Engagement Index Research Articles

Outcomes of Providing Children Aged 7-12 Years With Access to Evidence-Based Anxiety Treatment Via a Standalone Digital Intervention Using Immersive Gaming Technology: Real-World Evaluation.

Anxiety disorders are among the most common mental health conditions in childhood, but most children with anxiety disorders do not access evidence-based interventions. The delivery of therapeutic interventions via digital technologies has been proposed to significantly increase timely access to evidence-based treatment. Lumi Nova (BfB Labs Limited) is a digital therapeutic intervention designed to deliver evidence-based anxiety treatment for those aged 7-12 years through a mobile app incorporating immersive gaming technology. We aimed to evaluate the real-world impact of providing access to Lumi Nova through UK National Health Service-funded mental health services. We analyzed precollected anonymized data routinely captured through the implementation of Lumi Nova from children aged 7-12 years, who lived in the United Kingdom and had the opportunity to use the intervention for at least 1 week over an 18-month period. Engagement indices included whether the game key was activated, number of unique sessions, time spent engaging, and number of "challenges" completed. Clinical outcomes were assessed using the Goal-Based Outcomes measure and Child Outcome Rating Scale. Demographic data were analyzed to assess the health equality implications of Lumi Nova. Of 1029 eligible families invited to use Lumi Nova, 644 (62.5%) activated their game key, of whom 374 (58.1%) completed at least one in-game graded exposure challenge. The median number of unique sessions was 6 (IQR 3-12) and the median time spent engaging with the intervention was 42 (IQR 15-79) minutes. For the subset of young people with paired outcomes, there were statistically significant small to medium improvements in goal-based outcome scores (n=224; t223=5.78, P<.001; d=0.37, 95% CI 0.25-0.52) and Child Outcome Rating Scale scores (n=123; t122=5.10, P<.001; d=0.46, 95% CI 0.27-0.65) between the first and last data points. Two in 5 young people's scores reflected a change that would be considered reliable. Analysis of demographic characteristics tentatively suggested that children from ethnic minority backgrounds and those living in the most deprived neighbourhoods may be less likely to access Lumi Nova, but children from socioeconomically deprived areas were more likely to successfully complete a challenge once they accessed the intervention (P=.02). However, the level of missing data and small number of children in some demographic groups limited meaningful statistical comparisons. This study provides initial evidence that Lumi Nova may be associated with improved outcomes for those aged 7-12 years seeking anxiety treatment in real-world settings. However, the lack of a control comparator group and information about concurrent treatments accessed by the young people, in addition to substantial attrition, limited the analysis that could be conducted and confidence in the conclusions drawn.

Prediction of Social Engagement in Long-Term Care Homes by Sex: A Population-Based Analysis Using Machine Learning.

The objective of this study was to use population-based clinical assessment data to build and evaluate machine-learning models for predicting social engagement among female and male residents of long-term care (LTC) homes. Routine clinical assessments from 203,970 unique residents in 647 LTC homes in Ontario, Canada, collected between April 1, 2010, and March 31, 2020, were used to build predictive models for the Index of Social Engagement (ISE) using a data-driven machine-learning approach. General and sex-specific models were built to predict the ISE. The models showed a moderate prediction ability, with random forest emerging as the optimal model. Mean absolute errors were 0.71 and 0.73 in females and males, respectively, using general models and 0.69 and 0.73 using sex-specific models. Variables most highly correlated with the ISE, including activity pursuits, cognition, and physical health and functioning, differed little by sex. Factors associated with social engagement were similar in female and male residents.

Neuroergonomic Attention Assessment in Safety-Critical Tasks: EEG Indices and Subjective Metrics Validation in a Novel Task-Embedded Reaction Time Paradigm.

