Understanding pathways from implementation to sustainment: a longitudinal, mixed methods analysis of promising practices implemented in the Veterans Health Administration.

BACKGROUND: The Veterans Health Administration (VHA) is the United States largest learning health system. The Diffusion of Excellence (DoE) program is a large-scale model of diffusion that identifies and diffuses evidence-informed practices across VHA. During the period of 2016-2021, 57 evidence-informed practices were implemented across 82 VHA facilities. This setting provides a unique opportunity to understand sustainment determinants and pathways. Our objective was to characterize the longitudinal pathways of practices as they transition from initial implementation to long-term sustainment at each facility. METHODS: A longitudinal, mixed-methods evaluation of 82 VHA facilities. Eighty-two facility representatives, chosen by leadership as points-of-contact for 57 DoE practices, were eligible for post-implementation interviews and annual sustainment surveys. Primary outcomes (implementation, sustainment), and secondary outcomes (institutionalization, effectiveness, anticipated sustainment) at four time-points were collected. We performed descriptive statistics and directed content analysis using Hailemariam et al.'s factors influencing sustainment. RESULTS: After approximately five years post-implementation (e.g., 2021 sustainment outcomes), of the 82 facilities, about one-third fully sustained their practice compared to one-third that did not fully sustain their practice because it was in a "liminal" stage (neither sustained nor discontinued) or permanently discontinued. The remaining one-third of facilities had missing 2021 sustainment outcomes. A higher percentage of facilities (70%) had inconsistent primary outcomes (changing over time) compared to facilities (30%) with consistent primary outcomes (same over time). Thirty-four percent of facilities with sustained practices reported resilience since they overcame implementation and sustainment barriers. Facilities with sustained practices reported more positive secondary outcomes compared to those that did not sustain their practice. Key factors facilitating practice sustainment included: demonstrating practice effectiveness/benefit, sufficient organizational leadership, sufficient workforce, and adaptation/alignment with local context. Key factors hindering practice sustainment included: insufficient workforce, not able to maintain practice fidelity/integrity, critical incidents related to the COVID-19 pandemic, organizational leadership did not support sustainment of practice, and no ongoing support. CONCLUSIONS: We identified diverse pathways from implementation to sustainment, and our data underscore that initial implementation outcomes may not determine long-term sustainment outcomes. This longitudinal evaluation contributes to understanding impacts of the DoE program, including return on investment, achieving learning health system goals, and insights into achieving high-quality healthcare in VHA.

Japanese General Clinical Oncologists' Knowledge and Real-world Experiences of Cancer Genomic Medicine: A Nationwide Web-based Survey Study.

Introduction: In Japan, insurance began covering two cancer gene panel tests in 2019. However, the availability of these tests remains limited to 247 facilities (as of October 2023). This survey-based study assessed the knowledge and recognition of cancer genomic medicine by physicians involved in cancer treatment. Methods: Written requests for participation in a web-based questionnaire survey were sent to 14,579 affiliated general clinical oncologists certified by the Japanese Board of Cancer Therapy. The survey was conducted from July 1 to 31st, 2021. Data between physicians affiliated with cancer genome hospitals and noncancer genome hospitals and between regions of Japan were compared. Results: In total, 2,402 valid responses were analyzed. Of the respondents, 1,296 and 1,106 were physicians working at cancer and noncancer genome hospitals, respectively. Physicians working at cancer genome hospitals showed significantly higher results for both knowledge of cancer genomic medicine and experience in cancer gene panel test performance compared with those working at noncancer genome hospitals. There were no significant regional differences in the percentage of physicians who reported having performed cancer gene panel tests. Conclusions: The survey results suggest a disparity in the knowledge of cancer genomic medicine between physicians working at cancer genome hospitals and those working at noncancer genome hospitals; this disparity should be addressed by stakeholders. Closer collaboration between these facilities may be necessary to achieve national dissemination of cancer genomic medicine.

The Primary Care and Environmental Health e-Learning Course to Integrate Environmental Health in General Practice: Before-and-After Feasibility Study.

