Applying Andersen's healthcare utilization model to assess factors influencing patients' expectations for diagnostic tests at emergency department visits during the COVID-19 pandemic.

Background: The uncertainties surrounding the COVID-19 pandemic led to a surge in non-urgent emergency department (ED) attendance among people presenting with upper respiratory tract infection (URTI) symptoms. These non-urgent visits, often manageable in primary care, exacerbated ED overcrowding, which could compromise the quality of ED services. Understanding patients' expectations and the reasons for these ED visits is imperative to mitigate the problem of ED overcrowding. Hence, we assessed the factors influencing patients' expectations for diagnostic tests during their ED visits for uncomplicated URTI during different phases of the pandemic. Methods: We conducted a cross-sectional study on adults with URTI symptoms seeking care at four public EDs in Singapore between March 2021 and March 2022. We segmented the study period into three COVID-19 pandemic phases-containment, transition, and mitigation. The outcome variables are whether patients expected (1) a COVID-19-specific diagnostic test, (2) a non-COVID-19-specific diagnostic test, (3) both COVID-19-specific and non-COVID-19-specific diagnostic tests, or (4) no diagnostic test. We built a multinomial regression model with backward stepwise selection and classified the findings according to Andersen's healthcare utilization model. Results: The mean age of participants was 34.5 (12.7) years. Factors (adjusted odds ratio [95% confidence interval]) influencing expectations for a COVID-19-specific diagnostic test in the ED include younger age {21-40 years: (2.98 [1.04-8.55])}, no prior clinical consultation (2.10 [1.13-3.89]), adherence to employer's health policy (3.70 [1.79-7.67]), perceived non-severity of illness (2.50 [1.39-4.55]), being worried about contracting COVID-19 (2.29 [1.11-4.69]), and during the transition phase of the pandemic (2.29 [1.15-4.56]). Being non-employed influenced the expectation for non-COVID-19-specific diagnostic tests (3.83 [1.26-11.66]). Factors influencing expectations for both COVID-19-specific and non-COVID-19-specific tests include younger age {21-40 years: (3.61 [1.26-10.38]); 41-60 years: (4.49 [1.43-14.13])}, adherence to employer's health policy (2.94 [1.41-6.14]), being worried about contracting COVID-19 (2.95 [1.45- 5.99]), and during the transition (2.03 [1.02-4.06]) and mitigation (2.02 [1.03-3.97]) phases of the pandemic. Conclusion: Patients' expectations for diagnostic tests during ED visits for uncomplicated URTI were dynamic across the COVID-19 pandemic phases. Expectations for COVID-19-specific diagnostic tests for ED visits for uncomplicated URTI were higher among younger individuals and those worried about contracting COVID-19 during the COVID-19 pandemic. Future studies are required to enhance public communications on the availability of diagnostic services in primary care and public education on self-management of emerging infectious diseases such as COVID-19.

Are physicians ready for precision antibiotic prescribing? A qualitative analysis of the acceptance of artificial intelligence-enabled clinical decision support systems in India and Singapore.

OBJECTIVES: Artificial intelligence (AI)-driven clinical decision support systems (CDSSs) can augment antibiotic decision-making capabilities, but physicians' hesitancy in adopting them may undermine their utility. We conducted a cross-country comparison of physician perceptions on the barriers and facilitators in accepting an AI-enabled CDSS for antibiotic prescribing. METHODS: We conducted in-depth interviews with physicians from the National Centre for Infectious Diseases (NCID), Singapore, and Christian Medical College Vellore (CMCV), India, between April and December 2022. Our semi-structured in-depth interview guides were anchored on Venkatesh's UTAUT model. We used clinical vignettes to illustrate the application of AI in clinical decision support for antibiotic prescribing and explore medico-legal concerns. RESULTS: Most NCID physicians felt that an AI-enabled CDSS could facilitate antibiotic prescribing, while most CMCV physicians were sceptical about the tool's utility. The hesitancy in adopting an AI-enabled CDSS stems from concerns about the lack of validated and successful examples, fear of losing autonomy and clinical skills, difficulty of use, and impediment in work efficiency. Physicians from both sites felt that a user-friendly interface, integration with workflow, transparency of output, a guiding medico-legal framework, and training and technical support would improve the uptake of an AI-enabled CDSS. CONCLUSION: In conclusion, the acceptance of AI-enabled CDSSs depends on the physician's confidence with the tool's recommendations, perceived ease of use, familiarity with AI, the organisation's digital culture and support, and the presence of medico-legal governance of AI. Progressive implementation and continuous feedback are essential to allay scepticism around the utility of AI-enabled CDSSs.