Background/Objectives: This study addresses the gap in methodological guidelines for neuroergonomic attention assessment in safety-critical tasks, focusing on validating EEG indices, including the engagement index (EI) and beta/alpha ratio, alongside subjective ratings. Methods: A novel task-embedded reaction time paradigm was developed to evaluate the sensitivity of these metrics to dynamic attentional demands in a more naturalistic multitasking context. By manipulating attention levels through varying secondary tasks in the NASA MATB-II task while maintaining a consistent primary reaction-time task, this study successfully demonstrated the effectiveness of the paradigm. Results: Results indicate that both the beta/alpha ratio and EI are sensitive to changes in attentional demands, with beta/alpha being more responsive to dynamic variations in attention, and EI reflecting more the overall effort required to sustain performance, especially in conditions where maintaining attention is challenging. Conclusions: The potential for predicting the attention lapses through integration of performance metrics, EEG measures, and subjective assessments was demonstrated, providing a more nuanced understanding of dynamic fluctuations of attention in multitasking scenarios, mimicking those in real-world safety-critical tasks. These findings provide a foundation for advancing methods to monitor attention fluctuations accurately and mitigate risks in critical scenarios, such as train-driving or automated vehicle operation, where maintaining a high attention level is crucial.

Patellar morphology is different in patellofemoral instability: An MRI comparative case-control study

PurposeAlthough patellofemoral instability (PFI) affects both femoral and patellar compartments, literature provided little attention for the patellar morphology contribution on PFI. This study evaluates the patellar morphology patterns on MRI to establish their contribution in PFI. MethodsThis study retrospectively analyzes patellar MRI and X-ray measurements performed between 2018 and 2022. 50 knees with recurrent patellar dislocation were matched with 50 matched knees of ACL-reconstruction candidates with no history of patellar dislocation based on age and gender. Caton-Deschamps’ index, Wiberg’s patellar morphotype, Dejour’s trochlear dysplasia classification, sagittal patellofemoral engagement index and additional patellar cartilage and bone parameters and their relative ratio measurements were assessed in both groups. ResultsStudy patients present differences in patellar morphology; a wider lateral facet (p = 0,019) and a narrower medial facet compared to the control group (p < 0,001). The subchondral patellar crest is medialized compared to the control group (p < 0,001). The cartilaginous crest measurements of the patella were not significantly different in both groups yet PFI group presents a wider Wiberg angle (p < 0,001), thus a flatter patella, compared to the control group. ConclusionThe patella in PFI patients presents a larger lateral facet, a narrower medial facet, a flatter surface and a medialized patellar crest compared with the control group. In PFI, a rather medial patellar crest might predispose towards a greater patellar tilt and destabilize the already compromised patellar-trochlear groove congruence. PFI is a multifactorial disease and both trochlea and patella play a role in its manifestation, thus, literature should address patellar morphotype contribution in patellofemoral instability.Level of Evidence: Level III.

The Triple E project: a factorial randomised controlled trial to enhance engagement with eHealth approaches to improve health risk behaviours among adolescents

BackgroundDigital, or eHealth, interventions are highly promising approaches to help adolescents improve their health behaviours and reduce their risk of chronic disease. However, they often have low uptake and retention. There is also a paucity of high-quality research into the predictors of eHealth engagement, and a lack of studies that have systematically evaluated existing engagement strategies in adolescent populations. This paper describes the protocol for a randomised controlled trial which primarily aims to assess the effectiveness of different strategies in increasing engagement with a healthy lifestyles app, Health4Life. Associations between the engagement strategies and improvements in adolescent health behaviours (healthy eating, physical activity, sleep, recreational screen time, smoking, alcohol use) will also be examined, along with potential predictors of adolescents’ intentions to use health apps and their use of the Health4Life app.MethodsThe current study will aim to recruit 336 adolescent and parent/guardian dyads (total sample N = 672) primarily through Australia wide online advertising. All adolescent participants will have access to the Health4Life app (a multiple health behaviour change, self-monitoring mobile app). The trial will employ a 24 factorial design, where participants will be randomly allocated to receive 1 of 16 different combinations of the four engagement strategies to be evaluated: text messages, access to a health coach, access to additional gamified app content, and provision of parent/guardian information resources. Adolescents and parents/guardians will both complete consent processes, baseline assessments, and a follow-up assessment after 3 months. All participants will also be invited to complete a qualitative interview shortly after follow-up. The primary outcome, app engagement, will be assessed via an App Engagement Index (Ei) using data collected in the Health4Life app and the Mobile App Rating Scale – User version.DiscussionThis research will contribute significantly to building our understanding of the types of strategies that are most effective in increasing adolescents’ engagement with health apps and which factors may predict adolescents’ use of health apps.Trial registrationThe trial is registered at the Australian New Zealand Clinical Trials Registry (ACTRN12623000399695). Date registered: 19/04/2023.