BACKGROUND: Environmental and behavioral factors are responsible for 12.6 million deaths annually and contribute to 25% of deaths and chronic diseases worldwide. Through the One Health initiative, the World Health Organization and other international health organizations plan to improve these indicators to create healthier environments by 2030. To meet this challenge, training primary care professionals should be the priority of national policies. General practitioners (GPs) are ready to become involved but need in-depth training to gain and apply environmental health (EH) knowledge to their practice. In response, we designed the Primary Care Environment and Health (PCEH) online course in partnership with the Occitanie Regional Health Agency in France. This course was used to train GP residents from the Montpelier-Nimes Faculty of Medicine in EH knowledge. The course was organized in 2 successive parts: (1) an asynchronous e-learning modular course focusing on EH knowledge and tools and (2) 1 day of face-to-face sessions. OBJECTIVE: This study assessed the impact of the e-learning component of the PCEH course on participants' satisfaction, knowledge, and behavior changes toward EH. METHODS: This was a pilot before-and-after study. Four modules were available in the 6-hour e-learning course: introduction to EH, population-based approach (mapping tools and resources), clinical cases, and communication tools. From August to September 2021, we recruited first-year GP residents from the University of Montpellier (N=130). Participants' satisfaction, knowledge improvements for 19 EH risks, procedure to report EH risks to health authorities online, and behavior change (to consider the possible effects of the environment on their own and their patients' health) were assessed using self-reported questionnaires on a Likert scale (1-5). Paired Student t tests and the McNemar χ2 test were used to compare quantitative and qualitative variables, respectively, before and after the course. RESULTS: A total of 74 GP residents completed the e-learning and answered the pre- and posttest questionnaires. The mean satisfaction score was 4.0 (SD 0.9) out of 5. Knowledge scores of EH risks increased significantly after the e-learning course, with a mean difference of 30% (P<.001) for all items. Behavioral scores improved significantly by 18% for the participant's health and by 26% for patients' health (P<.001). These improvements did not vary significantly according to participant characteristics (eg, sex, children, place of work). CONCLUSIONS: The e-learning course improved knowledge and behavior related to EH. Further studies are needed to assess the impact of the PCEH course on clinical practice and potential benefits for patients. This course was designed to serve as a knowledge base that could be reused each year with a view toward sustainability. This course will integrate new modules and will be adapted to the evolution of EH status indicators and target population needs.

Can Generative AI improve social science?

Generative AI that can produce realistic text, images, and other human-like outputs is currently transforming many different industries. Yet it is not yet known how such tools might influence social science research. I argue Generative AI has the potential to improve survey research, online experiments, automated content analyses, agent-based models, and other techniques commonly used to study human behavior. In the second section of this article, I discuss the many limitations of Generative. I examine how bias in the data used to train these tools can negatively impact social science research-as well as a range of other challenges related to ethics, replication, environmental impact, and the proliferation of low-quality research. I conclude by arguing that social scientists can address many of these limitations by creating open-source infrastructure for research on human behavior. Such infrastructure is not only necessary to ensure broad access to high-quality research tools, I argue, but also because the progress of AI will require deeper understanding of the social forces that guide human behavior.

Dysfunctional Beliefs and Attitudes about Sleep-6 (DBAS-6): Data-driven shortened version from a machine learning approach.

BACKGROUND: The Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS-16) is a widely used self-report instrument for identifying sleep-related cognition. However, its length can be cumbersome in clinical practice. This study aims to develop a data-driven shortened version of the DBAS-16 that efficiently predicts the DBAS-16 total score among the general population. METHODS: We collected 1000 responses to the DBAS-16 from the general population through three separate surveys, each focusing on different aspects of insomnia severity and related factors. Using Exploratory Factor Analysis (EFA) on the survey responses, we grouped DBAS-16 items based on response pattern similarities. The most representative item from each group, showing the highest regression performance with eXtreme Gradient Boosting (XGBoost) in predicting the DBAS-16 total score, was selected to create a shortened version of the DBAS-16. RESULTS: Through EFA and XGBoost, we categorized the DBAS-16 items into six distinct groups. Selecting one item from each group, based on the highest coefficient of determination R2 values in predicting the DBAS-16 total score. After measuring the R2 values for all possible combinations of six items, items 4, 5, 7, 11, 13, and 15 were chosen, exhibiting the highest R2 value. Based on these six items, we developed the DBAS-6, a data-driven shortened version of the DBAS-16. The DBAS-6 exhibited outstanding predictive ability, achieving the highest R2 value of 0.90 for predicting the DBAS-16 total score, surpassing that of a previously developed shortened version. Notably, the DBAS-6 efficiently encapsulates the core aspects of the DBAS-16 and demonstrates robust predictive power over heterogeneous test data samples with distinct statistical characteristics from the training data. CONCLUSION: With its concise format and high predictive accuracy, the DBAS-6 offers a practical tool for assessing dysfunctional beliefs about sleep in clinical settings.

