Broad Groups Research Articles

Copper(II)-Mediated Dual Reactivity of 2-(5-Phenylisoxazol-3-yl)aniline: Directed Amination and Oxidative C(═O)─C Cleavage of Amides Enabling Direct Access to Urea Derivatives.

The dual reactivity of amides fused to 2-(5-phenylisoxazol-3-yl)aniline as a directing group for the formation of urea derivatives via chemospecific cleavage of the C(═O)─C bond and C(sp2)-H amination is reported here. Employing inexpensive copper as the catalyst and O2 in air as the oxidant, this protocol exhibited broad functional group tolerance for both the transformations. Detailed mechanistic studies and DFT calculations were performed to gain insights into a plausible mechanism for the formation of urea derivatives.

Investigating inequalities in patient outcomes for first-episode psychosis.

Understanding inequalities in outcomes between demographic groups is a necessary step in addressing them in clinical care. Inequalities in treatment uptake between demographic groups may explain disparities in outcomes in people with first-episode psychosis (FEP). To investigate disparities between broad demographic groups in symptomatic improvement in patients with FEP and their relationship to treatment uptake. We used data from 6813 patients from the 2021-2022 National Clinical Audit of Psychosis data-set. Data were grouped by category type to obtain mean outcomes before adjustment to see whether disparities in outcomes remained after differences in treatment uptake had been accounted for. After matching, the average effect of each demographic variable in terms of outcome change was calculated. Moderator effects on specific treatments were investigated using interaction terms in a regression model. Observational results showed that patients aged 18-24 years were less likely to improve in outcome, unless adjusted for intervention uptake. Patients classified as Black and Black British were less likely to improve in outcome (moderation effect 0.04, 95% CI 0-0.07) after adjusting for treatment take-up and demographic factors. Regression analysis showed the general positive effect of supported employment interventions in improving outcomes (coefficient -0.13, 95% CI -0.07 to -0.18, P < 0.001), and moderator analysis suggested targeting particular groups for interventions. Inequalities in treatment uptake and psychotic symptom outcome of FEP by social and demographic factors require monitoring over time. Our analysis provides a framework for monitoring health inequalities across national clinical audits in the UK.

THE FIGHT INHERITED RETINAL BLINDNESS! PROJECT: A NEW TREATMENT OUTCOME AND NATURAL HISTORY REGISTRY FOR INHERITED RETINAL DISEASE.

To design and build a new disease registry to track the natural history and outcomes of approved gene therapy in patients with inherited retinal diseases (IRDs). A core committee of 6 members was convened to oversee the construction of the FIRB! module. A further 11 experts formed a steering committee, which discussed disease classification and variables to form minimum datasets via a consensus approach. The web-based FIRB! registry records baseline demographic, clinical and genetic data together with follow-up data. The Human Phenotype Ontology and Monarch Disease Ontology nomenclature were incorporated within the FIRB! architecture to standardise nomenclature. The registry software assigns individual diagnoses to one of 7 broad phenotypic groups, with minimum datasets dependent upon the broad phenotypic group. Additionally, minimum datasets were agreed upon for patients undergoing approved gene therapy with voretigene neparvovec (Luxturna). New patient entries can be completed in 5 minutes, and follow-up data can be entered in 2 minutes. Fight Inherited Retinal Blindness! (FIRB!) is an organized, web-based system that uses observational study methods to collect uniform data from IRD patients to track natural history and (uniquely) treatment outcomes. It is free to Users, who have control over their data.

Electrochemical C-O and C-N Arylation using Alternating Polarity in flow for Compound Libraries.

Etherification and amination of aryl halide scaffolds are commonly used reactions in parallel medicinal chemistry to rapidly scan structure-activity relationships with abundant building blocks. Electrochemical methods for aryl etherification and amination demonstrate broad functional group tolerance and extended nucleophile scope compared to traditional methods. Nevertheless, there is a need for robust and scale-transferable workflows for electrochemical compound library synthesis. Herein we describe a platform for automated electrochemical synthesis of C-X arylation (X=NH, OH) in flow to access compound libraries. A comprehensive Design of Experiment (DoE) study identifies an optimal protocol which generates high yields across>30 aryl halide scaffolds, diverse amines (including electron-deficient sulfonamides, sulfoximines, amides, and anilines) and alcohols (including serine residues within peptides). Reaction sequences are automated on commercially available equipment to generate libraries of anilines and aryl ethers. The unprecedented application of potentiostatic alternating polarity in flow is essential to avoid accumulating electrode passivation. Moreover, it enables reactions to be performed in air, without supporting electrolyte and with high reproducibility over consecutive runs. Our method represents a powerful means to rapidly generate nucleophile independent C-X arylation compound libraries using flow electrochemistry.

