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Objective Machine learning (ML) has enabled healthcare discoveries by facilitating efficient modeling, such as for cancer screening. Unlike clinical trials, real-world data used in ML are often gathered for multiple purposes, leading to bias and missing information for a specific classification task. This challenge is especially pronounced in healthcare because of stringent ethical considerations and resource constraints. This study proposed an integrated approach to enhance the quality of health evidence from a classification task for predicting Medicare's Diagnosis-Related Groups of ischemic heart disease (IHD) patients. Methods Eligible participants were identified from the Medical Information Mart for Intensive Care IV (MIMIC IV), a publicly available hospital database. Six ML models were selected for model triangulation. Sequential triangulation was employed via Local Process Mining (LPM) and Qualitative Comparative Analysis (QCA). Results A total of 1545 IHD hospitalizations from 916 patients were identified from the MIMIC IV. Eight health process features were identified through LPM aligned with clinical knowledge. The correlation coefficients for process features, ranging from 0.24 to 0.42, are higher than those for non-process features ranged from 0.02 to 0.36. A total of 56 unique combinations were identified from the QCA, with 28 configurations having raw coverage lower than 1.0%. The overall model performance (i.e. weighted F1 and area under the curve scores) increased after adopting this integrated approach. The proportion of cases misclassified by any of the six models decreased by 47% after incorporating process features (from 5.29% to 2.91%) and further decreased to 0.0% after applying the QCA solutions. Conclusion The integrated approach demonstrates its ability to enhance quality of a classification task through its clinical relevance, improved model performance, and reduced case-level error rates. However, more scalable QCA methods are needed for larger datasets. Developing health process feature engineering for broader applications can be a future direction.

Background: During human locomotion, a sufficiently stiff foot allows the ankle plantar flexors to generate large propulsive powers. Increasing foot stiffness (e.g., via a carbon plate) increases the ankle's external moment arm in relation to the internal moment arm (i.e., increasing gear ratio), reduces plantar flexor muscles’ shortening velocity, and enhances muscle force production. In contrast, when activation of the foot's intrinsic muscles is impaired, there is a reduction in foot and ankle work and metatarsophalangeal joint stiffness. We speculated that the reduced capacity to actively control metatarsophalangeal joint stiffness may impair the gearing function of the foot at the ankle. Methods: We used a tibial nerve block to examine the direct effects of the intrinsic foot muscles on ankle joint kinetics, in vivo medial gastrocnemius’ musculotendinous dynamics, and ankle gear ratio on 14 participants during maximal vertical jumping. Results: Under the nerve block, the internal ankle plantar flexion moment decreased (p = 0.004) alongside a reduction in external moment arm length (p = 0.021) and ankle joint gear ratio (p = 0.049) when compared to the non-blocked condition. Although medial gastrocnemius muscle–tendon unit and fascicle velocity were not different between conditions, the Achilles tendon was shorter during propulsion in the nerve block condition (p < 0.001). Conclusion: In addition to their known role of regulating the energetic function of the foot, our data indicate that the intrinsic foot muscles also act to optimize ankle joint torque production and leverage during the propulsion phase of vertical jumping.

BackgroundInteractive, mixed reality technologies such as augmented reality, virtual reality, and holographic technology may provide a novel solution to fast-track the translation of evidence into practice. They may also help overcome barriers to both mental health and asthma management service uptake, such as cost, availability of appointments, fear of judgment, and quality of care. ObjectiveThis study aimed to investigate if mixed reality technology is an acceptable mechanism for the delivery of a component of cognitive and behavioral therapies for the management of elevated psychological distress among young people with asthma. MethodsTo explore the perceived acceptability of these technologies, mixed reality tools were evaluated via qualitative, 1-on-1 interviews with young people with asthma and symptoms of psychological distress, parents/caregivers of young people with asthma and symptoms of psychological distress, and relevant health professionals. The Theoretical Framework of Acceptability was used for the deductive coding of the recorded interview transcripts. ResultsThis study enrolled the following participants: (1) 3 adolescents with asthma and symptoms of psychological distress with a mean age of 14 (SD 1.7) years; (2) 4 parents/caregivers of adolescents with asthma with a mean age of 55 (SD 14.6) years; and (3) 6 health professionals with a mean age of 40.8 (SD 4.3) years. A total of 4 constructs—experienced affective attitude, experienced effectiveness, self-efficacy, and intervention coherence—were coded in all participant transcripts. The most frequently coded constructs were experienced affective attitude and intervention coherence, which were reported a total of 96 times. The least frequently coded construct was anticipated opportunity cost, which was reported a total of 5 times. Participants were mostly positive about the mixed reality resources. However, some concerns were raised regarding ethicality, particularly regarding privacy, accessibility, and messaging. Participants noted the need for technology to be used in conjunction with face-to-face engagement with health professionals and that some patients would respond to this type of delivery mechanism better than others. ConclusionsThese results suggest that mixed reality technology to deliver psychological interventions may be an acceptable addition to current health care practices for young people with asthma and symptoms of psychological distress. Trial RegistrationAustralia and New Zealand Clinical Trials Registry ACTRN12620001109998; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380427

