Design and Assessment of a Mobile Health Care Solution for the Military Pediatrician: The DHA Pediatrics App.

INTRODUCTION: Mobile health technology design and use by patients and clinicians have rapidly evolved in the past 20 years. Nevertheless, the technology has remained in silos of practices, patients, and individual institutions. Uptake across integrated health systems has lagged. MATERIALS AND METHODS: In 2015, the authors designed a mobile health application (App) aimed at augmenting the capabilities of clinicians who care for children within the Military Health System (MHS). This App incorporated a curated, system-based collection of Clinical Practice Guidelines, access to emergency resuscitation cards, call buttons for local market subspecialty and inpatient teams, links to residency academic calendars, and other web-based resources. Over the next 5 years, three Plan-Do-Study-Act cycles facilitated multiple enhancements for the App which eventually transitioned from the Android/iOS stores to a web browser. The "People At the Centre of Mobile Application Development" tool which has validity evidence captured user experience. The team assessed the App's global effectiveness using Google Analytics. A speed test measured time saved and accuracy of task completion for clinicians using the App compared to non-users. Finally, MHS medical librarians critiqued the App using a questionnaire with validity evidence. The Walter Reed National Military Medical Center Institutional Review Board reviewed the study and deemed it exempt. RESULTS: Clinician respondents (n = 68 complete responses across six MTFs, 51% graduate medical trainees representing a 7.4% response rate of active duty pediatrician forces) perceived the App to have appropriate qualities of efficiency, effectiveness, learnability, memorability, errors, satisfaction, and cognitive properties following App use in clinical practice. Google Analytics demonstrated more than 1,000 unique users on the App from May 1, 2020 to January 20, 2021. There were 746 instances (26% of all sessions) when a user navigated between more than one military treatment facility. App users were faster and more accurate at task completion during a digital scavenger hunt. Medical librarians measured the App to have acceptable usefulness, accuracy, authority, objectivity, timeliness, functionality, design, security, and value. CONCLUSIONS: The App appears to be an effective tool to extend a clinician's capabilities and inter-professional communication between world-wide users and six MHS markets. This App was designed-and used-for a large health care network across a wide geographic footprint. Next steps are establishing an enduring chain of App champions for continued updates and sharing the App's code with other military medical disciplines and interested civilian centers.

Effect of branched-Chain Amino Acid Supplementation on Muscle Soreness following Exercise: A Meta-Analysis.

Delayed onset muscle soreness (DOMS) is a symptom of exercise-induced muscle damage that occurs following exercise. Previous research has indicated that branched-chain amino acid (BCAA) supplementation may attenuate exercise-induced muscle damage that causes delayed onset muscle soreness, however the results are inconsistent. The primary aim of this study was to examine the previous literature assessing the effect of BCAA supplementation on DOMS following an acute bout of exercise in adults. This review was conducted in accordance with PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-analyses), and identified peer-reviewed articles comparing a BCAA supplement to a placebo non-BCAA supplement following an acute bout of exercise. An electronic search of three databases (EbscoHost, Web of Science, and SPORTDiscus) yielded 42 articles after duplicates were removed. All studies included in the current analyis were: 1) peer-reviewed publications; 2) available in English; 3) utilized a random control design that compared a BCAA group to a placebo control group following exercise; 4) and assessed soreness of muscle tissue during recovery. DOMS was assessed in 61 participants following ingestion of a BCAA supplement over the course of these interventions. The cumulative results of 37 effects gathered from 8 studies published between 2007 and 2017 indicated that BCAA supplementation reduced DOMS following exercise training (ES = 0.7286, 95% CI: 0.5017 to 0.9555, p < 0.001). A large decrease in DOMS occurs following BCAA supplementation after exercise compared to a placebo supplement.

Collaboration reduces the frequency of false memories in older and younger adults.