Quantitative Measures of Engagement in History Classes: Analyzing the Efficacy of Interactive Pedagogies

This study aimed to evaluate the impact of interactive pedagogy on student engagement and knowledge retention. A quantitative method was used. The sample was 500 students from three high schools. The Engagement measurement instrument and Knowledge Retention Test were used to measure engagement and knowledge retention metrics. Data collection was conducted over one semester. Data analysis used descriptive statistics, inferential, ANOVA, and Effectiveness Index. The results of this study confirmed that classroom activity engagement reached 88.32%, and history knowledge retention reached 80.30%, indicating the success of the pedagogical intervention. The Effectiveness Index of student engagement and knowledge retention was 35.70%.

A Study of the Impact of Artificial Intelligence on Consumer Decision Making

The article considers not only the obvious benefits of using AI, but also potential risks associated with changing consumer behavior. The study introduces the User Engagement Index (UEI), which allows measuring and comparing user activity and interaction with marketplaces, considering the influence of AI. The proposed methodology can become the basis for further research in the field of human-artificial intelligence interaction in the digital environment. The UEI formula allows for a comprehensive assessment of user engagement, considering several key factors that influence user behavior on the site.

Predicting Long-Term Engagement in mHealth Apps: Comparative Study of Engagement Indices.

Digital health care apps, including digital therapeutics, have the potential to increase accessibility and improve patient engagement by overcoming the limitations of traditional facility-based medical treatments. However, there are no established tools capable of quantitatively measuring long-term engagement at present. This study aimed to evaluate an existing engagement index (EI) in a commercial health management app for long-term use and compare it with a newly developed EI. Participants were recruited from cancer survivors enrolled in a randomized controlled trial that evaluated the impact of mobile health apps on recovery. Of these patients, 240 were included in the study and randomly assigned to the Noom app (Noom Inc). The newly developed EI was compared with the existing EI, and a long-term use analysis was conducted. Furthermore, the new EI was evaluated based on adapted measurements from the Web Matrix Visitor Index, focusing on click depth, recency, and loyalty indices. The newly developed EI model outperformed the existing EI model in terms of predicting EI of a 6- to 9-month period based on the EI of a 3- to 6-month period. The existing model had a mean squared error of 0.096, a root mean squared error of 0.310, and an R2 of 0.053. Meanwhile, the newly developed EI models showed improved performance, with the best one achieving a mean squared error of 0.025, root mean squared error of 0.157, and R2 of 0.610. The existing EI exhibited significant associations: the click depth index (hazard ratio [HR] 0.49, 95% CI 0.29-0.84; P<.001) and loyalty index (HR 0.17, 95% CI 0.09-0.31; P<.001) were significantly associated with improved survival, whereas the recency index exhibited no significant association (HR 1.30, 95% CI 1.70-2.42; P=.41). Among the new EI models, the EI with a menu combination of menus available in the app's free version yielded the most promising result. Furthermore, it exhibited significant associations with the loyalty index (HR 0.32, 95% CI 0.16-0.62; P<.001) and the recency index (HR 0.47, 95% CI 0.30-0.75; P<.001). The newly developed EI model outperformed the existing model in terms of the prediction of long-term user engagement and compliance in a mobile health app context. We emphasized the importance of log data and suggested avenues for future research to address the subjectivity of the EI and incorporate a broader range of indices for comprehensive evaluation.

