Site Information Research Articles

Web Presence and Search Engine Optimization on Hotel Patronage in Akwa Ibom State, Nigeria

This study examined the effect of web presence and search engine optimization on hotel patronage in Akwa Ibom State, Nigeria. Web presence, search engine optimization and hotel patronage formed the specific objectives of the study. 1122 employees that had access to information of customers who made hotel reservations from forty-one hotels registered with Akwa Ibom State Hotels Management and Tourism Board formed the population. The study employed a census sampling technique. Primary data were gathered through a structured questionnaire. Simple percentages and charts were employed for the demographic analyses, leveraging the Statistical Package for Social Sciences (SPSS) version 25 to facilitate the data analyses. The univariate analyses were done using means and standard deviations to provide insights into the central tendencies and variability of the data. To test the study hypotheses, the researchers employed Partial Least Square-Structural Equation Modelling (PLS-SEM), facilitated by the SmartPLS version 3.2.9 software. Findings of the study showed that web presence (β = 0.713, t- value = 10.156, p-value = 0.011 < 0.05) had positive significant effect on hotel patronage in Akwa Ibom State and search engine optimization (β = 0.613, t-value = 8.046, p-value = 0.003 < 0.05, a statistically significant and positive effect on hotel patronage. Based on the empirical findings, we recommended that management of hotels in Akwa Ibom State should ensure that they have a well- designed, user-friendly, and informative website that showcase their offerings and provides a seamless booking experience for customers. Regular updates and maintenance of the website should be a priority to keep it relevant and engaging. The hotel owners and operators should prioritize the implementation of effective search engine optimization strategies to improve their visibility on search engine results pages. This should include optimizing their website content, improving website structure and navigation, and leveraging relevant keywords to attract potential customers.

Examining the sustainable leisure and business values in sporting events and lottery analyses development

Purpose: This study aims to clarify the meaning of sport analysis, explore the contributions derived from sporting event analysts, and highlights the importance of responsible sport gambling. It also investigates how sustainable practices can be integrated into sports analysis to enhance social well-being. Design/methodology/approach: Secondary text data from government documents, news articles, and website information were extracted by searching keywords such as sports lottery and sports analysis in traditional Chinese, and then analyzed to establish the research framework and scope. Subsequently, 18 interviews were conducted with stakeholders to gain deeper insights. Findings: The content analyses reveals that sport analysis tends to be sport data science. Sporting event analysts may contribute to improving the performance of players or a team, enhancing spectator sports, and increasing sports lottery revenues. In the leisure aspect, the professionalism of sporting event analysts not only increases epistemic and entertainment values in spectator sports but also boosts engagement with sport lotteries. To ensure these enhancements remain beneficial, it is vital to emphasize responsible sport gambling and sustainable practices that protect vulnerable groups and promote long-term health benefits for those involved in sports. The integration of sustainable practices in sport analysis and the expertise of sporting event analysts can significantly advance economic and social development by generating funds through sport lottery industry for athlete programs, sports infrastructure, and educational initiatives, aligning with multiple Sustainable Development Goals. Additionally, the professionalism of these analysts may enhance public understanding and engagement of sports, promoting increased participation in sports, reducing healthcare costs, and contributing to the development of a healthier and more resilient society. Originality: Emphasizing responsible sports gambling is essential to the sustainability of sports lotteries and the role of sporting event analysts.

Challenges and guidance for implementing social distancing for COVID-19 in care homes: a mixed methods rapid review.