[Undiagnosed arterial hypertension in a Latin American country, 2019 to 2021]. / Hipertensión arterial no diagnosticada en un país de Latinoamérica, 2019 a 2021.

Objective: To determine the factors associated with undiagnosed hypertension. Method: A quantitative, observational, retrospective, cross-sectional and analytical study was carried out in people aged 15 years and over included in the Demographic and Family Health Survey from 2019 to 2021 in Peru. A statistical analysis was carried out using the corrected F test, and crude and adjusted prevalence ratio (aPR), with a 95% confidence interval (95%CI) for inferential analysis, through Poisson regression with robust variance. Likewise, the CSPLAN analysis was carried out for complex samples according to the sample design and taking into account the weighting factor. Results: In the multivariate analysis, a significant association was found between the factors male sex (aPR: 1.22; 95%CI: 1.19-1.26), age from 30 to 49 years (aPR: 0.94; 95%CI: 0.92-0.96), native ethnicity (aPR: 1.07; 95%CI: 1.04-1.10), having health insurance (aPR: 0.91; 95%CI: 0.89-0.93), suffering from some permanent limitation (aPR: 0.83; 95%CI: 0.76-0.91) and diabetes mellitus (aPR: 0.59; 95%CI: 0.55-0.64). No significant association was found with educational level, language, Afro-Peruvian ethnicity, or alcohol or tobacco consumption (p > 0.05). Conclusions: The prevalence of undiagnosed arterial hypertension is high, 69.5%. The associated factors are male sex, native ethnicity, age between 30 and 49 years, having health insurance, suffering from some permanent limitation and having diabetes mellitus.

Objetivo: Determinar los factores asociados a hipertensión arterial no diagnosticada. Método: Estudio de tipo cuantitativo, observacional, retrospectivo, transversal y analítico, en personas de 15 y más años de edad contenidas en la Encuesta Demográfica y Salud Familiar de 2019 a 2021 en Perú. Se realizó un análisis estadístico haciendo uso de la prueba F corregida y la razón de prevalencia cruda y ajustada (RPa), con un intervalo de confianza del 95% (IC95%) para el análisis inferencial, a través de regresión de Poisson con varianza robusta. Asimismo, se realizó el análisis CSPLAN para muestras complejas de acuerdo con el diseño de la muestra y teniendo en cuenta el factor de ponderación. Resultados: En el análisis multivariado se halló una asociación significativa de los factores sexo masculino (RPa: 1.22; IC95%: 1.19-1.26), edad de 30 a 49 años (RPa: 0.94; IC95%: 0.92-0.96), etnia nativa (RPa: 1.07; IC95%: 1.04-1.10), tenencia de un seguro de salud (RPa: 0.91; IC95%: 0.89-0.93), sufrir alguna limitación permanente (RPa: 0.83; IC95%: 0.76-0.91) y diabetes mellitus (RPa: 0.59; IC95%: 0.55-0.64). No se encontró asociación significativa con el nivel de instrucción, el idioma, la etnia afroperuana ni el consumo de alcohol o tabaco (p > 0.05). Conclusiones: La prevalencia de hipertensión arterial no diagnosticada es alta, del 69.5%. Los factores asociados son el sexo masculino, la etnia nativa, la edad entre 30 y 49 años, la tenencia de un seguro de salud, sufrir alguna limitación permanente y tener diabetes mellitus.

Impact of Incentives on Physician Participation in Research Surveys: Randomized Experiment.

