Healthcare professionals' digital health competence and its core factors; development and psychometric testing of two instruments.

BACKGROUND: Healthcare professionals' digital health competence is an important phenomenon to study as healthcare practices are changing globally. Recent research aimed to define this complex phenomenon and identify the current state of healthcare professionals' competence in digitalisation but did not include an overarching outlook when measuring digital health competence of healthcare professionals. OBJECTIVES: The purpose of this study was to develop and psychometrically validate two self-assessed instruments measuring digital health competence and factors associating with it. METHODS: The study followed three phases of instrument development and validation: 1) conceptualisation and item pool generation; 2) content validity testing and pilot study; and 3) construct validity and reliability testing. The conceptual background of the instruments was based on individual interviews conducted with healthcare professionals (n = 20) and previous systematic reviews. A total of 17 experts assessed the instrument's content validity. Face validity was evaluated by a group of healthcare professionals (n = 20). Data collection from 817 professionals took place in spring-summer 2022 in nine organisations. Construct validity was confirmed with exploratory factor analysis. Cronbach's alpha was used to assess the internal consistency of the instruments. RESULTS: The instrument development and validation process resulted in two instruments: DigiHealthCom and DigiComInf. DigiHealthCom included 42 items in 5 factors related to digital health competence, and DigiComInf included 15 items in 3 factors related to educational and organisational factors associated with digital health competence. The DigiHealthCom instrument explained 68.9 % of the total variance and the factors' Cronbach alpha values varied between 0.91 and 0.97. The DigiComInf instrument explained 59.6 % of the total variance and the factors' Cronbach alpha values varied between 0.76 and 0.88. CONCLUSIONS: The two instruments gave valid and reliable results in psychometric testing. The instruments could be used to evaluate healthcare professionals' digital health competence and associated factors.

Formation and relaxation of K-2 and K-2V double-core-hole states in n-butane.

Using a magnetic bottle multi-electron time-of-flight spectrometer in combination with synchrotron radiation, double-core-hole pre-edge and continuum states involving the K-shell of the carbon atoms in n-butane (n-C4H10) have been identified, where the ejected core electron(s) and the emitted Auger electrons from the decay of such states have been detected in coincidence. An assignment of the main observed spectral features is based on the results of multi-configurational self-consistent field (MCSCF) calculations for the excitation energies and static exchange (STEX) calculations for energies and intensities. MCSCF results have been analyzed in terms of static and dynamic electron relaxation as well as electron correlation contributions to double-core-hole state ionization potentials. The analysis of applicability of the STEX method, which implements the one-particle picture toward the complete basis set limit, is motivated by the fact that it scales well toward large species. We find that combining the MCSCF and STEX techniques is a viable approach to analyze double-core-hole spectra.

Neonatal pneumothorax: symptoms, signs and timing of onset in the post-surfactant era.

AIM: The primary objective was to describe the incidence, symptoms, clinical signs, and time of onset of neonatal pneumothorax in Örebro County during 2011-2017. Secondary objectives were to describe risk factors, diagnostic procedures, treatments, and mortality and to compare preterm with term/post-term neonates. MATERIALS AND METHODS: This retrospective population-based descriptive study included all neonates born in Örebro County during 2011-2017 and admitted to the neonatal intensive care unit at Örebro University Hospital at age <28 days with an x-ray verified diagnosis of "Pneumothorax originating in the perinatal period" in their medical record. RESULTS: Seventy-five neonates matched the inclusion criteria. The incidence of neonatal pneumothorax in Örebro County during the study period was 3.1 (95% CI: 2.5-3.8) per 1000 live births. All neonates were <48 h at debut of respiratory symptoms and the most common symptom was tachypnea. Twelve (16%) received invasive treatment. The mortality rate was 2 (3%), none due to pneumothorax. CONCLUSION: The incidence of 3.1 per 1000 live births was relatively high, but the frequency of invasive treatment and mortality was low, indicating a high proportion of mild pneumothoraces. The lack of patients aged >48 h indicates that most neonatal pneumothoraces now occur very early in life.

Non-negative data-driven mapping of structural connections with application to the neonatal brain.