Older (mean age = 74.23) and younger (mean age = 33.50) participants recalled items from 6 briefly exposed household scenes either alone or with their spouses. Collaborative recall was compared with the pooled, nonredundant recall of spouses remembering alone (nominal groups). The authors examined hits, self-generated false memories, and false memories produced by another person's (actually a computer program's) misleading recollections. Older adults reported fewer hits and more self-generated false memories than younger adults. Relative to nominal groups, older and younger collaborating groups reported fewer hits and fewer self-generated false memories. Collaboration also reduced older people's computer-initiated false memories. The memory conversations in the collaborative groups were analyzed for evidence that collaboration inhibits the production of errors and/or promotes quality control processes that detect and eliminate errors. Only older adults inhibited the production of wrong answers, but both age groups eliminated errors during their discussions. The partners played an important role in helping rememberers discard false memories in older and younger couples. The results support the use of collaboration to reduce false recall in both younger and older adults.

Tea consumption and basal cell and squamous cell skin cancer: results of a case-control study.

BACKGROUND: Tea constituents, including polyphenols, are hypothesized to have chemopreventive properties, and inhibit the induction of skin cancers in animal models. OBJECTIVE: To explore the association between regular tea consumption (>or=1 cup/d for >or=1 month) and the incidence of squamous cell (SCC) and basal cell (BCC) carcinomas. METHODS: A population-based case-control study of 770 individuals with BCC, 696 with SCC, and 715 age- and sex-matched control subjects. RESULTS: After adjustment for age, sex, and lifetime history of painful sunburns, ever having consumed tea regularly was associated with a significantly lower risk of SCC (odds ratio [OR] = 0.70; 95% confidence interval [CI] 0.53-0.92), especially among long-term drinkers (>or=47 years consumption: SCC, OR = 0.49; 95% CI 0.29-0.83; P for trend = .008) and among those consuming >or=2 cups/d (OR = 0.65; 95% CI 0.44-0.96; P for trend = 0.013). After adjustment for age and sex, ever having consumed tea regularly was weakly associated with BCC risk (OR = 0.79; 95% CI 0.63-0.98). LIMITATIONS: Our case-control study was susceptible to recall bias and to confounding by unknown cancer risk factors associated with tea consumption. CONCLUSIONS: Our findings support the existence of an inverse association between tea consumption and skin carcinogenesis.

Inhibition of Neisseria gonorrhoeae genital tract infection by leading-candidate topical microbicides in a mouse model.

The development of effective vaginal microbicides is paramount in the fight against the spread of sexually transmitted infections. Preclinical testing of candidate microbicides for the prevention of gonorrhea has been seriously hindered by the lack of an animal model. We assessed the efficacy of 7 promising formulated agents--CarraGuard, Ushercell, [poly]sodium 4-styrene sulfonate (T-PSS), PRO 2000, ACIDFORM, cellulose acetate phthalate (CAP), and BufferGel--by use of a mouse model of Neisseria gonorrhoeae genital tract infection. Mice received test agent, relevant placebo, or no treatment, followed by intravaginal N. gonorrhoeae challenge. N. gonorrhoeae colonization was tested by vaginal culture. CarraGuard, Ushercell, and T-PSS demonstrated significant protection, compared with control agents and no treatment. PRO 2000, ACIDFORM, and CAP showed significant protection, compared with no treatment but not compared with respective control agents. Mice that received BufferGel were provided significant protection, compared with untreated control mice; no placebo was tested. The findings of the present study suggest that topical agents may effectively reduce N. gonorrhoeae infection and that further evaluation is warranted.

Use of tanning devices and risk of basal cell and squamous cell skin cancers.

Use of artificial tanning devices that emit UV radiation, such as tanning lamps and tanning beds, has become increasingly popular in the United States. Although an excess risk of nonmelanoma skin cancers might be predicted from this exposure, little epidemiologic data exist. We conducted a population-based, case-control study that included 603 basal cell carcinoma (BCC) case patients, 293 squamous cell carcinoma (SCC) case patients, and 540 control subjects. Study participants were interviewed in person to obtain information on tanning device use, sun exposure history, sun sensitivity, and other risk factors for skin cancer. Overall, any use of tanning devices was associated with odds ratios of 2.5 (95% confidence interval [CI] = 1.7 to 3.8) for SCC and 1.5 (95% CI = 1.1 to 2.1) for BCC. Adjustment for history of sunburns, sunbathing, and sun exposure did not affect our results. Our findings suggest that the use of tanning devices may contribute to the incidence of nonmelanoma skin cancers. They highlight the need to further evaluate the potential risks of BCC and SCC that are associated with tanning lamp exposure and the appropriate public health response.