BACKGROUND: Web-based surveys can be effective data collection instruments; however, participation is notoriously low, particularly among professionals such as physicians. Few studies have explored the impact of varying amounts of monetary incentives on survey completion. OBJECTIVE: This study aims to conduct a randomized study to assess how different incentive amounts influenced survey participation among neurologists in the United States. METHODS: We distributed a web-based survey using standardized email text to 21,753 individuals randomly divided into 5 equal groups (≈4351 per group). In phase 1, each group was assigned to receive either nothing or a gift card for US $10, $20, $50, or $75, which was noted in the email subject and text. After 4 reminders, phase 2 began and each remaining individual was offered a US $75 gift card to complete the survey. We calculated and compared the proportions who completed the survey by phase 1 arm, both before and after the incentive change, using a chi-square test. As a secondary outcome, we also looked at survey participation as opposed to completion. RESULTS: For the 20,820 emails delivered, 879 (4.2%) recipients completed the survey; of the 879 recipients, 622 (70.8%) were neurologists. Among the neurologists, most were male (412/622, 66.2%), White (430/622, 69.1%), non-Hispanic (592/622, 95.2%), graduates of American medical schools (465/622, 74.8%), and board certified (598/622, 96.1%). A total of 39.7% (247/622) completed their neurology residency more than 20 years ago, and 62.4% (388/622) practiced in an urban setting. For phase 1, the proportions of respondents completing the survey increased as the incentive amount increased (46/4185, 1.1%; 76/4165, 1.8%; 86/4160, 2.1%; 104/4162, 2.5%; and 119/4148, 2.9%, for US $0, $10, $20, $50, and $75, respectively; P<.001). In phase 2, the survey completion rate for the former US $0 arm increased to 3% (116/3928). Those originally offered US $10, $20, $50, and $75 who had not yet participated were less likely to participate compared with the former US $0 arm (116/3928, 3%; 90/3936, 2.3%; 80/3902, 2.1%; 88/3845, 2.3%; and 74/3878, 1.9%, for US $0, $10, $20, $50, and $75, respectively; P=.03). For our secondary outcome of survey participation, a trend similar to that of survey completion was observed in phase 1 (55/4185, 1.3%; 85/4165, 2%; 96/4160, 2.3%; 118/4162, 2.8%; and 135/4148, 3.3%, for US $0, $10, $20, $50, and $75, respectively; P<.001) and phase 2 (116/3928, 3%; 90/3936, 2.3%; 80/3902, 2.1%; 88/3845, 2.3%; and 86/3845, 2.2%, for US $0, $10, $20, $50, and $75, respectively; P=.10). CONCLUSIONS: As expected, monetary incentives can boost physician survey participation and completion, with a positive correlation between the amount offered and participation.

Willingness to pay for improved working conditions of nurses: Results from a factorial survey experiment in Germany.

BACKGROUND: Many countries face substantial shortages of skilled nurses. With an aging population and global demographic changes, developing a skilled workforce of nurses has become one of the central challenges for public health care. The recent COVID-19 pandemic has exacerbated labor shortages, which pose a threat to the quality of publicly provided health care. Improving nurses' working conditions could be a means by which to address the global shortages of nurses. However, in countries with public health care, such improvements may come with additional costs in the form of higher taxes or social security contributions. Therefore, such improvements partly depend on people's willingness to pay (WTP) for them. OBJECTIVE: In this paper, we investigate workers' willingness to pay for improvements in the working conditions of nurses. DESIGN: This study is a factorial survey experiment included as part of an online survey. SETTING(S): The factorial survey experiment was implemented within the high-frequency online panel survey "Life and Employment in Times of Corona" (IAB-HOPP) conducted by the Institute for Employment Research (Germany). PARTICIPANTS: We analyze data from N = 2128 survey participants; our main analysis consists of N = 6384 responses from those participants. METHODS: Our research is based on a factorial survey experiment (vignette analysis) designed to quantitatively measure the willingness to pay for various improvements in the working conditions of nurses. We use random effect models and mixed models to estimate the individual-level willingness to pay for these improvements. RESULTS: Our results show that the survey participants are generally willing to pay for particular policies aimed at improving the working conditions of nurses. However, the amount that respondents are willing to pay varies with the type of policy changes. Survey participants exhibit a high willingness to pay for increases in minimum wages for nurses and wage-related improvements in general. We find, however, a lower willingness to pay for the right to participate in training courses aimed at reducing work-related stress. CONCLUSIONS: The broad support for improvements in the working conditions of nurses provides policymakers with some guidance in implementing policy measures that might address labor shortages in the nursing sector. REGISTRATION: There was no preregistration. Tweetable abstract Many people are willing to pay extra to improve the working conditions of nurses. Wage-related increases for nurses show the highest willingness to pay.