Abstract Background Student Interest Group in Neurology (SIGN) chapters across the medical schools in the United States provide opportunities for medical students to participate in clinical, research, and service activities in neurology. Despite these, applicants for the field of neurology have traditionally been low. Methods Following changes were introduced: an open board style SIGN chapter executive committee with greater active engagement of first and second year students. New activities included journal clubs, hands on workshops, celebration/cause events (example ALS walk). In addition, a free neurology clinic was introduced. Activities were planned in consultation with office of medical education, and were organized during ‘down times’. Data on student enrollment, activities successfully carried out, students interested in neurology residency, number of neurology-related research projects with student involvement were collected prior to changes and compared to values after changes were introduced. Results Post intervention, student engagement in neurology activities and projects increased significantly. However, a similar increase in applications to neurology residency was not yet observed. Conclusions An open chapter with early engagement and involvement of first and second year medical students, creating a variety of chapter activities with greater hands on involvement, planned in conjunction with office of medical education has reinvigorated our SIGN chapter.

Empirical methods for estimating shallow-water bathymetry using passive multispectral satellite imagery are robust and globally applicable, in theory, but they require copious local measurements of water depth for algorithm calibration. Such calibration data have historically been unavailable for most locations, but NASA’s Ice, Cloud, and Land Elevation Satellite-2 (ICESat-2), a satellite-based LiDAR, might hold unique promise to fill this critical data gap. Although ICESat-2 was not designed as a marine altimeter, its ATLAS sensor consists of six green (532 nm) lasers that can penetrate a water surface and return photons reflected by the seabed, thereby generating bathymetric profiles. Utilizing TCarta’s NSF SBIR-funded Space-Based Laser Bathymetry Extraction Tool and ICESat-2’s ATL03 geolocated photon data product, we have compared ICESat-2 bathymetric retrievals with a portfolio of soundings acquired in situ using a vessel-mounted single-beam echosounder. This analysis demonstrated very high correlation (R2 = 0.96) between the field and space-based bathymetry data. The comparisons were made at multiple Caribbean and Pacific coral reef sites over water depths ranging from 1 to 20 m. Results suggest that ICESat-2 could be an effective approach for calibrating and validating empirical and radiative transfer methods, alike, for estimating shallow-water bathymetry from remote sensing imagery, thereby enabling the immediate potential for shallow-water bathymetric mapping of Earth’s reefs.

Australia has one of the highest asthma prevalence rates in the world, with this chronic and debilitating condition affecting one in nine people. The health and mental wellbeing of young people with asthma are worse than not only their peers without asthma but also worse than that of people with asthma at other ages. Psychological interventions could be beneficial in treating symptoms of elevated psychological distress in patients with asthma. However, evidence suggests that engagement with mental health services is low in this population. Technology-based solutions that engage youth may overcome barriers to service uptake for both mental health and asthma management. To fast-track the successful translation of evidence-based treatment into practice, interactive, mixed-reality technologies such as augmented reality (AR), virtual reality (VR) and holographic technology may provide a novel, low-cost solution, yet to date, methodological rigor in the evaluation of mixed reality for this purpose is lacking. To evaluate the perceived usability and acceptability of these technologies, mixed reality tools will be developed by the author team to deliver a component of a psychological intervention for treatment of elevated psychological distress among young people with asthma. Qualitative research will be conducted through one-on-one interviews with young people with asthma, parents/caregivers of young people with asthma, and with health professionals, during which participants will have time to interact with the resources. Moderator guides will be used to direct interviews, and will be supplemented with a questionnaire, including Likert-type measures of usability and acceptability to facilitate triangulation of data. Understanding and data obtained through this study will be used to develop version 2.0 mixed reality tools, which will be tested for feasibility in a RCT. Improving access to and uptake of evidence-based treatments for elevated psychological distress in young people with asthma may reduce the burden of this highly prevalent disease.