Mapping connections in the neonatal brain can provide insight into the crucial early stages of neurodevelopment that shape brain organisation and lay the foundations for cognition and behaviour. Diffusion MRI and tractography provide unique opportunities for such explorations, through estimation of white matter bundles and brain connectivity. Atlas-based tractography protocols, i.e. a priori defined sets of masks and logical operations in a template space, have been commonly used in the adult brain to drive such explorations. However, rapid growth and maturation of the brain during early development make it challenging to ensure correspondence and validity of such atlas-based tractography approaches in the developing brain. An alternative can be provided by data-driven methods, which do not depend on predefined regions of interest. Here, we develop a novel data-driven framework to extract white matter bundles and their associated grey matter networks from neonatal tractography data, based on non-negative matrix factorisation that is inherently suited to the non-negative nature of structural connectivity data. We also develop a non-negative dual regression framework to map group-level components to individual subjects. Using in-silico simulations, we evaluate the accuracy of our approach in extracting connectivity components and compare with an alternative data-driven method, independent component analysis. We apply non-negative matrix factorisation to whole-brain connectivity obtained from publicly available datasets from the Developing Human Connectome Project, yielding grey matter components and their corresponding white matter bundles. We assess the validity and interpretability of these components against traditional tractography results and grey matter networks obtained from resting-state fMRI in the same subjects. We subsequently use them to generate a parcellation of the neonatal cortex using data from 323 new-born babies and we assess the robustness and reproducibility of this connectivity-driven parcellation.

Double and Triple Ionisation of Isocyanic Acid.

Double and triple ionisation spectra of the reactive molecule isocyanic acid (HNCO) have been measured using multi-electron and ion coincidence techniques combined with synchrotron radiation and compared with high-level theoretical calculations. Vertical double ionisation at an energy of 32.8 ± 0.3 eV forms the 3A" ground state in which the HNCO2+ ion is long lived. The vertical triple ionisation energy is determined as 65 ± 1 eV. The core-valence double ionisation spectra resemble the valence photoelectron spectrum in form, and their main features can be understood on the basis of a simple and rather widely applicable Coulomb model based on the characteristics of the molecular orbitals from which electrons are removed. Characteristics of the most important dissociation channels are examined and discussed.

Coulomb explosion of CD3I induced by single photon deep inner-shell ionisation.

L-shell ionisation and subsequent Coulomb explosion of fully deuterated methyl iodide, CD3I, irradiated with hard X-rays has been examined by a time-of-flight multi-ion coincidence technique. The core vacancies relax efficiently by Auger cascades, leading to charge states up to 16+. The dynamics of the Coulomb explosion process are investigated by calculating the ions' flight times numerically based on a geometric model of the experimental apparatus, for comparison with the experimental data. A parametric model of the explosion, previously introduced for multi-photon induced Coulomb explosion, is applied in numerical simulations, giving good agreement with the experimental results for medium charge states. Deviations for higher charges suggest the need to include nuclear motion in a putatively more complete model. Detection efficiency corrections from the simulations are used to determine the true distributions of molecular charge states produced by initial L1, L2 and L3 ionisation.

Parametrization of energy sharing distributions in direct double photoionization of He.

We present experimental results on the characteristic sharing of available excess energy, ranging from 11-221 eV, between two electrons in single-photon direct double ionization of He. An effective parametrization of the sharing distributions is presented along with an empirical model that describes the complete shape of the distribution based on a single experimentally determinable parameter. The measured total energy sharing distributions are separated into two distributions representing the shake-off and knock-out parts by simulating the sharing distribution curves expected from a pure wave collapse after a sudden removal of the primary electron. In this way, empirical knock-out distributions are extracted and both the shake-off and knock-out distributions are parametrized. These results suggest a simple method that can be applied to other atomic and molecular systems to experimentally study important aspects of the direct double ionization process.

Exercise training alters lipoprotein particles independent of brown adipose tissue metabolic activity.