Asymmetric Photoinduced Excited-State Nazarov Reaction.

We report herein the first asymmetric photoinduced excited-state Nazarov reaction of non-aromatic dicyclic divinyl ketones by using hydrogen-bonding catalysis. The enantioselectivity of photoinduced electrocyclization is highly dependent on the structural features of the substrate and its interaction with chiral catalysts. For the simple dicyclic divinyl ketone substrates, there is no discernible selectivity of the hydrogen bond coordination between the thiourea and carbonyl groups of the substrates in the ground state. However, we found that the direction of the electrocyclization was well controlled in each coordination model and the N,N'-dimethylamine motif acts as a base in the regioselective deprotonation process, which leads to the formation of two stereoisomers with high enantioselectivity. Photolysis of dicyclic divinyl ketones bearing a 1,3-dioxolane motif in the presence of bifunctional hybrid peptide-thiourea chiral catalysts gave the tricyclic cis-hydrofluorenones with good enantioselectivity. Mechanistic and DFT studies suggested that the amide and thiourea groups in the bifunctional chiral catalysts play a key role as H-bond donors, which coordinate with both the carbonyl group and the 1,3-dioxolane motif to provide a more favorable chiral species, and control the direction of the electrocyclization. Due to the presence of the rigid 1,3-dioxolane ring, the deprotonation/protonation process occurs regiospecifically with high driving force. This photo-electrocyclization is mild (room temperature and neutral solution), which results a broad reaction scope and functional group tolerance and demonstrates its synthetic potential in organic synthesis.

Alicyclobacillus suci produces more guaiacol in media and has duplicate copies of vdcC compared to closely related Alicyclobacillus acidoterrestris.

Microbial spoilage increases food waste. To address that challenge, it is critical to recognize and control those microbial groups with the greatest spoilage potential. Non-specific targeting of broad microbial groups (e.g., the genus of Alicyclobacillus) in which only some members cause food spoilage results in untenable, overly broad interventions. Much of the food industry does not differentiate between guaiacol-producing and non-guaiacol-producing Alicyclobacillus species. This is overly broad because Alicyclobacillus spp. which cannot produce guaiacol can be present in beverages without causing spoilage. Furthermore, no distinction is made between Alicyclobacillus suci and Alicyclobacillus acidoterrestris because A. suci is newly split from A. acidoterrestris and most of the food industry still considers them to be the same. However, these findings indicate that A. suci may have greater spoilage potential than A. acidoterrestris due to differences in their genomic determinants for guaiacol production.

Diagnostic Approach to Mesenchymal and Spindle Cell Tumors of the Breast

Mesenchymal and spindle cell tumors of the breast represent a broad and heterogeneous group of lesions that may be sampled on core needle biopsy or surgical excision. Mesenchymal lesions unique to the breast are those that derive from the specialized breast myofibroblast, such as mammary myofibroblastoma and pseudoangiomatous stromal hyperplasia. However, any mesenchymal lesion arising in extramammary soft tissue may also arise in the breast, including fibroblastic, peripheral nerve sheath, adipocytic, and vascular lesions. The spindle cell lesions pose the greatest diagnostic challenge, due to the significant radiographic, morphologic, and immunophenotypic overlap within the category of mesenchymal lesions and more broadly with other nonmesenchymal breast lesions. The distinction is particularly challenging on the limited material of breast core needle biopsies, and caution should be taken before definitively classifying a breast spindle cell lesion on core needle biopsy to avoid unnecessary treatment if misdiagnosed. Consideration of a wide differential diagnosis, adequate sampling of a resection specimen, use of a targeted immunopanel, and selective use of molecular assays are essential steps for accurate classification of mesenchymal lesions in the breast. This review covers the clinical, histologic, and immunophenotypic features of mesenchymal tumors of the breast, with a special emphasis on the differential diagnoses unique to the breast and challenges encountered on breast core needle biopsy.

Palladium-Catalyzed Cyclization and Direct Arylation of 1-[2-(2,2-Dibromoethenyl)phenyl]-1H-pyrrole with Allenes.