[Advancing standards for the development of evidence-based health information for consumers: Needs and priorities among members of the Network for Evidence-based Medicine]. / Inhaltliche Weiterentwicklung von Standards zur Erstellung evidenzbasierter Gesundheitsinformationen: Eine Bedarfserhebung und Priorisierung im EbM-Netzwerk.

BACKGROUND: The Good Practice Guidelines for health information, Good Health Information Austria and Guideline Evidence-based Health Information are established resources for developing evidence-based health information in the German-speaking regions. The aim of this project was to capture challenges in applying these standards in practice, identify gaps and development needs and gain insights for their further development. METHODS: In December 2020, members of the working group for patient information and involvement of the Network for Evidence-based Medicine were invited to share their experiences and needs in applying German standards for evidence-based health information through an online survey focussing on open questions (part 1: needs assessment). The feedback was analysed using qualitative content analysis and presented in a workshop at the EbM Congress 2021 with the goal of specifying the feedback from the needs assessment and discussing ideas for the further development of the standards (part 2: specification). In the final step, a second survey was conducted in February 2023 to prioritize the identified topics by the working group members (part 3: prioritization). The results were analysed descriptively. RESULTS: Among the 41 participants, only 23% considered the standards to be sufficient, and only 55% found their application in the development of information to be easy or rather easy. The needs assessment and workshop (n=46) helped to identify various areas of action. With regard to the application of the standards, the following challenges were identified: lack of user orientation, content gaps, methods and risk communication. Gaps in the standards were identified regarding formats, content, and the connection to healthcare provision. For the advancement of the standards ideas for additional content, stakeholder involvement, and improvement of the usability of the standards were identified. In the prioritization survey, the topic areas, "presenting benefits and harms" and "content beyond treatments (in particular, diagnostics and prognosis)" were considered to be the most important (n=36). DISCUSSION: Among members of the working group for patient information and involvement of the German Network for Evidence-based Medicine, a high demand has been identified for the further development of standards for creating evidence-based health information. In addition to content development, the integration of existing documents and tools should also be considered, including products issued by other institutions. The success of advancing the standards also depends on improving their applicability - for example through an attractive online platform. The results are limited by the sample which only included members of the EbM Network's patient information and participation working group and a limited response rate. CONCLUSIONS: The needs assessment showed that the currently established standards and recommendations for the development of evidence-based health information in the German-speaking regions represent important cornerstones but need to be expanded to answer more practice-oriented questions. The challenges and proposed solutions stated by the participants can help further develop the standards. The prioritization can be used to set priorities for the development of the standards, guide the order of possible work packages and allocate resources.

The current state of digital cytology and artificial intelligence (AI): global survey results from the American Society of Cytopathology Digital Cytology Task Force.

INTRODUCTION: The integration of whole slide imaging (WSI) and artificial intelligence (AI) with digital cytology has been growing gradually. Therefore, there is a need to evaluate the current state of digital cytology. This study aimed to determine the current landscape of digital cytology via a survey conducted as part of the American Society of Cytopathology (ASC) Digital Cytology White Paper Task Force. MATERIALS AND METHODS: A survey with 43 questions pertaining to the current practices and experiences of WSI and AI in both surgical pathology and cytology was created. The survey was sent to members of the ASC, the International Academy of Cytology (IAC), and the Papanicolaou Society of Cytopathology (PSC). Responses were recorded and analyzed. RESULTS: In total, 327 individuals participated in the survey, spanning a diverse array of practice settings, roles, and experiences around the globe. The majority of responses indicated there was routine scanning of surgical pathology slides (n = 134; 61%) with fewer respondents scanning cytology slides (n = 150; 46%). The primary challenge for surgical WSI is the need for faster scanning and cost minimization, whereas image quality is the top issue for cytology WSI. AI tools are not widely utilized, with only 16% of participants using AI for surgical pathology samples and 13% for cytology practice. CONCLUSIONS: Utilization of digital pathology is limited in cytology laboratories as compared to surgical pathology. However, as more laboratories are willing to implement digital cytology in the near future, the establishment of practical clinical guidelines is needed.

Who uses connected health technologies after a cancer diagnosis? evidence from the US Health Information National Trends Survey.