Lack of medication adherence is a prevalent problem that causes a broad range of healthandhealth-economics-related issues. Adherence management is therefore an importantstrategy, but it also presents its own set of challenges. Interventional communication fromcare support teams at managed care organizations and disease management and wellnessprograms has proved effective at modifying patients' medication adherence and reportingbehaviors. However, these communications do not work well from an economic standpoint.It is not economically feasible to scale call centers and the numbers of clinical and professionalstaff to communicate with the increasing number of patients with chronic diseaseswho require ongoing medication use. Using communication automation to augment traditionalcall center outreach can help to mediate patient medication-taking behaviors. Specificdesign criteria for the automation of this interaction are discussed in this article, offering supporting data from arecent trial of 304 elderly patients with hypertension, and showing the benefits of using such a system for effectiveblood pressure monitoring, at reduced costs. [ABSTRACT FROM AUTHOR]

This article provides an integrative treatment protocol for eczema (atopic dermatitis) using natural therapies. The protocol addresses several primary causative factors such as essential fatty acid deficiency and food allergies. In addition, it identifies a patented chamomile preparation proven in clinical studies to be as effective as hydrocortisone in relieving associated symptoms of itching and inflammation while enhancing granulation and epithelialization without deleterious side effects associated with long-term use of corticosteroid therapy. [ABSTRACT FROM AUTHOR]

This paper examines the practice of participatory evaluation through an exploratory single case study of the Evaluation Team of Books & Beyond, a co-curricular service-learning program of the Global Village Living-Learning Center at Indiana University. The paper, which is authored by three undergraduate members of the evaluation team and their faculty advisor, juxtaposes the process of conducting the evaluation and reporting the results with reflections from the Evaluation Team participants on conducting youth participatory action research, which offers a means of improving youth-serving programs and developing a greater understanding of why youth choose to participate in these programs. In their review of the implementation of their evaluation project, the team noted that the difficulties of getting past lessons learned to methodological rigor in service-learning evaluation are compounded by the realities of engaging in a student-faculty partnership in a co-curricular service-learning context.

The hnRNP A/B paralogs A1, A2/B1 and A3 are key components of the nuclear 40S hnRNP core particles. Despite a high degree of sequence similarity, increasing evidence suggests they perform additional, functionally distinct roles in RNA metabolism. Here we identify and study the functional consequences of differential post-translational modification of hnRNPs A1, A2 and A3. We show that while arginine residues in the RGG box domain of hnRNP A1 and A3 are almost exhaustively, asymmetrically dimethylated, hnRNP A2 is dimethylated at only a single residue (Arg-254) and this modification is conserved across cell types. It has been suggested that arginine methylation regulates the nucleocytoplasmic distribution of hnRNP A/B proteins. However, we show that transfected cells expressing an A2(R254A) point mutant exhibit no difference in subcellular localization. Similarly, immunostaining and mass spectrometry of endogenous hnRNP A2 in transformed cells reveals a naturally-occurring pool of unmethylated protein but an exclusively nuclear pattern of localization. Our results suggest an alternative role for post-translational arginine methylation of hnRNPs and offer further evidence that the hnRNP A/B paralogs are not functionally redundant.

