Digital Health for Oncological Care.

ABSTRACT: Digital health tools extend well beyond telemedicine, holding great potential to advance oncological care. We survey digital health and provide recommendations across the health continuum, tailoring them to oncology, including prevention, detection and diagnosis, and treatment and monitoring. Within the prevention realm, we review wellness technologies, cancer screening, mental health solutions, and digital biomarkers. For detection and diagnosis, we describe existing and emerging solutions for remote patient monitoring and various means to capture digital biomarkers, the "digital exam," and "digital outcomes." Treatment and monitoring solutions include telemedicine, chatbots, and digital therapeutics, which are also explored. We also discuss a host of technology enablers that are required for successful implementation and sustainment of digital health-enabled care. Our recommendations pertain to health care systems as well as companies that work with these systems or provide care to patients directly.

Measuring Morality: An Examination of the Moral Foundation Questionnaire's Factor Structure.

Moral foundations theory proposes five domains of morality-harm, fairness, loyalty, purity, and authority. Endorsement of these moral domains is assessed by the Moral Foundations Questionnaire (MFQ), a 30-item scale that has undergone intense measurement scrutiny. Across five samples (N = 464,229), we show greatly improved model fit using a Bifactor model that accounts for two kinds of items in the MFQ: judgment and relevance. We add to this space by demonstrating how using this improved measurement structure changes the strength of correlations of the moral foundations with numerous attitudes, cognitive styles, and moral decision-making. Future research should continue to identify what, if anything, the relevance and judgment factors might substantively capture over and above the substantive domains of moral foundations. In the meantime, we recommend that researchers use the Bifactor model for its improved model structure, rather than dropping the relevant items as some have proposed.

C-H-E-A-T: Wordle Cheating Is Related to Religiosity and Cultural Tightness.

Wordle is a daily, online brainteaser. The widespread popularity of the game in the early months of 2022 has also led to widespread cheating. Here, we use data from Google Trends and Twitter to explore correlates of cheating on Wordle. We find that cheating behavior is negatively related to religiosity and cultural tightness. Although this is a benign example of cheating behavior, we discuss how popular trends can be used as case studies of group-level behavior.

Is Religion Special?

Religion makes unique claims (e.g., the existence of supernatural agents) not found in other belief systems, but is religion itself psychologically special? Furthermore, religion is related to many domains of psychological interest, such as morality, health and well-being, self-control, meaning, and death anxiety. Does religion act on these domains via special mechanisms that are unlike secular mechanisms? These could include mechanisms such as beliefs in supernatural agents, providing ultimate meaning, and providing literal immortality. We apply a critical eye to these questions of specialness and conclude that although it is clear that religion is psychologically important, there is not yet strong evidence that it is psychologically special, with the possible exception of its effects on health. We highlight what would be required of future research aimed at convincingly demonstrating that religion is indeed psychologically special, including careful definitions of religion and careful attention to experimental design and causal inference.

Systematic Evaluation of Research Priorities in Critical Care Electroencephalography.

PURPOSE: The Critical Care EEG Monitoring Research Consortium (CCEMRC) is an international research group focusing on critical care EEG and epilepsy. As CCEMRC grew to include 50+ institutions over the past decade, members met to establish research priorities. METHODS: The authors used an analytical hierarchy process-based research prioritization method, adapted from an approach previously applied to a Department of Defense health-related research program. Forty-six CCEMRC members identified and scored a set of eight clinical problems (CPs) and 15 research topic areas (RTAs) at an annual CCEMRC meeting. Members scored CPs on three criteria using a five-point ordinal scale: Incidence, Impact, and Gap Size; and RTAs on four additional criteria: Niche, Feasibility, Scientific Importance, and Medical Importance, each of which was assigned a weight. The first three RTA criteria were scored using a five-point scale, and CPs were mapped to RTAs using a four-point scale. The Medical Importance score was a weighted average of its mapping scores and the CP score. Finally, a Priority score was calculated for each RTA as a product of the four RTA criteria scores. RESULTS: The CPs with the highest scores were "Altered mental status" and "Long-term neurologic disability after hospital discharge." The RTAs with the highest priority scores were "Development of risk prediction tools," "Multicenter observational studies," and "Outcome prediction." CONCLUSIONS: Research prioritization helped CCEMRC evaluate its current research trajectory, identify high-priority near-term research pursuits, and create a roadmap for future research plans aligned with its mission. This approach may be helpful to other academic consortia and research programs.

Aligning mission to digital health strategy in academic medical centers.