Special measures to promote supplementary professional education services: formation and evaluation of effectiveness

Introduction. The problem of promotion of supplementary professional education services is one of the important issues for attracting consumers of professional retraining and advanced development programmes, contributing to marketing attainments and a company’s efficiency in general. The solution largely depends on the developmental level of the market of supplementary professional education services at a regional level, the specifics and quality of training courses, as well as the relevance of promotion tools used by the organisation. Purpose of the research: development and approbation of the methodology for forming and evaluating the effectiveness of a special tool for the promotion of supplementary professional education services. Materials and methods. To determine the format of a special survey, an online questioning of 1,035 potential consumers was carried out; ten marketing and advertising experts were interviewed and selected by the Delphi method modified by J. Fowles; a questioning of 319 participants and 20 organisers of the special survey was undertaken. The expert judgement was arranged using the Hierarchy Analysis Method by T. Saati, including the processing of the data obtained in the course of the experts interviewing and the calculation of eigenvectors of the pairwise comparison matrix. Results. A methodology for forming and evaluating the effectiveness of a special survey was developed. As a result of the approbation, eleven qualitative indicators were evaluated, scoring 7.92 out of nine, totalling 88%. The quantitative indicators, particularly, the engagement index was 56.8%; the key performance indicator was 8.5% and the return on investment was 336.8%. As a result of the special survey, 27 participants acquired the Internet marketing course. Conclusion. The proposed methodology can extend the opportunities of organisations providing supplementary special education services in terms of selecting, planning and realisation of efficient promotion tools. The methodology can be applied to the formation and evaluation of different-format special surveys with regard to their specifics.

Reconsidering the impact of environmental, social and governance practices on firm profitability

PurposeThis paper investigates the relationship between commitment to ESG practices and firm performance using a synthetic index based on ESG disclosure and ESG performance scores.Design/methodology/approachUsing the Mazziotta-Pareto aggregation method, we develop a novel synthetic index of ESG engagement based on ESG rating and disclosure. This index is employed in a dynamic panel regression, implemented using the Arellano-Bond estimator, to explain profitability in a sample of 146 listed Canadian firms over the period spanning from 2014 to 2021.FindingsESG practices may either foster or hinder firm performance. In particular, a synergy emerges between the social and environmental dimensions of ESG practices, shedding light on the relevance of high standards in terms of environmental and social activities.Practical implicationsThe study emphasizes the significance of acknowledging the various facets of ESG engagement and the necessity of transcending the current constraints of accessible ESG data and ratings. Synthetic indices combining different types of ESG information may contribute to mitigating the problems created by strategic disclosure on the part of firms, which typically results in undesirable practices such as greenwashing and social washing.Originality/valueThis is the first study that applies the Mazziotta-Pareto method to develop a synthetic index of ESG engagement, tackling each pillar separately. Moreover, when investigating the effect of ESG engagement on profitability, we allow for cross-pillar synergies and/or trade-offs.

The Impact of User Engagement With Exposure Components on Posttraumatic Stress Symptoms in an mHealth Mobile App: Secondary Analysis of a Randomized Controlled Trial.