Background: Youth with disabilities are five times more likely to experience anxiety or depression than peers without disabilities. Engagement in sufficient daily physical activity (PA), adequate nightly sleep, and limited daily screen time (collectively known as 24-h movement guidelines) is associated with lower odds of anxiety and depression for peers without disabilities. Extending the investigation of these modifiable behaviors to youth with disabilities is warranted., Objective: To estimate the association between meeting 24-h movement guidelines and anxiety and depression among a nationally representative sample of youth with disabilities., Methods: A cross-sectional secondary analysis of the 2019-2020 NSCH was conducted and included youth 6-17 years old who were currently receiving special education services. Weighted prevalence estimates and logistic regressions were employed to estimate the association between meeting guidelines (separately and combined) and current anxiety or depression status., Results: Compared to youth with disabilities who met the guideline, those not meeting the sleep or screen time guidelines, independently, had significantly higher odds of depression, or anxiety (aOR range 1.53, 2.31 respectively). Comparable odds were observed between those meeting the PA guidelines, alone or in combination, and those meeting none of the 24-h movement guidelines., Conclusion: Adequate nightly sleep, and limited screen time, were significantly associated with anxiety and depression among youth with disabilities, a pattern consistent to peers without disabilities. Yet, meeting more than one guideline did not further reduce odds of poor mental health, warranting further investigation of compounding benefits of the 24-h guidelines within this population., Competing Interests: Conflicts of interest The Author(s) declare(s) that there is no conflict of interest., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Interventions for blood pressure (BP) control have positive effects on outcomes for patients with hypertension. Research on these effects in small- and medium-sized practices is limited. Our retrospective analysis used data from Healthy Hearts in the Heartland (H3), a research program conducted in 2016-2018 as part of the Agency for Healthcare Research and Quality's EvidenceNOW initiative, to examine the impact of implementing more interventions for BP control in these settings. Thirty-eight H3 practices met inclusion criteria and were assigned to an implementer group (high or low) based on the number of interventions implemented with the support of a practice facilitator during the study. Practices in the high-implementer group implemented a mean of 2.2 additional interventions relative to the low-implementer group. Groups were compared on two measures of BP control: (1) mean percentage of hypertensive patients with a most recent BP below 140/90, and (2) mean systolic and diastolic BP of hypertensive patients. In the first measure, practices in the high-implementer group had greater improvement between baseline and the end of the study. Among the 10,150 patients included in the second measure, reductions in mean SBP and DBP were greater for the high-implementer group. These outcomes show that implementing additional interventions had a positive association with measures of BP control, though clinical significance was unknown or limited. Future research is needed to understand the impact of interventions for BP control in small- and medium-sized practices, including the interactions among intervention implementation, practice facilitation, and practice and patient characteristics., (© 2023. The Author(s), under exclusive licence to Springer Nature Limited.)

Flourishing is a positive health indicator that aligns with strengths-based perspectives and measures within autism research. Flourishing indicators were recently included in the National Survey of Children's Health (NSCH) and have been used to evidence disparities in flourishing experienced by autistic children compared to non-autistic peers. Yet, little has been done to examine the utility of standard flourishing items for this population. This study examined the NSCH caregiver-reported flourishing items for measurement item bias. A cross-sectional, representative sample of autistic and non-autistic US children aged 6-17 years (n = 41,691) was drawn from the 2018-2019 NSCH public dataset. A confirmatory factor analysis using a multiple indicators and multiple causes model (MIMIC-CFA) was conducted to (1) test for differential item functioning (DIF; i.e., measurement bias); and (2) estimate latent mean group differences after controlling for DIF. Findings supported a 3-factor (social competence, school motivation, and behavioral control), 10-item model structure consistent with past literature, yet measurement bias was evident for 6 of the 10 items. Persistent group differences, after accounting for DIF and covariates, indicates that caregivers of autistic children perceive their children are experiencing meaningfully lower flourishing outcomes compared to caregivers of non-autistic children. However, evidence of measurement bias for items related to the social competence dimension calls into question the applicability of this measure for autistic children. Further interpretation of group differences and use of this measure should be approached with caution., (© 2023 International Society for Autism Research and Wiley Periodicals LLC.)

Federal funding agencies have invested significant resources supporting evidence-based, innovative approaches that address education problems and incorporate rigorous design and evaluation, particularly through randomized controlled trials (RCTs), the gold standard for yielding causal inference in scientific research. In this study, we introduced factors (i.e., evaluation design, attrition, outcome measures, analytic approach, and fidelity of implementation) that are often times required in the Federal Notice for application by the U.S. Department of Education, with an emphasis on What Works Clearinghouse (WWC) standards. We further presented a federally funded research protocol with a multi-year, clustered RCT design to determine the impact of an instructional intervention on students' academic performance in high-needs schools. In the protocol, we elaborated on how our research design, evaluation plan, power analysis, as well as confirmatory research questions and analytical approaches were aligned with the grant requirement and WWC standards. We intend to provide a road map to meeting WWC standards and to increase the likelihood of successful grant applications., Competing Interests: Conflict of interest We have no known conflict of interest to disclose., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

The U.S. Report Card on Physical Activity for Children and Youth has tracked 10 physical activity (PA) indicators common to the Active Healthy Kids Global Matrix since 2014. This article expands on the U.S. report cards by presenting PA indicator assessments among children and adolescents with disabilities. Grades for indicators were assigned based on a search of peer-reviewed articles presenting nationally representative data. The Global Matrix 3.0 benchmarks and grading framework guided the process. Grades for overall PA, sedentary behaviors, organized sports, and school were F, D+, D+, and D, respectively. Insufficient evidence existed to assign grades to the remaining six indicators. There is a need in the United States for targeted PA promotion strategies that are specific to children and adolescents with disabilities. Without a commitment to this effort across sectors and settings, the low grades identified in this para report card are expected to remain.