The strategies of academic medical centers arise from core values and missions that aim to provide unmatched clinical care, patient experience, research, education, and training. These missions drive nearly all activities. They should also drive digital health activities - and particularly now given the rapid adoption of digital health, marking one of the great transformations of healthcare; increasing pressures on health systems to provide more cost-effective care; the pandemic-accelerated funding and rise of well-funded new entrants and technology giants that provide more convenient forms of care; and a more favorable regulatory and reimbursement landscape to incorporate digital health approaches. As academic medical centers emerge from a pandemic-related reactionary digital health posture, where pressures to adopt more digital health technologies mount, a broad digital health realignment that leverages the strengths of such centers is required to accomplish their missions.

Telehealth for Comprehensive Care of Acute Neurologic Disorders.

A teleneurology hospitalist model aims to address the demand for high-quality neurologic acute care and the shortage of neurologists. Here, we review concepts and models of teleneurology services to address access and care gaps in neurology beyond telestroke models. The goal of these emergent teleservices is to empower community hospitals to deliver the highest quality care, while also reducing unnecessary patient transfers to tertiary care hospitals. We highlight the clinical models, patient populations, and innovative approaches of different tele-neurohospitalist services. This includes challenges related to clinical limitations, legal issues, and reimbursement. We highlight specific areas of research that can further clarify and refine the appropriate use, cost-effectiveness, and clinical outcomes of these telemedicine-based care models.

Persistent Genital Arousal and Major Depressive Disorder in an Adolescent Male: Case Report and Discussion.

Persistent genital arousal disorder [PGAD] is a distressing physiologic arousal condition with no psychologic etiology. We highlight identification and treatment of PGAD and associated mental comorbidities in a 15-year-old male who presented to Pediatric Urology with PGAD with pain, and resultant depression and suicidal ideation. After failure of conservative pharmacologic management, MRI of the lumbosacral spine demonstrated an L5-S1 annular tear and herniation of the nucleus pulposus. The patient underwent transforaminal steroid injection with reduction in symptoms, and eventually lumbar discectomy with near complete resolution of symptoms. Management of this condition should include a focus on the mental health component.

Mobile app validation: a digital health scorecard approach.

While digital health solutions continue to grow in number and in complexity, the ability for stakeholders in healthcare to easily discern quality lags far behind. This challenge is in part due to the lack of a transparent and standardized approach to validation. Evaluation of mobile health applications (apps) is further burdened by low barriers to development and direct-to-user marketing, leading to a crowded and confusing landscape. In this context, we investigated the pragmatic application of a previously described framework for digital health validation, the Digital Health Scorecard, in a cohort of 22 popular mobile health oncology apps. The apps evaluated using this framework performed poorly, scoring 49.4% across all evaluation criteria as a group. Performance across component domains varied considerably with cost scoring highest at 100%, usability at 56.7%, technical at 37.3%, and clinical at 15.9%. satisfaction of prospectively determined end-user requirements derived from patient, family, and clinician consensus scored 37.2%. While cost outperformed consistently and usability was adequate, the results also suggested that apps suffered from significant technical limitations, were of limited clinical value, and generally did not do what end users wanted. These large gaps further support the need for transparent and standardized evaluation to help all stakeholders in healthcare improve the quality of mobile health.

Faith and science mindsets as predictors of COVID-19 concern: A three-wave longitudinal study.

The COVID-19 pandemic allowed for a naturalistic, longitudinal investigation of the relationship between faith and science mindsets and concern about COVID-19. Our goal was to examine two possible directional relationships: (Model 1) COVID-19 concern ➔ disease avoidance and self-protection motivations ➔ science and faith mindsets versus (Model 2) science and faith mindsets ➔ COVID-19 concern. We surveyed 858 Mechanical Turk workers in three waves of a study conducted in March, April, and June 2020. We found that science mindsets increased whereas faith mindsets decreased (regardless of religious type) during the early months of the pandemic. Further, bivariate correlations and autoregressive cross-lagged analyses indicated that science mindset was positive predictor of COVID-19 concern, in support of Model 2. Faith mindset was not associated with COVID-19 concern. However, faith mindset was a negative predictor of science mindset. We discuss the need for more research regarding the influence of science and faith mindsets as well as the societal consequences of the pandemic.

Stress and sleep across the onset of the novel coronavirus disease 2019 pandemic: impact of distance learning on US college students' health trajectories.