INTRODUCTION: New strategies for weight loss and weight maintenance in humans are needed. Human brown adipose tissue (BAT) can stimulate energy expenditure and may be a potential therapeutic target for obesity and type 2 diabetes. However, whether exercise training is an efficient stimulus to activate and recruit BAT remains to be explored. This study aimed to evaluate whether regular exercise training affects cold-stimulated BAT metabolism and, if so, whether this was associated with changes in plasma metabolites. METHODS: Healthy sedentary men (n = 11; aged 31 [SD 7] years; body mass index 23 [0.9] kg m-2; VO2 max 39 [7.6] mL min-1 kg-1) participated in a 6-week exercise training intervention. Fasting BAT and neck muscle glucose uptake (GU) were measured using quantitative [18F]fluorodeoxyglucose positron emission tomography-magnetic resonance imaging three times: (1) before training at room temperature and (2) before and (3) after the training period during cold stimulation. Cervico-thoracic BAT mass was measured using MRI signal fat fraction maps. Plasma metabolites were analysed using nuclear magnetic resonance spectroscopy. RESULTS: Cold exposure increased supraclavicular BAT GU by threefold (p < 0.001), energy expenditure by 59% (p < 0.001) and plasma fatty acids (p < 0.01). Exercise training had no effect on cold-induced GU in BAT or neck muscles. Training increased aerobic capacity (p = 0.01) and decreased visceral fat (p = 0.02) and cervico-thoracic BAT mass (p = 0.003). Additionally, training decreased very low-density lipoprotein particle size (p = 0.04), triglycerides within chylomicrons (p = 0.04) and small high-density lipoprotein (p = 0.04). CONCLUSIONS: Although exercise training plays an important role for metabolic health, its beneficial effects on whole body metabolism through physiological adaptations seem to be independent of BAT activation in young, sedentary men.

Relative extent of triple Auger decay in CO and CO2.

Systematic measurements on single and triple Auger decay in CO and CO2 after the creation of a C 1s or a O 1s core vacancy show that the percentage of triple Auger decay is on the order of 10-2 of the single Auger decay in these molecules. The fractions of triple Auger decay are compared with triple Auger fractions for carbon atoms and some noble gas atoms, and are found to follow a linear trend correlated to the number of valence electrons on the atom with the initial core vacancy and on its closest neighbours. This linear trend for the percentage of triple Auger decay is represented by a predictive equation TA = 0.13·Nve - 0.5.

Dissociations of water ions after valence and inner-valence ionization.

Energy selected and mass-resolved electron-ion coincidence spectra of heavy water have been recorded for ionization energies from 18 to 35 eV. Dissociation from the B2B2 state produces both O+ and D2 + at energies near their thermodynamic thresholds in addition to the known products D+ and OD+. The relative yields of O+, OD+, and D+ in the B2B2 state breakdown diagram are modulated by the vibrational structure of the B-state population, implying incomplete energy equilibration before fragmentation. Decay from the C-state produces OD+ in addition to the known O+ and D+. The fragment kinetic energies suggest that O+ and D+ from the C state are the products of full atomization of the molecule.

Abundance of molecular triple ionization by double Auger decay.

Systematic measurements of electron emission following formation of single 1s or 2p core holes in molecules with C, O, F, Si, S and Cl atoms show that overall triple ionization can make up as much as 20% of the decay. The proportion of triple ionization is observed to follow a linear trend correlated to the number of available valence electrons on the atom bearing the initial core hole and on closest neighbouring atoms, where the interatomic distance is assumed to play a large role. The amounts of triple ionization (double Auger decay) after 1s or 2p core hole formation follow the same linear trend, which indicates that the hole identity is not a crucial determining factor in the number of electrons emitted. The observed linear trend for the percentage of double Auger decay follows a predictive line equation of the form DA = 0.415 · Nve + 5.46.

Daily adjunctive therapy with vitamin D3 and phenylbutyrate supports clinical recovery from pulmonary tuberculosis: a randomized controlled trial in Ethiopia.