Background: Despite known benefits of engaging in recommended amounts of physical activity (PA), sleep, and sedentary behavior (SB), little is known about how adults with visual impairments (VIs) meet these guidelines in isolation or simultaneously., Objective: This study estimated (a) the prevalence of US adults with VIs who are partially or fully meeting the 24-h movement guidelines, and (b) the differential contribution of work-related, leisure, and transportation to total time accrued for PA., Methods: A cross-sectional sample of adults with VIs (n = 466) was drawn from the National Health and Nutritional Examination Survey (NHANES) 2015-2018 combined datasets. Guideline adherence was measured using self-report items for average time spent physically active, sitting and sleeping. Weighted prevalence estimates were produced for meeting guidelines separately and in combination. The average percent of PA minutes accrued across work-related, leisure and transportation were compared among those meeting PA guidelines., Results: An estimated 29.6% (SE = 3.6) of US adults with VIs met all three guidelines. An estimated 59.3% (SE = 3.5) adults with VIs met PA guidelines alone or in combination with SB and sleep. Within this group, the majority of weekly PA minutes (average 63.9%) was accrued at work., Conclusions: An estimated two thirds of adults with VIs are not engaged in healthful 24-h movement behaviors. Targeted interventions for adults with VIs are warranted that may require a comprehensive approach to PA, SB, and sleep. Work emerged as an important location for adults with VIs to accrue PA, inviting future research to explore associations between employment and 24-h movements within this population., Competing Interests: Conflicts of interest The authors declare that there is no conflict of interest., (Copyright © 2022 Elsevier Inc. All rights reserved.)

This study aimed to quantify and compare physical activity, sitting time, and sleep behaviors among US adults with and without disabilities using the 2020 Canadian 24-hour movement framework. The weighted prevalence of 24-hour movement guideline adherence was estimated among a nationally representative sample from the 2017 to 2018 National Health and Nutrition Examination Survey of US adults (18-65 years old) with (n = 1070) and without (n = 33,370) functional disabilities in vision, hearing, mobility, cognitive, and self-care domains. The adjusted odds of single and combination guideline compliance were estimated by disability type, in reference to adults without disabilities, using separate multivariable logistic regressions. After adjusting for age, sex, and income, adults with disabilities in mobility, cognitive, or self-care domains had approximately half the odds of meeting all 3 guidelines, compared with adults without disabilities (adjusted odds range: 0.49-0.77). Significantly lower adherence was observed among adults with functional disabilities, compared with no disabilities, for sleep, and moderate to vigorous physical activity, but not sedentary guidelines. This report establishes baseline prevalence estimates for guidelines compliance among US adults with functional disabilities ages 18-65 years old. Low guideline adherence, and evidence for significant differences in physical activity and sleep, signals a need to further explore combination health behaviors among adults with disabilities.

Purpose: The aims of the current study include to: (1) describe the item development; and (2) begin the process of establishing the internal consistency and known-groups validity of the Self-Directed Mobility Scale. The purpose of the scale is to assess paediatric physical and occupational therapists' views towards self-directed mobility and their perceived ability and intentions to advocate for children's access to self-directed mobility., Methods: Three individuals with expertise in kinesiology, psychology, paediatric rehabilitation, and disability studies served as the expert panel for item development. Four samples were included to determine internal consistency and known-groups validity: 350 physical therapists, 89 occupational therapists, 279 kinesiology undergraduate students, and 528 health and wellness undergraduate students., Results: The internal consistency was above the acceptable level of 0.70 (range = 0.72-0.77) for all samples when two items regarding promoting other motor skills prior to powered mobility use and the temporary use of a mobility device were removed. Known-groups validity was established between all samples., Conclusions: The Self-Directed Mobility Scale appears to be a valid tool for assessing views of self-directed mobility and mobility advocacy intentions in paediatric physical and occupational therapists, as well as undergraduate students. Future work should examine the internal consistency based on study sample to ensure the (> 0.70) acceptable Cronbach's alpha level is met.Implications for rehabilitationThe Self-Directed Mobility Scale is a viable measurement tool to assess views of self-directed mobility and mobility advocacy intentions of pediatric physical and occupational therapists.In combination with other measures, the Self-Directed Mobility Scale may be used in future rehabilitation research to evaluate factors associated with provision of mobility technology to children with disabilities.