A novel and efficient palladium-catalyzed highly regioselective reaction of 1-[2-(2,2-dibromoethenyl)phenyl]-1H-pyrrole with allenes was realized to synthesize pyrrolo[1,2-a]quinolones. The tandem process involves intermolecular cyclization and intramolecular direct arylation, leading to the formation three new C-C bonds and two new rings. Notably, this transformation exhibits broad substrate scope and high functional group tolerance.

A Pilot Study of Age Estimation and Cause of Death: Insights into Skeletal Aging

Background/Objectives: Forensic anthropological age estimations are often limited by a lack of diversity in reference samples, imprecision, and, for certain populations, inaccuracy. This study aims to explore the relationship between health, as indicated by cause of death, and skeletal age estimation, with the goal of determining whether including health information can improve accuracy and precision in age estimation. Methods: Skeletal age data were collected from the Maxwell Museum Documented Skeletal Collection using the Lovejoy et al. method for the auricular surface and the Suchey-Brooks method for the pubic symphysis. All individuals had a known cause of death, which was categorized into two broad groups: disease-related and trauma-related. Cause of death category served as a proxy for health status. Results: Individuals who died from disease-related causes often fell within the upper end of the age ranges for both the auricular surface and pubic symphysis methods. In contrast, those who died from trauma-related causes tended to fall within the lower end of these age ranges. Conclusions: These results indicate that incorporating factors such as health into existing forensic age estimation methods could enhance the precision of age estimates, particularly by addressing the influence of environmental and lifestyle factors on skeletal aging.

Thematic mapping of biosecurity highlights divergent conceptual foundations in human, animal, plant and ecosystem health

Effective biosecurity policies are essential to address several major sociological and environmental challenges facing humankind including existential pandemic risks, threats to food security, loss of ecosystem services and public resistance to pesticides and vaccines. Yet biosecurity is subject to multiple interpretations that include dealing with the threats from bioterrorism, managing laboratory biosafety to prevent the escape of pathogenic organisms, handling food and agricultural production systems to prevent disease introduction and addressing the threat of introduced organisms to flora, fauna and humans. The absence of a shared vision of what biosecurity encompasses means that decision-makers are often challenged to design appropriate biosecurity policies at national and global scales. The design of effective policy strategies requires an understanding of the methodological and conceptual barriers that constrain attempts to build an interdisciplinary approach to biosecurity. Here, the first thematic map of the biosecurity research landscape is undertaken to assess just how diverse the interpretation of biosecurity is amongst the global research community and the extent to which the articles published since 2000 represent a common conceptual foundation or are largely clustered within sectors. Co-citation, bibliographic coupling and co-word analyses highlighted that the field of biosecurity encompasses a wide range of domains from biochemistry through to political science, but the research supporting different sectors largely draws from a distinct literature base. While ecosystem and plant health were clustered together within the broad grouping of biological invasions, there was a clear separation from both human and animal health. Yet, there is considerable scope for the management of biological invasions to benefit from insights derived from social perspectives in human and animal health. Biosecurity remains divided by conceptual differences and specialised vocabularies that limit the effectiveness of biosecurity policies addressing biodiversity conservation, public health and food security. To overcome these constraints requires the building of a global biosecurity community that accepts a broader definition of biosecurity, avoids sectorial jargon and establishes mechanisms to cultivate interdisciplinarity through specialised collaborative centres, cross-sectorial research programmes and conceptually rich training programmes.

Validity and timeliness of cancer diagnosis data collected during a prospective cohort study and reported by the English and Welsh cancer registries: a retrospective, comparative analysis