Mobile mental health apps are a cost-effective option for managing mental health problems, such as posttraumatic stress disorder (PTSD). The efficacy of mobile health (mHealth) apps depends on engagement with the app, but few studies have examined how users engage with different features of mHealth apps for PTSD. This study aims to examine the relationship between app engagement indices and PTSD symptom reduction using data from an unblinded pilot randomized controlled trial of "Renew" (Vertical Design), an exposure-based app for PTSD with and without coaching support. Because exposure is an effective approach for treating PTSD, we expected that engagement with exposure activities would be positively related to symptom reduction, over and above overall app usage. Participants were veterans (N=69) with clinically significant PTSD symptoms who were recruited online using Facebook advertisements and invited to use the Renew app as often as they wanted over a 6-week period. Participants completed screening and assessments online but provided informed consent, toured the app, and completed feedback interviews via telephone. We assessed users' self-reported PTSD symptoms before and after a 6-week intervention period and collected app usage data using a research-instrumented dashboard. To examine overall app engagement, we used data on the total time spent in the app, the number of log-in days, and the number of points that the user gained in the app. To examine engagement with exposure components, we used data on total time spent completing exposure activities (both in vivo and imaginal), the number of in vivo exposure activities completed, and the number of characters written in response to imaginal exposure prompts. We used hierarchical regression analyses to test the effect of engagement indices on change in PTSD symptoms. Usage varied widely. Participants spent an average of 166.09 (SD 156.52) minutes using Renew, over an average of 14.7 (SD 10.71) mean log-in days. Engagement with the exposure components of the app was positively associated with PTSD symptom reduction (F6,62=2.31; P=.04). Moreover, this relationship remained significant when controlling for overall engagement with the app (ΔF3,62=4.42; P=.007). The number of characters written during imaginal exposure (β=.37; P=.009) and the amount of time spent completing exposure activities (β=.36; P=.03) were significant contributors to the model. To our knowledge, this is the first study to show a relationship between symptom improvement and engagement with the active therapeutic components of an mHealth app (ie, exposure) for PTSD. This relationship held when controlling for overall app use, which suggests that it was engagement with exposure, specifically, that was associated with symptom change. Future work to identify ways of promoting greater engagement with self-guided exposure may help improve the effectiveness of mHealth apps for PTSD.

Scalp Electroencephalogram-Derived Involvement Indexes during a Working Memory Task Performed by Patients with Epilepsy.

Electroencephalography (EEG) wearable devices are particularly suitable for monitoring a subject's engagement while performing daily cognitive tasks. EEG information provided by wearable devices varies with the location of the electrodes, the suitable location of which can be obtained using standard multi-channel EEG recorders. Cognitive engagement can be assessed during working memory (WM) tasks, testing the mental ability to process information over a short period of time. WM could be impaired in patients with epilepsy. This study aims to evaluate the cognitive engagement of nine patients with epilepsy, coming from a public dataset by Boran et al., during a verbal WM task and to identify the most suitable location of the electrodes for this purpose. Cognitive engagement was evaluated by computing 37 engagement indexes based on the ratio of two or more EEG rhythms assessed by their spectral power. Results show that involvement index trends follow changes in cognitive engagement elicited by the WM task, and, overall, most changes appear most pronounced in the frontal regions, as observed in healthy subjects. Therefore, involvement indexes can reflect cognitive status changes, and frontal regions seem to be the ones to focus on when designing a wearable mental involvement monitoring EEG system, both in physiological and epileptic conditions.

Developing U.S. West Coast recreational fishing community measures: Applying an index approach in the context of COVID-19 and social vulnerability

Despite the socio-economic importance of recreational fishing across many coastal communities, a well-defined conceptualization for place-based recreational fishing communities has remained noticeably absent across the U.S. West Coast. Following the framework of natural-resource dependence, this study constructs and evaluates recreational fishing indices, which serve as tools for assessing the involvement and impact of recreational fishing within different communities at the scale of the Census Designated Place. Components of the indices are selected to construct an engagement index of the overall economic activity related to recreational fishing, while a reliance index considers engagement per capita. The indices were then conceptually validated through correlation analyses with proxies for participation and interest. Temporal variations in both indices were evaluated in the context of the COVID-19 pandemic through a series of mixed-linear models, providing the first detailed assessment of the pandemic's impact on recreational fishing activity across the region. Despite shifts in individual angler participation and interest, the indices remained stable, with engagement declining following the pandemic. Additionally, the communities are evaluated with regard to their social vulnerability, finding communities with higher engagement as less vulnerable than those with higher reliance. Overall, this work provides valuable insights for identifying and assessing recreational fishing communities, potentially informing more sustainable and socially equitable management approaches.

Relationships among health promotion behaviors, patient engagement, and the nurse practitioner-patient partnership.