PURPOSE: As the number of people living with and beyond cancer increases, connected health technologies offer promise to enhance access to care and support, while reducing costs. However, uptake of connected health technologies may vary depending on sociodemographic and health-related variables. This study aimed to investigate demographic and health predictors of connected health technology use among people living with and beyond cancer. METHODS: Cross-sectional data from the US Health Information National Trends Survey Version 5 Cycle 4 (H5c4) was used. Regression analysis was used to examine associations between sociodemographic factors and the use of connected health technologies. The sample was restricted to individuals who self-reported a cancer diagnosis or history of cancer. RESULTS: In this cycle, 626 respondents self-reported a cancer diagnosis, with 41.1% using connected health technologies (health and wellness apps and/or wearable devices). Most were female (58.9%) and white (82.5%); 43.4% had graduated college or higher education. One third (33.6%) had a household income of $75,000 or more. Respondents who were younger, have higher education, were living as married, had higher incomes, had higher self-rated health and had higher health-related self-efficacy were significantly more likely to use connected health technologies. There were no significant associations between gender, race, stratum, time since diagnosis, history of anxiety or depression, and use of connected health technologies among people living with and beyond cancer. CONCLUSIONS: Connected health technology use among people living with and beyond cancer is associated with sociodemographic factors. Future research should examine these demographic disparities as the use of connected health technologies in healthcare continues to gather momentum. IMPLICATIONS FOR CANCER SURVIVORS: The study underscores a disparity in connected heath technology usage among people living with and beyond cancer. There is a pressing need for research into adoption barriers and interventions to ensure equitable digital healthcare integration among this population, especially with the heightened adoption of technology post COVID-19 pandemic.

Findings from the 2019 nationally representative oral health survey for adults in Singapore.

OBJECTIVES: The aim of this study was to present key findings from the 2019 national adult oral health survey in Singapore (NAOHS). METHODS: A multi-stage stratified sampling method was used to recruit participants for a representative national adult oral health survey. A total of 12 212 households were randomly selected from the National Database on Dwellings in Singapore. Within each household eligible persons aged ≥65 years were automatically invited to participate while a Kish selection method was used to invite those between 21 and 64 years old. The survey comprised a face-to-face interview questionnaire and a clinical examination which recorded details of tooth loss, DMFT, DMFS and prevalence of periodontal disease according to the CPITN and the US CDC-AAP classifications. Weighted analysis was performed to adjust for oversampling, non-response and post-stratification. Multivariate regression with backward stepwise selection was carried out to identify predictors of chronic periodontal disease and untreated dental caries. RESULTS: Six hundred and sixty-three participants completed both the questionnaires and the clinical examination. The prevalence of edentulousness was 2.7%. Of participants, 34.8% presented with untreated dental caries with a higher proportion found in those who were aged ≥60 years, of Malay ethnicity, living in 1-2-room public housing and who only visited the dentist when there was a problem. Mean DMFS and DMFT indices were 24.7 and 7.9 respectively. Based on the CDC-AAP classification, the prevalence of moderate-severe chronic periodontitis was 56.9% and increased with age, with a higher proportion in males. Participants with untreated dental caries were more likely to have moderate or severe periodontal disease. CONCLUSIONS: Survey findings showed high prevalence of dental caries and periodontal disease, at 34.8% and 77.6% respectively. A clear socio-economic gradient in the distribution of tooth loss, untreated dental caries and moderate-to-severe periodontitis was observed.

Epistaxis first-aid: a multi-center knowledge assessment study among medical workers.

PURPOSE: To assess the knowledge and confidence level regarding the basic first-aid for treating epistaxis among medical staff, including nurses and physicians across various medical disciplines. The study focused three aspects of first aid management: location of digital pressure, head position and duration of pressure. METHODS: The study involved 597 participants, categorized into five groups according to their specialties: emergency medicine, internal medicine, surgery, pediatrics, and community-based healthcare. A paper-based multiple-choice questionnaire assessed knowledge of managing epistaxis. Correct answers were determined from literature review and expert consensus. RESULTS: Most medical staff showed poor knowledge regarding the preferred site for applying digital pressure in epistaxis management. For head position, pediatricians and internal medicine physicians were most accurate (79.4% and 64.8%, respectively, p < 0.01), and nurses from the emergency department outperformed nurses from other disciplines; internal medicine, surgery, pediatrics, and community-based healthcare (61.1%, 41.5%, 43.5%, 60%, 45.6%, respectively, p < 0.05). While most medical staff were unfamiliar with the recommended duration for applying pressure on the nose, pediatricians and community clinic physicians were most accurate (47.1% and 46.0%, respectively, p < 0.01), while ER physicians were least accurate (14.9%, p < 0.01). Interestingly, a negative correlation was found between years of work experience and reported confidence level in managing epistaxis. CONCLUSIONS: Our findings indicate a significant lack of knowledge concerning epistaxis first-aid among medical staff, particularly physicians in emergency departments. This finding highlights the pressing need for education and training to enhance healthcare workers' knowledge in managing epistaxis.