Cancer places a high burden on society and health-care systems. Cancer research requires high-quality data, which is resource-intensive to obtain. Using administrative datasets such as cancer registries could improve the efficiency of cancer studies if data were valid and timely. We aimed to compare the validity and timeliness of diagnostic cancer data on-site during the SYMPLIFY study to that obtained from the cancer registries of England and Wales. Cancer data were collected from 5461 participants across 44 hospital sites during a prospective observational study in England and Wales, SYMPLIFY (ISRCTN10226380). Linked cancer data were obtained from Digital Health and Care Wales (DHCW), the Welsh Cancer Intelligence and Surveillance Unit (WCISU), and the English National Cancer Registration Dataset (NCRD) and Rapid Cancer Registration Dataset (RCRD), regularly between April, 2022, and September, 2023. The primary objectives of the study were to evaluate the validity (via assessment of the proportion of completed data fields and concordance with SYMPLIFY sites), and timeliness of the data in all datasets, for all cancers diagnosed within 9 months of study enrolment. Data fields investigated were cancer site via International Classification of Disease, 10th Revision (ICD-10) code; cancer morphology via International Classification of Diseases for Oncology, 3rd Edition (ICD-O-3) morphology histology code and broad morphological grouping; overall stage; and TNM classification. For data collected between April, 2022, and September, 2023, completeness at the last data cut available for each dataset ranged from 84% to 100% for ICD-O-3 morphology, from 43% to 100% for overall stage, and from 74% to 83% for TNM stage. The concordance between SYMPLIFY data and NCRD was 96% (95% CI 92-98) for ICD-10, 60% (53-66) for ICD-O-3 morphology, 83% (78-88) for ICD-O-3 broad morphology groupings, 73% (67-78) for stage, and 51% (44-59) for TNM; and with WCISU was 89% (95% CI 81-94) for ICD-10, 63% (53-73) for ICD-O-3 morphology, 80% (70-87) for ICD-O-3 broad morphology groupings, 83% (74-90) for overall stage, and 49% (38-61) for TNM stage. Concordance between SYMPLIFY and RCRD was 95% (95% CI 92-98) for ICD-10, 67% (60-74) for ICD-O-3 morphology, 85% (79-90) for ICD-O-3 broad morphology groupings, and 73% (65-80) for overall stage; and between SYMPLIFY and DHCW was 96% (91-99) for ICD-10, 74% (64-83) for ICD-O-3 morphology, 84% (75-91) for ICD-O-3 broad morphology groupings, and 87% (74-95) for stage. The SYMPLIFY dataset reached completion at 12 months post-enrolment in November, 2022, compared with 13 months for NCRD in December, 2023. RCRD and DHCW reached completion at 13 months and 15 months post-enrolment, in December, 2022, and February, 2023, respectively. We report similar completeness of data fields, concordance, and timeliness between on-site and centrally collected cancer outcomes data. Our findings suggest that central registry data can help alleviate the resource burden in clinical trials and improve cancer research. Cancer registries might need additional resources to provide data for registry-based trials at scale. GRAIL Bio UK.

Photoinduced Hydrosilylation of Fluorinated Alkenes.

A visible-light-induced synthesis protocol for silylmonofluoroalkanes is described. The silylation of alkenyl fluorides using (trimethylsilyl)silanes as organosilicon reagents proceeds well under mild conditions via a sequential photoinduced single-electron transfer and protonation process. The protocol shows a broad substrate scope, transition-metal-free conditions, and high functional group tolerance. A wide variety of silylmonofluoroalkanes were obtained in generally good yields (up to 82%).

Pediatric Pain

ABSTRACT OBJECTIVE This article reviews pain disorders encountered in pediatric neurology practice and provides current information regarding the assessment and treatment of pediatric chronic pain. LATEST DEVELOPMENTS Data about pediatric pain management remain sparse, owing to a dearth of controlled trials and longitudinal studies in these patients. However, the field of pain management and understanding of central and peripheral pain processing has expanded to allow more effective treatment of a broad group of children and adolescents with pain associated with neurologic disease. Neuroimaging visualizes sensory and nonsensory systems, and genetic markers of sensitivity and disease may guide specific therapy. The concept of central sensitization in chronic pain disorders has supported the development of multidisciplinary paradigms for the comprehensive care of these patients. ESSENTIAL POINTS Pain involves sensory activation and central nervous system modulation in pediatric patients. Pediatric neurologists should be prepared to define, investigate, and treat pain disorders in this complex patient population. Appropriate interventions during childhood may attenuate or prevent chronic pain later in life. Current interventions include behavioral, physical, and pharmacologic approaches, as well as potential noninvasive tools for neuromodulation. Research is progressing in sensory measurement, neuroimaging, genetics, and neuroinflammation to guide future targeted therapies.