Individuals adopting health promotion behaviors benefit from improved health and reduced risk of chronic diseases. Patient engagement and a strong provider-patient partnership may play a role in health promotion. This study examined the relationships between patient engagement, the nurse practitioner-patient partnership and health promotion behaviors among adults in a primary care setting. A descriptive correlational study using convenience sampling to recruit 85 participants from a nurse practitioner primary care practice. Participants completed questionnaires measuring health promotion behaviors (Health Promoting Lifestyle Profile II), the quality of the nurse practitioner-patient partnership (Patient Reactions Assessment), and a person's capacity to engage in their health care (Person Engagement Index). Moderate to strong correlations were found among the main study variables. Multiple regression analysis found a person's capacity to engage in health care significantly predicted health promotion behaviors (R2 = 0.362, p < .001) and explained 36.2% of the variance in health promotion behaviors. Patient engagement is a significant predictor of health promotion behaviors. The interactive care model can serve as a framework for nurse practitioners to build partnerships and facilitate patient engagement. Nurse practitioners can serve as a coach, navigator, collaborator, and trusted health care partner with their patients. Nurse practitioners in primary care may need to restructure the health care encounter to allow for adequate time to communicate, listen, educate, and enlist patients in the shared decision-making process. Nurse practitioners can provide the support patients need to engage in their health care as they accept greater responsibility for their health.

A dissociation between the effects of expectations and attention in selective visual processing

It is often claimed that probabilistic expectations affect visual perception directly, without mediation by selective attention. However, these claims have been disputed, as effects of expectation and attention are notoriously hard to dissociate experimentally. In this study, we used a new approach to separate expectations from attention. In four experiments (N = 60), participants searched for a target in a rapid serial visual presentation (RSVP) stream and had to identify a digit or a letter defined by a low-level cue (colour or shape). Expectations about the target's alphanumeric category were probabilistically manipulated. Since category membership is a high-level feature and since the target was embedded among many distractors that shared its category, targets from the expected category should not attract attention more than targets from the unexpected category. In the first experiment, these targets were more likely to be identified relative to targets from the unexpected category. Importantly, in the following experiments, we also included behavioural and electrophysiological indices of attentional guidance and engagement. This allowed us to examine whether expectations also modulated these or earlier attentional processes. Results showed that category-based expectations had no modulatory effects on attention, and only affected processing at later encoding-related stages. Alternative interpretation of expectation effects in terms of repetition priming or response bias were also ruled out. These observations provide new evidence for direct attention-independent expectation effects on perception. We suggest that expectations can adjust the threshold required for encoding expectations-congruent information, thereby affecting the speed with which target objects are encoded in working memory.

Impact of Adverse Childhood Experiences and Mental Health on School Success in Autistic Children: Findings from the 2016-2021 National Survey of Children's Health.

School is an important developmental setting for children. Adverse childhood experiences (ACEs) are linked to overall lower educational attainment and are more prevalent in children with Autism Spectrum Disorder (ASD) than in their neurotypical peers. The aim of this study is to test the association between ACEs and school outcomes among autistic children and whether mental health conditions explain this association. We combined 2016-2021 data from the National Surveys of Children's Health for children, ages 6-17, identified by parents as having ASD (N = 4,997), to examine the relationship between ACEs and school outcomes (grade progression, school attendance, and engagement). We analyzed depression and anxiety variables to investigate the extent to which mental health can explain the relationships between ACEs and school outcomes. ACEs were significantly associated with school outcomes. With increased ACEs, autistic children experienced a significant decrease in the odds of school attendance, grade progression and school engagement (p < .05). Furthermore, although depression and anxiety symptoms were significantly associated with school outcomes, they cannot explain away the enduring, strong relationship between ACEs and level of grade progression, engagement, and school success index. Our findings suggest ACEs predict school success among autistic children, with mental health conditions appearing to mediate the relationship between ACEs and key factors in school success. Efforts should be made to proactively identify and address the impact of ACEs and associated mental health conditions among autistic students.