An Evidence-Based Serious Game App for Public Education on Antibiotic Use and Antimicrobial Resistance: Protocol of a Randomized Controlled Trial.

BACKGROUND: The misuse and overuse of antibiotics contribute to the acceleration of antimicrobial resistance (AMR), but public knowledge on appropriate antibiotic use and AMR remained low despite ongoing health promotion efforts. App gamification has gained traction in recent years for health promotion and to affect change in health behaviors. Hence, we developed an evidence-based serious game app "SteWARdS Antibiotic Defence" to educate the public on appropriate antibiotic use and AMR and address knowledge gaps. OBJECTIVE: We aim to evaluate the effectiveness of the "SteWARdS Antibiotic Defence" app in improving the knowledge of, attitude toward, and perception (KAP) of appropriate antibiotic use and AMR among the public. The primary objective is to assess the changes in KAP of antibiotic use and AMR in our participants, while the secondary objectives are to assess the extent of user engagement with the app and the level of user satisfaction in using the app. METHODS: Our study is a parallel 2-armed randomized controlled trial with a 1:1 allocation. We plan to recruit 400 participants (patients or their caregivers) aged 18-65 years from government-funded primary care clinics in Singapore. Participants are randomized in blocks of 4 and into the intervention or control group. Participants in the intervention group are required to download the "SteWARdS Antibiotic Defence" app on their smartphones and complete a game quest within 2 weeks. Users will learn about appropriate antibiotic use and effective methods to recover from uncomplicated upper respiratory tract infections by interacting with the nonplayer characters and playing 3 minigames in the app. The control group will not receive any intervention. RESULTS: The primary study outcome is the change in participants' KAP toward antibiotic use and AMR 6-10 weeks post intervention or 6-10 weeks from baseline for the control group (web-based survey). We will also assess the knowledge level of participants immediately after the participant completes the game quest (in the app). The secondary study outcomes are the user engagement level (tracked by the app) and satisfaction level of playing the game (via the immediate postgame survey). The satisfaction survey will also collect participants' feedback on the game app. CONCLUSIONS: Our proposed study provides a unique opportunity to assess the effectiveness of a serious game app in public health education. We anticipate possible ceiling effects and selection bias in our study and have planned to perform subgroup analyses to adjust for confounding factors. The app intervention will benefit a larger population if it is proven to be effective and acceptable to users. TRIAL REGISTRATION: ClinicalTrials.gov NCT05445414; https://clinicaltrials.gov/ct2/show/NCT05445414. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/45833.

Gravimetric weight loss of steel in self-compacting concrete blended with wood ash and silica fume.

The present research work deals with the development of self-compacting concrete (SCC) containing wood ash (WA), silica fume (SF) and their combination (1:1 ratio). Several research studies have reported on the performance of WA and SF-blended SCC. However, very limited information is available on the effects of silica dioxide (SiO2) and subsequent formation of calcium-silicate-hydrate (C-S-H) gel and its benefit on the strength and durability enhancement of self-compacting concrete. In this work, wood ash (WA) and silica fume (SF) were used as cement replacement materials, and studies were carried out on the chemical composition and its contribution in the strength development of SCC. Compressive strength, ultrasonic pulse velocity and dynamic modulus of elasticity have been increased when the cement is replaced with WA, SF and WA + SF content up to 10%, 6% and 30 + 8% respectively than normal SCC. From the EDAX analysis, Ca content in the mixes, NSCC mix has higher Ca content (52.04%) whereas 10% WA SCC, 6% SF and 30% WA + 6% SF SCC has 41.78%, 33.64% and 28.77% respectively. Similarly, SiO2 content 6% SF-blended SCC has higher value (38.03%) than other mixes. As 6% SF-blended SCC has a higher value of SiO2, it gives the higher compressive strength and UPV values because of high reactivity and subsequent formation of C-S-H gel.

Strength and durability characteristics of steel fiber-reinforced geopolymer concrete with addition of waste materials.