Unravelling Prokaryotic Codon Usage: Insights from Phylogeny, Influencing Factors and Pathogenicity

Analyzing prokaryotic codon usage trends has become a crucial topic of study with significant ramifications for comprehending microbial genetics, classification, evolution, and the control of gene expression. This review study explores the numerous facets of prokaryotic codon usage patterns, looking at different parameters like habitat and lifestyle across broad groups of prokaryotes by emphasizing the role of codon reprogramming in adaptive strategies and its integration into systems biology. We also explored the numerous variables driving codon usage bias, including natural selection, mutation, horizontal gene transfer, codon-anticodon interaction, and genomic composition in prokaryotes through a thorough study of current literature. Furthermore, a special session on codon usage on pathogenic prokaryotes and the role of codon usage in the phylogeny of prokaryotes has been discussed. We also looked at the various software and indices that have been recently applied to prokaryotic genomes. The promising directions that lay ahead to map the future of codon usage research on prokaryotes have been emphasized. Codon usage variations across prokaryotic communities could be better understood by combining environmental, metagenomic, and system biology approaches.

Cross-Cultural Comparison of the Strengths and Difficulties Self-Report Questionnaire in 12 Asian and European Countries

The self-report Strengths and Difficulties Questionnaire (SDQ) is widely used globally; hence, the validity of the intergroup comparisons is essential. This study examined the structure of the self-report SDQ in a large multinational adolescent sample, tested its measurement invariance across genders and countries, and compared youth mental health in 12 European and Asian countries. This study is part of the Eurasian Child Mental Health Study (EACMHS), a cross-cultural research study of child and adolescent well-being and mental health in 12 Asian and European countries. The sample (N= 26,306) came from a cross-sectional school-based survey of adolescents. Confirmatory factor analysis was used to assess a common measurement model for the self-report SDQ and the measurement invariance of the model across gender and country. Fit indices in the total sample, in each gender, and in each of the 12 countries separately supported the use of the first-order 3-factor model (without the reverse-coded items) as a common measurement model for the self-report SDQ. Measurement invariance analyses provided good support for configural, metric, and scalar invariance across gender; however, metric invariance across countries was not supported. There were significant gender main effects for all SDQ subscales except for hyperactivity/inattention. Culture had significant main effects and moderated the magnitude of gender differences in all subscales. The present findings support the use of the correlated 3-factor model comprising the positive dimension of prosocial behavior and 2 broad groupings of internalizing and externalizing problems, without the reverse-coded problem items, as a common measurement model for the self-report SDQ internationally.

PPh3-catalyzed chemoselective reduction of aldehydes to alcohols

Reduction of aldehydes to alcohols is a fundamental organic transformation, typically achieved through metal-catalyzed reductions or by the use of hydride-based reagents. However, these conventional methods often go through harsh conditions with expensive catalysts and additional reductants, limiting their broader applications. In this study, for the first time we introduce an efficient, metal-free reduction strategy using triphenylphosphine (PPh3) and KOtBu in MeOH. This method exhibits broad functional group tolerance, mild environment and selectivity in reducing aldehydes even in the presence of other reactive functionalities (NO2, CN, ketone, etc.). Key features highlight this novel approach with practicality, scalability to gram scales and excellent yields for the reduction of varied aldehydes to alcohols (30 examples; 65–95 % Yields).

A Trend Analysis of Project-based Learning in Chemistry Experiment: A Bibliometric Analysis

Project-based learning is a global trend, widely adopted across countries. Project-based learning has developed diversely by emphasizing interdisciplinary, cross-domain, and regional collaboration. To provide in-depth resources for researchers and educators on project-based learning in chemistry experiments, this study aims to make a bibliometric analysis on the topic of project-based learning globally using publication characteristics analysis. The database used in this study used Scopus and obtained 5900 articles from 2018-2023. Bibliometric analysis was analyzed using VOSviewer and Microsoft Excel. The results of the bibliometric analysis show that Boone, C.D. is the author with the highest number of citations on the research topic, Project-based learning in a chemistry experiment. The United States is the most productive country in researching this topic, with 1351 articles. The most influential journal with the highest number of articles is the Journal of Physics Conference Series, with 243 articles. The major contextualized learning literatures in this study tend to fall into broad groups such as Project-based Learning, Education, and STEM Education. These findings suggest the need for multidisciplinary and cross-disciplinary studies on project-based learning research on chemistry learning and advocate for the inclusion of project-based learning research in education from a broader geographical context.