OBJECTIVE: Immunotherapy using vitamin D (vitD3 ) and phenylbutyrate (PBA) may support standard drug regimens used to treat infectious diseases. We investigated if vitD3 + PBA enhanced clinical recovery from pulmonary tuberculosis (TB). METHODS: A randomized controlled trial was conducted in Addis Ababa, Ethiopia. Patients with smear-positive or smear-negative TB received daily oral supplementation with 5000 IU vitD3 and 2 × 500 mg PBA or placebo for 16 weeks, together with 6-month chemotherapy. Primary end-point: reduction of a clinical composite TB score at week 8 compared with baseline using modified intention-to-treat (mITT, n = 348) and per-protocol (n = 296) analyses. Secondary end-points: primary and modified TB scores (week 0, 4, 8, 16, 24), sputum conversion, radiological findings and plasma 25(OH)D3 concentrations. RESULTS: Most subjects had low baseline plasma 25(OH)D3 levels that increased gradually in the vitD3 + PBA group compared with placebo (P < 0.0001) from week 0 to 16 (mean 34.7 vs. 127.4 nmol L-1 ). In the adjusted mITT analysis, the primary TB score was significantly reduced in the intervention group at week 8 (-0.52, 95% CI -0.93, -0.10; P = 0.015) while the modified TB score was reduced at week 8 (-0.58, 95% CI -1.02, -0.14; P = 0.01) and 16 (-0.34, 95% CI -0.64, -0.03; P = 0.03). VitD3 + PBA had no effect on longitudinal sputum-smear conversion (P = 0.98). Clinical adverse events were more common in the placebo group (24.3%) compared with the vitD3 + PBA group (12.6%). CONCLUSION: Daily supplementation with vitD3 + PBA may ameliorate clinical TB symptoms and disease-specific complications, while the intervention had no effect on bacterial clearance in sputum.

Robust high-yield ~1 TBq production of cyclotron based sodium [99mTc]pertechnetate.

This paper presents the irradiation and processing of high-current 100Mo targets at the University of Alberta (UofA) in a GMP compliant setting. For purpose of comparison with a second production facility, additional studies at Centre Hospitalier Universitaire de Sherbrooke (CHUS) are also described. INTRODUCTION: More than 70% of today's diagnostic radiopharmaceuticals are based on 99mTc, however the conventional supply chain for obtaining 99mTc is fragile. The aim of this work was to demonstrate reliable high yield production and processing of 99mTc with medium-energy, high-current, cyclotrons. METHODS: We used two cyclotrons (TR-24, Advanced Cyclotron Systems, Inc) for irradiations with 22 MeV or 24 MeV incident energy and 400 µA current up to a maximum of 6 h. The irradiated 100Mo was dissolved using peroxide, basified using ammonium carbonate, and purified using a PEG-based solid phase extraction technique. RESULTS: High-yield productions with 22 MeV (400 µA, 6 h) yielded an average isolated [99mTc]TcO4- yield of 878 GBq ±â€¯99 GBq (23.7 Ci ±â€¯2.7 Ci) decay corrected to EOB, n = 8 (isolated saturation yield: 4.36 ±â€¯0.49 GBq/µA). Irradiations with 24 MeV (400 µA, 6 h) resulted in an average isolated [99mTc]TcO4- yield of 993 GBq ±â€¯100 GBq (26.8 Ci ±â€¯2.7 Ci) decay corrected to EOB, n = 7 (isolated saturation yield: 4.97 ±â€¯0.50 GBq/µA). These yields corresponds to 600-700 GBq (16-19 Ci) of [99mTc]TcO4- at release (i.e. 3 hour post-EOB). For all tested batches, the QC results were within the recently published specifications in the European Pharmacopoeia. CONCLUSION: Reliable near-TBq production yields for 99mTc can be obtained using medium-energy cyclotrons. ADVANCES IN KNOWLEDGE AND IMPLICATIONS FOR PATIENT CARE: This work presents evidence that medium-energy high-current cyclotrons can provide high yields of [99mTc]TcO4- with radionuclidic impurities levels within the specifications of the existing European Pharmacopoeia monograph, indicating that this technology can have a share in the future 99mTc supply market.

Effect on Body Weight, Quality of Life and Appetite Following Individualized, Nutritional Counselling to Home-Living Elderly after Rehabilitation - An Open Randomized Trial.

