronic referrals: what matters to the users.

BACKGROUND: Between September 2010 and May 2011 we evaluated three implementations of electronic referral (eReferral) systems at Hutt Valley, Northland and Canterbury District Health Boards in New Zealand. METHODS: Qualitative and quantitative data were gathered through project documentation, database records and stakeholder interviews. This paper reports on the user perspectives based on interviews with 78 clinical, management and operational stakeholders in the three regions. Themes that emerge across the regions are compared and synthesised. Interviews focused on pre-planned domains including quality of referral, ease of use and patient safety, but agendas were adapted progressively to elaborate and triangulate on themes emerging from earlier interviews and to clarify indications from analysis of database records. RESULTS AND DISCUSSION: The eReferral users, including general practitioners, specialists and administrative staff, report benefits in the areas of: (1) availability and transparency of referral-related data; (2) work transformation; (3) improved data quality and (4) the convenience of auto-population from the practice management system into the referral forms. eReferral provides enhanced visibility of referral data and status within the limits of the implementation (which only goes to the hospital door in some cases). Users in all projects indicated the desire to further exploit IT to enhance two-way communication between community and hospital. Reduced administrative handling is a clear work transformation benefit with mixed feedback regarding clinical workload impact. Innovations such as GP eReferral triaging teams illustrate the further potential for workflow transformation. Consistent structure in eReferrals, as well as simple legibility, enhances data quality. Efficiency and completeness is provided by auto-population of forms from system data, but opens issues around data accuracy. All three projects highlight the importance of user involvement in design, implementation and refinement. In keeping with this, Canterbury utilises a systematic pathway definition process that brings together GPs and specialist to debate and agree on the local management of a condition. User feedback exposes many opportunities for improving usability. STUDY LIMITATIONS: The findings are based on individual experiences accounted by participating stakeholders; the risk of bias is mitigated, however, by triangulation across three distinct implementations of eReferrals. Quantitative follow-up on key outstanding issues, notably impact of structured eReferral forms on GP time to write a referral, is warranted. CONCLUSION: Key eReferral users include clinicians on both ends of the referral process as well as the administrative staff. User experience in three eReferral projects has shown that they particularly appreciate improvement of referral visibility, as well as information quality; promising workflow transformations have been achieved in some places. Auto-population of forms leads to opportunities, and issues, that are prompting further attention to data quality. While the importance of user feedback should be obvious, it is not universal to seek it or to provide resources to effectively follow up with improvements driven by such feedback. To maximise benefits, innovative health IT projects must take an iterative approach guided by ongoing user experience.

[Development and validation of a finite element model of human knee joint for dynamic analysis].

Based on the biomechanical response of human knee joint to a front impact in occupants accidents, a finite element (FE) model of human knee joint was developed by using computer simulation technique for impacting. The model consists of human anatomical structure, including femoral condyle, tibia condyle, fibular small head, patellar, cartilage, meniscus and primary ligament. By comparing the results of the FE model with experiments of the knee joint in axial load conditions, the validation of the model was verified. Furthermore, this study provides data for the mechanical of human knee joint injury, and is helpful for the design and optimization of the vehicle protective devices.

University Students' Ability to Assess Misinformation About COVID-19.

In a university student survey on COVID-19 information assessment, 66% participants identified the falsehood of all misinformation statements and 66% provided web page URLs that are adequate in supporting statement accuracy assessment. The most cited web resources were government websites (43%) and media reports (30%). Those who identified misinformation falsehood were more likely to have higher GPA and liberal-leaning political views, and to implement evidence-based COVID prevention measures including mask-wearing and not self-medicating on (hydroxy-)chloroquine.

Effective use of online COVID-19 information and eHealth information literacy among US university students.

Objective: This study aimed to understand students' ability to search the Internet for COVID-19 information and apply it to evaluate the veracity of specific statements. Participants: Undergraduate students (N = 239) at a US university completed a Web-based questionnaire in September-October 2020. Methods: The questionnaire included self-reported measures of online health information literacy, COVID-19 knowledge, and anxiety along with exercises on searching and evaluating COVID information online. Results: Students reported moderate levels of information literacy (76%, 3.8 out of 5), but did not perform as well while searching the Internet for COVID-19 information (average accuracy: 65%, 10.5 out of 16 points). Students with higher Internet exercise scores reported higher GPA, higher household income, and liberal political views, and were more likely to follow public health measures [ie, social distancing, mask wearing, and not self-medicating with (hydroxy)chloroquine]. Conclusions: University students may overestimate their information literacy while struggling with searching the Internet for accurate COVID-19 information.