Myasthenia Gravis Disease Burden and Its Impact on Satisfaction with Life: A Qualitative Survey of Patients' Perspectives in Japan.

INTRODUCTION: Myasthenia gravis (MG) has a negative impact on patients' health-related quality of life; however, many clinicians do not fully understand their patients' lived experience of the disease. To understand the actual conditions of patients with MG and clarify the problems they perceive, we conducted a survey to evaluate the effects of the disease on patients' daily life and work. METHODS: A questionnaire-based, qualitative, cross-sectional, non-interventional survey was conducted in Japan between April and May 2022 in patients with MG who were receiving regular outpatient treatment. The questionnaire included items regarding the patients' disease characteristics and experience, satisfaction with life, current treatment status, and treatment satisfaction. RESULTS: In total, 452 patients were included in the survey population (66.6% aged ≥ 60 years; 64.6% with MG disease duration ≥ 10 years; 76.6% acetylcholine receptor [AChR] autoantibody positive). The symptoms of MG had a significant impact on the patients' daily lives, with the most common symptoms being fatigability (74.8%), ptosis (59.7%), diplopia (54.2%), and weakness in the arms and/or legs (50.9%). Patients commonly identified exercise (73.7%), work 68.0%), hobbies (60.4%), travel (60.0%), and socializing with friends (59.7%) as being difficult to perform, with approximately 50% of patients reporting that hospitalization sometimes interfered with their ability to work. In total, 27.2% of patients were dissatisfied with life, with the highest rates of dissatisfaction among patients who were either positive for muscle-specific kinase (MuSK) autoantibodies or seronegative for both AChR and MuSK autoantibodies. CONCLUSION: In Japanese patients with MG, over 25% are dissatisfied with life, indicating several unmet needs in this population.

Association between Serum Ferritin Levels and Metabolic-associated Fatty Liver Disease in Adults: a Cross-sectional Study Based on the NHANES.

OBJECTIVE: Ferritin, initially acting as an iron-storage protein, was found to be associated with metabolic diseases. Our study was designed to investigate the association between serum ferritin and metabolic-associated fatty liver disease (MAFLD) using data from the National Health and Nutrition Examination Survey (NHANES) of the United State of America. METHODS: A cross-sectional study was conducted, enrolling a total of 2145 participants from the NHANES in the 2017-2018 cycles. Hepatic steatosis and liver fibrosis were assessed by ultrasound images and several non-invasive indexes. Multiple regression analysis was conducted to determine the associations between serum ferritin concentration and MAFLD and liver fibrosis. RESULTS: The analysis revealed that participants with higher serum ferritin levels (Q3 and Q4 groups) had a higher prevalence of MAFLD than those with the lowest serum ferritin levels [Q3 vs. Q1: OR=2.17 (1.33, 3.53), P<0.05 in fatty liver index (FLI); Q4 vs. Q1: OR=3.13 (1.91, 5.13), P<0.05 in FLI]. Additionally, participants with the highest serum ferritin levels (Q4 group) displayed a higher prevalence of liver fibrosis [Q4 vs. Q1: OR=2.59 (1.19, 5.62), P<0.05 in liver stiffness measurement; OR=5.06 (1.12, 22.94), P<0.05 in fibrosis-4 index], with significantly increased risk observed in participants with concomitant diabetes [OR=7.45 (1.55, 35.72), P=0.012]. CONCLUSION: Our study revealed that elevated serum ferritin levels are associated with a higher prevalence of MAFLD and advanced liver fibrosis in patients. Elevated serum ferritin levels combined with diabetes are important risk factors for liver fibrosis.

Problems of operation of positive pressure ventilators on the basis of surveys of Polish officers of the State Fire Service.