Anxiety Symptoms in Young Children Are Associated With a Maladaptive Neurobehavioral Profile of Error Responding

BackgroundChildhood anxiety symptoms have been linked to alterations in cognitive control and error processing, but the diverse findings on neural markers of anxiety in young children, which vary by severity and developmental stage, suggest the need for a wider perspective. Integrating new neural markers with established ones, such as the error-related negativity, the error positivity, and frontal theta, could clarify this association. Error-related alpha suppression (ERAS) is a recently proposed index of post-error attentional engagement that has not yet been explored in children with anxiety. MethodsTo identify neurobehavioral profiles of anxiety in young children by integrating ERAS with the error-related negativity, error positivity, frontal theta, and post-error performance indicators, we employed K-means clustering as an unsupervised multimetric approach. For this, we first aimed to confirm the presence and scalp distribution of ERAS in young children. We performed event-related potentials and spectral analysis of electroencephalogram data collected during a Go/NoGo task (Zoo Task) completed by 181 children (ages 4–7 years; 103 female) who were sampled from across the clinical-to-nonclinical range of anxiety severity using the Child Behavior Checklist. ResultsResults confirmed ERAS, showing lower post-error alpha power, maximal suppression at occipital sites, and less ERAS in younger children. K-means clustering revealed that high anxiety and younger age were associated with reduction in ERAS and frontal theta, less negative error-related negativity, enlarged error positivity, more post-error slowing, and reduced post-error accuracy. ConclusionsOur findings indicate a link between ERAS, maladaptive neural mechanisms of attention elicited by errors, and anxiety in young children, suggesting that anxiety may arise from or interfere with attention and error processing.

Social engagement and cognitive impairment among nursing home residents: The role of sensory impairment

Background and objectivesUsing US national nursing home data, this cross-sectional study sought to evaluate 1) the association between lack of social engagement and level of cognitive impairment; and 2) the extent to which this association differs by hearing and visual impairment. Research design and methodsOur sample included 793,846 nursing home residents aged ≥ 50 years. The Index of Social Engagement was categorized as none/lower (0, 1, 2) or higher levels (3 through 6). Cognitive Performance Scale was grouped as intact/mild (0, 1, 2), moderate (3, 4), or severe (5, 6). Multinomial models provided adjusted odds ratio (aOR) and 95 % confidence intervals (CI) between none/lower social engagement and cognitive impairment. We estimated relative excess risk due to interaction (RERI) to quantify the joint effects of social engagement and sensory impairment types. ResultsOverall, 12.6 % had lower social engagement, 30.3 % had hearing impairment, and 40.3 % had visual impairment. Compared to residents with high social engagement, those with lower social engagement were more likely to have moderate/severe cognitive impairment (aORmoderate = 2.21, 95 % CI 2.17–2.26; aORsevere = 6.49, 95 % CI 6.24–6.74). The impact of low social engagement on cognitive impairment was more profound among residents with hearing impairment and/or visual impairment (RERIhearing = 3.89, 95 % CI 3.62–4.17; RERIvisual = 25.2, 95 % CI 23.9–26.6)). Discussion and implicationsResidents with lower social engagement had higher levels of cognitive impairment. Residents with sensory impairments are potentially more susceptible to the negative impact of lower levels of social engagement on level of cognitive impairment.

The human subthalamic nucleus transiently inhibits active attentional processes.