OBJECTIVES: We examined if individually-adapted nutritional counselling could prevent > 5% weight loss among elderly patients 3 months after discharge from a rehabilitation institution. In addition we assessed quality of life (QoL) and appetite. DESIGN: An open, randomized trial. SETTING: Godthaab Health and Rehabilitation Institution in Bærum, Norway. PARTICIPANTS: Patients identified as being undernourished or at risk of disease-related malnutrition using the Nutritional Risk Screening tool NRS-2002. INTERVENTION: Shortly before discharge, patients in the intervention group received an individually-tailored nutrition plan. During the subsequent 3 months these patients were contacted 3 times via telephone calls and they received one visit at their homes, for nutrition counselling. Focus on this counselling was on optimizing meal environment, improving appetite, increasing food intake, advice on food preparation, and motivation and support. MEASUREMENTS: In addition to weight, QoL and appetite were assessed using the EQ-5D questionnaire and a modified version of the Disease-Related Appetite Questionnaire, respectively. RESULTS: Among 115 considered eligible for the study, 100 were enrolled (72 women and 28 men), with a mean age of 75 years and a mean body mass index of 20 kg/m2. Two in the intervention group (n = 52) and 5 in the control group (n = 48) lost > 5% of their body weight, giving an odds ratio of 0.34 (95% CI: 0.064 - 1.86; p = 0.22). We did not detect any significant differences in the QoL- or appetite scores between the two study groups after three months. CONCLUSION: An individually-adapted nutritional counselling did not improve body mass among elderly patients 3 months after discharge from a rehabilitation institution. Neither quality of life nor appetite measures were improved. Possibly, nutritional counselling should be accompanied with nutritional supplementation to be effective in this vulnerable group of elderly. The trial is registered in Clinical Trials (ID: NCT01632072).

Challenges in diagnosing normal pressure hydrocephalus: Evaluation of the diagnostic guidelines.

PURPOSE: To evaluate the present diagnostic guidelines of idiopathic normal pressure hydrocephalus (iNPH) in a sample from the general population. METHODS: A total of 168 individuals (93 females, 75 males), mean age 75 years (range 66-92) with and without symptoms of iNPH underwent a CT-scan of the brain, a neurological examination with assessment of the triad symptoms, i.e. gait disturbances, memory impairment and urgency incontinence. The participants were then diagnosed as "unlikely", "possible" and "probable" iNPH according to the American-European and the Japanese guidelines, respectively. Separately, a senior consultant in neurology diagnosed each patient based on the overall clinical picture. RESULTS: Obtaining a diagnosis of "probable iNPH" was three times more likely according to the American-European guidelines (n = 35) compared to the Japanese guidelines (n = 11) or the neurologist (n = 11). The concordance was highest (Kappa = 0.69) between the Japanese guidelines and the neurologist. CONCLUSIONS: Considerable discrepancies were found when diagnosing iNPH according to two international guidelines and a neurologist, respectively. The Japanese guidelines, which include a minimum of two triad symptoms, were most concordant with the neurologist. As a step towards widely accepted, standardized diagnostic criteria, we suggest a revision of the current guidelines, preferably into one common diagnostic system.

Relative extent of double and single Auger decay in molecules containing C, N and O atoms.

We show that the proportion of double Auger decay following creation of single 1s core holes in molecules containing C, N and O atoms is greater than usually assumed, amounting to about 10% of single Auger decay in many cases. It varies from molecule to molecule, where the size of the molecule has a positive correlation to the amount of double Auger decay. In neon, examined as a related benchmark, the proportion of double Auger decay is similar to that in methane, and is in the order of 5%.

Dissociation of multiply charged ICN by Coulomb explosion.

The fragmentations of iodine cyanide ions created with 2 to 8 positive charges by photoionization from inner shells with binding energies from 59 eV (I 4d) to ca. 900 eV (I 3p) have been examined by multi-electron and multi-ion coincidence spectroscopy with velocity map imaging ion capability. The charge distributions produced by hole formation in each shell are characterised and systematic effects of the number of charges and of initial charge localisation are found.