Positive pressure ventilators (PPV) used by 97.7% of officers of the National Fire Service in Poland, are characterized by work that is not in line with the expectations of the firefighters. In order to improve the technical and operational features of these devices, a survey was conducted among 25,000 eligible firefighters, identifying the application of these devices, problems in use and expected development directions. A total of 682 officers voluntarily completed the survey. Based on their findings, it was determined that ventilators are most often used to smoke out buildings after or during a fire. Mentioned problems when using these devices were mainly noise (78.2%), exhaust emissions (68.5%), and impediments to mobility through the device's relatively heavy weight (40.2%). Other inconveniences were mentioned by less than 20% of firefighters. Polish firefighters expect the development of these devices mainly in terms of the above-mentioned features (noise reduction (81.7%) and reduction of the weight and size of the ventilators (about 50%)). Other expectations relate to the improvement of smoke removal in buildings: increasing the efficiency of smoke removal (46.4%) and efficiency regarding the rate of smoke removal in a building by increasing the size of the incoming airflow from the building's surroundings (33.2%). About 15% of firefighters expect changes in the operation of the ventilator itself, that is, an increase in the effective operating time (electric ventilators) and an increase in the device's uptime. The aim of the article is to identify the issues encountered during the operation and to indicate the expected direction of development for PPV by users. This information can be used by engineers to initiate new development work on these devices.

Plant-parasitic Nematodes Associated with Grasses Grown for Seed in the Willamette Valley of Oregon.

Plant-parasitic nematodes (PPN) are an understudied pathogen group in the Oregon cool-season grass seed cropping system. In this survey, the PPN associated with annual ryegrass, bentgrass, fine fescue, orchardgrass, perennial ryegrass, and tall fescue were determined. Thirty-seven fields were sampled in the 2022 or 2023 growing season by collecting 10 soil cores in each of six 100-m transects for nematode extraction and visual identification. PerMANOVA testing indicated significant differences in PPN community composition across grass host and sampling time. Pratylenchus and Meloidogyne were the most commonly encountered nematodes, with maximum population densities of 1,984 and 2,496 nematodes/100 g soil, respectively. Sequencing of the COX1 gene region indicated the presence of P. crenatus, P. fallax, P. neglectus, P. penetrans, and P. thornei, with some of these species being detected for the first time on these grass hosts. The only Meloidogyne sp. found in these grasses was M. nassi, based upon sequencing of the ITS gene region. This first-of-its-kind survey indicates the need for further assessment of the impact of these PPNs on yield and stand longevity in cool-season grass seed fields in Oregon.

Trolleys, crashes, and perception-a survey on how current autonomous vehicles debates invoke problematic expectations.

Ongoing debates about ethical guidelines for autonomous vehicles mostly focus on variations of the 'Trolley Problem'. Using variations of this ethical dilemma in preference surveys, possible implications for autonomous vehicles policy are discussed. In this work, we argue that the lack of realism in such scenarios leads to limited practical insights. We run an ethical preference survey for autonomous vehicles by including more realistic features, such as time pressure and a non-binary decision option. Our results indicate that such changes lead to different outcomes, calling into question how the current outcomes can be generalized. Additionally, we investigate the framing effects of the capabilities of autonomous vehicles and indicate that ongoing debates need to set realistic expectations on autonomous vehicle challenges. Based on our results, we call upon the field to re-frame the current debate towards more realistic discussions beyond the Trolley Problem and focus on which autonomous vehicle behavior is considered not to be acceptable, since a consensus on what the right solution is, is not reachable.

Representativeness of a national, probability-based panel survey of COVID-19 isolation practices-United States, 2020-2022.

The U.S. Centers for Disease Control and Prevention (CDC) received surveillance data on how many people tested positive for SARS-CoV-2, but there was little information about what individuals did to mitigate transmission. To fill the information gap, we conducted an online, probability-based survey among a nationally representative panel of adults living in the United States to better understand the behaviors of individuals following a positive SARS-CoV-2 test result. Given the low response rates commonly associated with panel surveys, we assessed how well the survey data aligned with CDC surveillance data from March, 2020 to March, 2022. We used CDC surveillance data to calculate monthly aggregated COVID-19 case counts and compared these to monthly COVID-19 case counts captured by our survey during the same period. We found high correlation between our overall survey data estimates and monthly case counts reported to the CDC during the analytic period (r: +0.94; p < 0.05). When stratified according to demographic characteristics, correlations remained high. These correlations strengthened our confidence that the panel survey participants were reflective of the cases reported to CDC and demonstrated the potential value of panel surveys to inform decision making.