The subthalamic nucleus (STN) of the basal ganglia is key to the inhibitory control of movement. Consequently, it is a primary target for the neurosurgical treatment of movement disorders like Parkinson's disease, where modulating the STN via deep brain stimulation (DBS) can release excess inhibition of thalamocortical motor circuits. However, the STN is also anatomically connected to other thalamocortical circuits, including those underlying cognitive processes like attention. Notably, STN-DBS can also affect these processes. This suggests that the STN may also contribute to the inhibition of non-motor activity and that STN-DBS may cause changes to this inhibition. Here we tested this hypothesis in humans. We used a novel, wireless outpatient method to record intracranial local field potentials (LFP) from STN DBS implants during a visual attention task (Experiment 1, n = 12). These outpatient measurements allowed the simultaneous recording of high-density EEG, which we used to derive the steady state visual evoked potential (SSVEP), a well established neural index of visual attentional engagement. By relating STN activity to this neural marker of attention (instead of overt behaviour), we avoided possible confounds resulting from STN's motor role. We aimed to test whether the STN contributes to the momentary inhibition of the SSVEP caused by unexpected, distracting sounds. Furthermore, we causally tested this association in a second experiment, where we modulated STN via DBS across two sessions of the task, spaced at least 1 week apart (n = 21, no sample overlap with Experiment 1). The LFP recordings in Experiment 1 showed that reductions of the SSVEP after distracting sounds were preceded by sound-related γ-frequency (>60 Hz) activity in the STN. Trial-to-trial modelling further showed that this STN activity statistically mediated the sounds' suppressive effect on the SSVEP. In Experiment 2, modulating STN activity via DBS significantly reduced these sound-related SSVEP reductions. This provides causal evidence for the role of the STN in the surprise-related inhibition of attention. These findings suggest that the human STN contributes to the inhibition of attention, a non-motor process. This supports a domain-general view of the inhibitory role of the STN. Furthermore, these findings also suggest a potential mechanism underlying some of the known cognitive side effects of STN-DBS treatment, especially on attentional processes. Finally, our newly established outpatient LFP recording technique facilitates the testing of the role of subcortical nuclei in complex cognitive tasks, alongside recordings from the rest of the brain, and in much shorter time than peri-surgical recordings.

Innovating Online Otolaryngology: The Development of the ENT Content Engagement and Quality Index for Audiovisual Material.

Introduction The advent of social media platforms, notably TikTok, has significantly transformed the landscape of health information dissemination, offering both opportunities and challenges for public health communication. This study focuses on TikTok's influence on sinus health information, addressing the dual challenge of widespread engagement and the risk of misinformation in otolaryngology, or ENT (ear-nose-throat), information online. We introduce the ENT Content Engagement and Quality Index (ENT-CEQI), a pioneering tool designed to assess the quality and engagement of ENT-related content on TikTok, aiming to improve public understanding of sinus health. Materials and methods Our methodology involved a systematic analysis of sinus health-related content on TikTok. We collected data on the top 100 most popular videos using the hashtag #sinus at two different points in time, analyzing engagement metrics and content quality. The ENT-CEQI was developed to evaluate content, incorporating both quantitative engagement metrics (views, likes, comments, shares, favorites) and qualitative assessments (accuracy, clarity, relevance, practicality, engagement). The study employed statistical analyses, including trend analysis, correlation analysis, principal component analysis (PCA), KMeans clustering, regression analysis, and the Kruskal-Wallis test, to understand the dynamics of content engagement and quality. Results Initial findings revealed significant disparities in engagement metrics and quality scores among different content creator categories, with physician-generated content showing the highest engagement and quality. The trend analysis indicated shifts in content popularity and quality over time, with a notable increase in views and likes for private company content. The PCA and clustering analyses identified distinct content clusters, offering insights into viewer engagement patterns. Regression analysis and the Kruskal-Wallis test, however, did not find significant predictors (p-value: 0.3916) of content quality or differences in likes across content types, suggesting complex factors influencing content engagement and quality perception. Discussion The study highlights TikTok's potential and pitfalls in disseminating sinus health information. The introduction of the ENT-CEQI represents a major step toward enhancing the evaluation of health content on social media, emphasizing the importance of accuracy, clarity, and relevance in public health communication. The analysis underscores the complexity of social media engagement and the need for robust tools to assess content quality. It also points to the critical role of healthcare professionals in engaging with the public through social media to combat misinformation. Conclusions TikTok serves as a potent platform for sinus health education, capable of reaching wide and diverse audiences. The ENT-CEQI emerges as a vital tool for assessing the quality and engagement of ENT-related content, guiding content creators toward producing more reliable and informative content. This study contributes to the understanding of social media's role in health communication, advocating for the strategic use of innovative tools such as the ENT-CEQI to enhance public health outcomes through improved online health education and misinformation management.