The Inherent Normativity of Concepts

Concept normativity is a prominent subject of inquiry in the philosophical literature on the nature of concepts. Concepts are said to be normative, in that the use of concepts to categorise is associated with an evaluation of the appropriateness of such categorisation measured against some objective external standard. Two broad groups of views have emerged in accounting for the normativity of concepts: a weaker view traces such normativity to the social practice in which the agent using the concept is embedded, while a stronger view traces such normativity to a first-person capacity of reflection. However, both views have drawbacks: the weaker view seems not to do justice to the basic sense of normativity associated with an individual agent using a concept, while the stronger view ties such normativity with the first-person conscious evaluation, which appears to be too strong. Here, we propose a different view of concepts using principles from the Active Inference framework. We reconceive concepts, defining them as Bayesian beliefs—that is, conditional probability distributions—that represent causes and contingencies in the world, their form grounded in the exchange between the agent and its environment. This allows us to present a different view on the source of normativity, with an emphasis on the structure of the agent itself as well as its interaction with the environment. On the Active Inference view, concepts are normative in that they are intrinsically connected to the self-evidencing nature of an agent, whose very structure implies an evaluation of the concepts it employs.

Assessment of landslide susceptibility in the Himalayan state of Tripura, India, using a Multi-Model Approach

Landslides are the down slope mass movement of soil, rocks, and debris due to a natural or human activities resulting in widespread hazard events in India. The most affected areas comprise 15 percent of its landmass which includes Tripura and eleven Himalayan states and parts of the Western and Eastern Ghats in India. In Tripura, landslides cause road blockage and destruction of settlements, bringing economic and life losses in every year. Thus, this research is focused on identifying landslide susceptible zones and the significant causative factors behind landslides. Assessment of Landslide Susceptibility (LS) identifies fifteen major causative factors under five broad groups; topographic, geotechnical, hydrological, environmental, and anthropogenic. With application of Analytical Hierarchical Process (AHP), Frequency Ratio (FR), and Random Forest (RF)-based models were performed to extract landslide susceptible zonation map for Tripura. This study reveals that the successive hill ranges formed by young sedimentary lithologic formations associated with deforestation, heavy rainfall during monsoon, and anthropogenic activities (road constructions and jhumming) are the responsible geo-conditions for triggering landslides. In this study, while the AHP and FR model show only 1.95% and 11.46% confined along the hilltop of Jampui, Sakhan, and Longtarai, the RF model designated Tripura’s 30% land area as high and very high landslide susceptible zones (LSZ), predominantly over hills, foothills, and low laying undulating land (tillas). For the accuracy assessment, the ROC curve is used, which shows that RF model appears to be the maximum accurate (0.810) one, followed by FR (0.806) and AHP (0.744).

Facilitators and challenges of implementing a digital patient education programme for rheumatoid arthritis into clinical practice

BackgroundThe integration of telehealth interventions into clinical practice is frequently delayed, hindering the full adoption. Previously, we developed a digital patient education (PE) programme for self-management in rheumatoid arthritis (RA). While the programme design considered crucial factors to ensure the likelihood of success in clinical practice, there is a need for a systematic evaluation of implementation perspectives. The purpose of this study was to explore perspectives crucial to implementation of a digital PE programme in clinical practice.MethodsThe non-adoption, abandonment, scale-up, spread and sustainability (NASSS) framework was used to evaluate the successes and challenges of implementing the digital PE programme. We included a data set consisting of qualitative focus group discussions involving study nurses, rheumatologists, and leaders from rheumatology departments. Data analysis was guided by a deductive content analysis approach. Further we included data from earlier studies pertaining to the programme’s implementation, comprising the programme development process, a randomized controlled trial evaluating the programme’s effectiveness, and a qualitative study exploring patients’ perspectives of the programme.ResultsFacilitators and challenges of importance to implementation of digital PE were identified. While a wide range of patients could benefit from using digital PE, future implementation should aim for an even broader group than those studied. Both patients and healthcare providers embraced the technology, and the fact that it did not require specific technical skills enhances its potential for success. However, offering digital PE should be based on individual assessments, and expanding its use will require organizational adjustments. An adaptable structure is needed to accommodate unforeseen care needs that may arise following the use of digital PE at home. There was indication of some reluctance among healthcare providers toward the programme shown by concerns about changing roles, which could impact the adoption of the program.ConclusionsThe design and ease of use of the technology, the program’s effectiveness, its availability, and the potential to release healthcare resources may encourage the implementation of digital patient education. Challenges associated with implementing this mode of care pertains to the condition and the patient population, user adoption of the technology, and the organization of patient education.Trial registrationThe study is registered by the Central Denmark Region Scientific Committee (no. 1-16-02-52-19).