STUDY OBJECTIVES: This study examined associations between average and intraindividual trajectories of stress, sleep duration, and sleep quality in college students before, during, and after transitioning to online learning due to the COVID-19 pandemic. METHODS: One hundred and sixty-four first-year college students answered twice-weekly questionnaires assessing stress exposure and perception, sleep duration, and sleep quality from January until May, 2020 (N = 4269 unique observations). RESULTS: Multilevel growth modeling revealed that prior to distance learning, student stress was increasing and sleep duration and quality were decreasing. After transitioning online, students' stress exposure and perception trajectories immediately and continuously decreased; sleep quality initially increased but decreased over time; and sleep duration increased but then plateaued for the remainder of the semester. Days with higher stress exposure than typical for that student were associated with lower sleep quality, and both higher stress exposure and perception at the transition were linked with simultaneous lower sleep quality. Specific groups (eg, females) were identified as at-risk for stress and sleep problems. CONCLUSIONS: Although transitioning to remote learning initially alleviated college students' stress and improved sleep, these effects plateaued, and greater exposure to academic, financial, and interpersonal stressors predicted worse sleep quality on both daily and average levels. Environmental stressors may particularly dictate sleep quality during times of transition, but adaptations in learning modalities may help mitigate short-term detrimental health outcomes during global emergencies, even during a developmental period with considerable stress vulnerability. Future studies should examine longer-term implications of these trajectories on mental and physical health.

Teleneurology Comprehensive Inpatient Consultations Expedite Access to Care and Decreases Hospital Length of Stay.

BACKGROUND AND PURPOSE: While the successful provision of telestroke care has been well documented in the literature, studies on the impact of comprehensive teleneurology service (TN) to hospital measures are lacking. We evaluated 3 traditional health services metrics of hospital performance: time from consult request to consult completion, inpatient length of stay (LOS), and the rate of patients transferred for tertiary care. METHODS: Medical records (n = 899) from 3 community hospitals and our TN consultation database were retrospectively reviewed during the 2 years before (n = 703, 3 hospitals) and 4 months (n = 2 hospitals) to 2 years (n = 1 hospital) after implementation (n = 196) of a TN program for routine and urgent consult requests. Consult order time, consult completion time, total length of stay and discharge disposition were compared across the pre-TN implementation group, which consisted of in-person consultations and the post-TN implementation group, which consisted of TN consultations only. RESULTS: After TN implementation, median length of stay decreased 28% (3.9 vs. 2.8 days, p < 0.0001) and median time from consult order to consult completion decreased by 74% across all diagnoses (5.8 vs. 1.5 hours, p < 0.0001). There were no significant differences in the percentage of patients discharged home (52.3% vs. 56.1%, p = 0.10) or transferred to tertiary care (6.1% to 9.2%, p = 0.10). CONCLUSIONS: Implementation of TN program was associated with significant reductions in LOS and time to consultation completion without an increase in shunting of patients to more advanced facilities. Further research is warranted to confirm these findings in independent cohorts and other models of teleneurology delivery.

The Digital Neurologic Examination.

Digital health has been rapidly thrust into the forefront of care delivery. Poised to extend the clinician's reach, a new set of examination tools will redefine neurologic and neurosurgical care, serving as the basis for the digital neurologic examination. We describe its components and review specific technologies, which move beyond traditional video-based telemedicine encounters and include separate digital tools. A future suite of these clinical assessment technologies will blur the lines between history taking, examination, and remote monitoring. Prior to full-scale implementation, however, much more investigation is needed. Because of the nascent state of the technologies, researchers, clinicians, and developers should establish digital neurologic examination requirements in order to maximize its impact.

Practicing in a Pandemic: A Clinician's Guide to Remote Neurologic Care.

Neurologists around the country and the world are rapidly transitioning from traditional in-person visits to remote neurologic care because of the coronavirus disease 2019 pandemic. Given calls and mandates for social distancing, most clinics have shuttered or are only conducting urgent and emergent visits. As a result, many neurologists are turning to teleneurology with real-time remote video-based visits with patients to provide ongoing care. Although telemedicine utilization and comfort has grown for many acute and ambulatory neurologic conditions in the past decade, remote visits and workflows remain foreign to many patients and neurologists. Here, we provide a practical framework for clinicians to orient themselves to the remote neurologic assessment, offering suggestions for clinician and patient preparation before the visit; recommendations to manage common challenges with remote neurologic care; modifications to the neurologic examination for remote performance, including subspecialty-specific considerations for a variety of neurologic conditions; and a discussion of the key limitations of remote visits. These recommendations are intended to serve as a guide for immediate implementation as neurologists transition to remote care. These will be relevant not only for practice today but also for the likely sustained expansion of teleneurology following the pandemic.

Stereotypes of nihilists are overwhelmingly negative.