In general, all countries in the world use ordinary Portland cement concrete for the construction purpose; this ordinary Portland cement (OPC) gives good mechanical properties and durability to the buildings. The binder cement and the filler aggregate are the ingredients widely used in the process of concrete. Natural resources are used to extract both filler and binder elements. In India, the fast-growing sectors like infrastructure, smart cities development, and real estate consume concrete in large quantity. Also, India is the second largest cement manufacturer in the world. The need of cement is increasing day to day, even though the country is manufacturing the cement more than the required demand. In an average, the cement manufacturing industries produce 6% of CO2; for example, if industries produce 1 tonne of cement, they also emit 1 tonne of CO2. This brings us environment changes and produces more pollution to the country. To handle this situation, after many research, geopolymer concrete has been developed. Geopolymer concrete (GC) is all about mixing of source materials to the alkaline solution. Fly ash (FA) that is collected from the power plant is used in GC. The FA-based GC gives more strength when compared to the normal OPC concrete. Under ambient and steam curing, the compression, flexural strength, and tensile strength of FAGC and steel-reinforced geopolymer (SFGC) were tested and results were compared with normal concrete. FAGC mix proportions were studied under different ratios for sodium hydroxide and sodium silicate with 10 M. When compared with normal cement, the strength given by FAGC achieved good strength under ambient temperature. FAGC was further tested for the acid, sulfate, water absorption, and sorptivity test and compared with OPC concrete.

Studies on workability, microstructural and hardened strength properties on self-compacted geopolymer concrete subjected to ambient curing.

Due to the enormous increase in the development of infrastructure in a very short span, there is an urge in the need of cement that is commonly used as a binder in the construction industry. This research work carries out the formation of self-compacted geopolymer concrete with the help of alkali activators that are used for curing under ambient curing. Durability, mechanical properties and microstructural analysis of ten different types of mixes of concrete with different combinations of fly ash, micro fly ash and slag were studied in detail. The formed mixes do not have any cement content and superplasticizers when tested are found to attain compressive strength of about 45 MPa at 28 days when compared to the normal concrete.

Effect on mechanical properties of lightweight sustainable concrete with the use of waste coconut shell as replacement for coarse aggregate.

Concrete is one of the most important materials that are used in the construction industry all around the world. A larger part of the capacity in concrete is generally employed by the coarse aggregate. Due to the tremendous use of coarse aggregate in the construction industry, the material is getting degraded. In order to preserve the natural material, we are in search of an alternate material that can be used in concrete instead of the original one. So in this research work, it has been attempted to study the mechanical behaviour of lightweight concrete when we use waste coconut shell as coarse aggregate inside concrete. To improve the strength of the concrete, we also use the sisal fibres in various proportions ranging between 1 and 5% in accordance to the binder weight. After the mechanical property tests such as the compression test, spilt tensile strength, flexural test, modulus of elasticity test, and impact resistant test were conducted, finally it was concluded that there was increment in the compression strength up to 5%, and tensile strength was increased to 17% and elastic modulus to 7% when the fibre content used was 3%. Thus, with the use of these waste materials, it was found that the concrete's strength gets increased and it leads to the formation of sustainable concrete thus reducing the pollution in the environment.

Factors predicting improved compliance towards colonoscopy in individuals with positive faecal immunochemical test (FIT).

OBJECTIVES: Follow-up colonoscopy after a positive faecal immunochemical test (FIT) in any colorectal cancer (CRC) screening programme is integral. However, many individuals who had a positive FIT declined colonoscopy subsequently. This study aims to uncover the predictors on completion of colonoscopy using the Health Belief Model (HBM) between individuals who complete and those who did not after a positive FIT. METHODS: A mixed-method study comprising qualitative semi-structured interviews followed by a locally validated questionnaire in Singapore was prospectively administered via telephone interview to average risk individuals with positive FIT results from a cohort of the national FIT screening database referred for follow-up colonoscopic evaluation. RESULTS: A total of 394 individuals, with a median age of 66 years (range, 46-89 years), were recruited. Fifty percent completed follow-up colonoscopic evaluation and formed the "doers" group. All participants demonstrated high knowledge of symptoms of CRC and awareness and qualitative responses were aligned to the various HBM domains. Using multi-variable analysis, doers felt that medical recommendations (odds ratio [OR], 2.39, 95% confidence interval [CI]: 1.23-4.63, p = 0.01) and mainstream media publicity (OR, 2.16, 95% CI: 1.09-4.26, p = 0.026) were important. Non-doers showed positive association with perceived barriers such as cost (OR, 2.15, 95% CI: 1.10-4.20, p = 0.026) and inconvenience (OR, 3.44, 95% CI: 1.50-7.89, p = 0.004). CONCLUSIONS: Identified factors such as tackling perceived barriers, public health education and active promotion by medical physicians, family and friends could help guide subsequent interventions to improve compliance of individuals with positive FIT to undergo follow-up colonoscopy.