Existential nihilism is on the rise in modern societies, but no previous work has investigated the social psychology of seeing no meaning in life. In the current research, five studies (N = 1,634) show that targets' existential nihilist beliefs elicit a range of negative stereotypes about personality traits, commonly valued social traits, and targets' ability to perform basic adaptive social tasks. Results demonstrate that these negative stereotypes are mediated by belief that the target is depressed more than the belief the target is non-religious or that the target does not plan for the future. Unlike atheists, who are seen as competent, no positive stereotypes emerged for nihilists, suggesting both future research and interventions aimed at updating false beliefs about nihilists.

Novel intraoperative online functional mapping of somatosensory finger representations for targeted stimulating electrode placement: technical note.

Defining eloquent cortex intraoperatively, traditionally performed by neurosurgeons to preserve patient function, can now help target electrode implantation for restoring function. Brain-machine interfaces (BMIs) have the potential to restore upper-limb motor control to paralyzed patients but require accurate placement of recording and stimulating electrodes to enable functional control of a prosthetic limb. Beyond motor decoding from recording arrays, precise placement of stimulating electrodes in cortical areas associated with finger and fingertip sensations allows for the delivery of sensory feedback that could improve dexterous control of prosthetic hands. In this study, the authors demonstrated the use of a novel intraoperative online functional mapping (OFM) technique with high-density electrocorticography to localize finger representations in human primary somatosensory cortex. In conjunction with traditional pre- and intraoperative targeting approaches, this technique enabled accurate implantation of stimulating microelectrodes, which was confirmed by postimplantation intracortical stimulation of finger and fingertip sensations. This work demonstrates the utility of intraoperative OFM and will inform future studies of closed-loop BMIs in humans.

Extended home use of an advanced osseointegrated prosthetic arm improves function, performance, and control efficiency.

Objective.Full restoration of arm function using a prosthesis remains a grand challenge; however, advances in robotic hardware, surgical interventions, and machine learning are bringing seamless human-machine interfacing closer to reality.Approach.Through extensive data logging over 1 year, we monitored at-home use of the dexterous Modular Prosthetic Limb controlled through pattern recognition of electromyography (EMG) by an individual with a transhumeral amputation, targeted muscle reinnervation, and osseointegration (OI).Main results.Throughout the study, continuous prosthesis usage increased (1% per week,p< 0.001) and functional metrics improved up to 26% on control assessments and 76% on perceived workload evaluations. We observed increases in torque loading on the OI implant (up to 12.5% every month,p< 0.001) and prosthesis control performance (0.5% every month,p< 0.005), indicating enhanced user integration, acceptance, and proficiency. More importantly, the EMG signal magnitude necessary for prosthesis control decreased, up to 34.7% (p< 0.001), over time without degrading performance, demonstrating improved control efficiency with a machine learning-based myoelectric pattern recognition algorithm. The participant controlled the prosthesis up to one month without updating the pattern recognition algorithm. The participant customized prosthesis movements to perform specific tasks, such as individual finger control for piano playing and hand gestures for communication, which likely contributed to continued usage.Significance.This work demonstrates, in a single participant, the functional benefit of unconstrained use of a highly anthropomorphic prosthetic limb over an extended period. While hurdles remain for widespread use, including device reliability, results replication, and technical maturity beyond a prototype, this study offers insight as an example of the impact of advanced prosthesis technology for rehabilitation outside the laboratory.

You can learn a lot about religion from food.

Religions' food practices can illustrate a lot about religions, and can raise new research questions. I will give examples of ways in which religious food practices are reflections of broader religious ideals. Foods contain essences and are religiously symbolic; foods are a window into how people understand the necessity to obey God; food practices relate to health outcomes; and food practices reflect and inculcate social structures and worldviews. The article will go on to consider some broader questions raised including the origins and cultural evolution of food rules, and how food practices relate to group differences and individual differences.

Prolonged Field Care Research Approach and Its Relevance to Civilian Medicine.

In early March 2020, Johns Hopkins University Applied Physics Lab hosted an Association of Military Surgeons of the United States regional conference to address medical demands of the future battlefield for which prolonged field care is expected. Arising from this conference, we propose here an approach to prolonged field care research-and also summarize the major concepts discussed at the conference. We draw parallels to prolonged field care investments and advancements that apply beyond the combat environment. The exceedingly daunting medical challenges of the future battlefield, on land and at sea, must be addressed to maintain an effective force able to compete with modern highly capable adversaries. Since the human element, and its health, will allow future mission success, we propose here an approach to making soldier health-related research most impactful.