Older people living in care homes are at high risk of poor health outcomes and mortality if they contract coronavirus disease 2019. Protective measures include social distancing and isolation, although implementation is challenging. To explore the real-life experiences of social distancing and isolation in care homes for older people, and to develop a toolkit of guidance and resources. A mixed-methods, phased design. Six care homes in England caring for older adults. Care home staff (n = 31), residents (n = 17), family members (n = 17), senior health and care leaders (n = 13). A rapid review to assess the social distancing and isolation measures used by care homes to control the transmission of coronavirus disease 2019 and other infectious diseases (phase 1), in-depth case studies of six care homes, involving remote individual interviews with staff, residents and families, collection of policies, protocols and routinely collected care home data, remote focus groups with senior health and care leaders (phase 2) and stakeholder workshops to co-design the toolkit (phase 3). Interview and focus group data and care home documents were analysed using thematic analysis and care home data using descriptive statistics. The rapid review of 103 records demonstrated limited empirical evidence and the limited nature of policy documentation around social distancing and isolation measures in care homes. The case studies found that social distancing and isolation measures presented moral dilemmas for staff and often were difficult, and sometimes impossible to implement. Social distancing and isolation measures made care homes feel like an institution and denied residents, staff and families of physical touch and other forms of non-verbal communication. This was particularly important for residents with cognitive impairment. Care homes developed new visiting modalities to work around social distancing measures. Residents and families valued the work of care homes to keep residents safe and support remote communication. Social distancing, isolation and related restrictions negatively impacted on residents' physical, psychological, social and cognitive well-being. There were feelings of powerlessness for families whose loved ones had moved into the care home during the pandemic. It was challenging for care homes to capture frequent updates in policy and guidance. Senior health and care leaders shared that the care home sector felt isolated from the National Health Service, communication from government was described as chaotic, and trauma was inflicted on care home staff, residents, families and friends. These multiple data sources have informed the co-design of a toolkit to care for residents, families, friends and care home staff. The review included papers published in English language only. The six care homes had a Care Quality Commission rating of either 'good' or 'outstanding'. There was a lack of ethnic diversity in resident and family participants. Care homes implemented innovative approaches to social distancing and isolation with varying degrees of success. A legacy of learning can help rebuild trust at multiple levels and address trauma-informed care for residents, families, friends and staff. Future work can include evaluation of the toolkit, research to develop a trauma-informed approach to caring for the care home sector and co-designing and evaluating an intervention to enable residents with different needs to transition to living well in a care home. This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR132541) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 45. See the NIHR Funding and Awards website for further award information.

Understanding and improving the quality of primary care for people in prison: a mixed-methods study.

People in prison are generally in poorer health than their peers in the community, often living with chronic illness and multimorbidity. Healthcare research in prisons has largely focused on specific problems, such as substance use; less attention has been paid to conditions routinely managed in primary care, such as diabetes or hypertension. It is important to understand how primary care in prisons is currently delivered in the United Kingdom and how it can be improved, in order to reduce health inequalities. To understand the quality of primary care in prison, including gaps and variations in care, in order to recommend how quality of prison health care can be improved. A mixed-methods study with six interlinked work packages. Predominantly the North of England. Between August 2019 and June 2022, we undertook the following work packages: (1) International scoping review of prison healthcare quality indicators. (2) Stakeholder consensus process to identify United Kingdom focused prison healthcare quality indicators. (3) Qualitative interview study with 21 people who had been in prison and 22 prison healthcare staff. (4) Quantitative analysis of anonymised, routinely collected data derived from prison healthcare records (~ 25,000 records across 13 prisons). (5) Stakeholder deliberation process to identify interventions to improve prison health care. (6a) Secondary analysis of the qualitative data set, focusing on mental health and (6b) analysis of the quantitative data set, focusing on health care of three mental health subgroups. Our scoping review found predominantly only papers from the United States of America and of variable rigour with the main finding being that performance measurement is very challenging in the prison healthcare setting. In collaboration with stakeholders, we prioritised, refined and applied a suite of 30 quality indicators across several healthcare domains. We found considerable scope for improvement in several indicators and wide variations in indicator achievement that could not be attributed to differences in prison population characteristics. Examples of indicators with scope for improvement included: diabetes care, medicines reconciliation and epilepsy review and control. Longer length of stay in prison was generally associated with higher achievement than shorter stays. Indicator achievement was generally low compared to that of community general practice. We found some encouraging trends and relatively good performance for a minority of indicators. Our qualitative interviews found that quality of health care is related to factors that exist at several levels but is heavily influenced by organisational factors, such as understaffing, leading to a reactive and sometimes crisis-led service. Our stakeholder deliberations suggested opportunities for improvement, ideally drawing on data to assess and drive improvement. Our mental health work package found that coded mental illness had mixed associations with indicator achievement, while the interviews revealed that mental distress is viewed by many as an inevitable facet of imprisonment. Our analyses of indicator achievement were limited by the quality and coverage of available data. Most study findings are localised to England so international applicability may differ. Marked variations in the quality of primary care in prisons are likely to be attributable to the local organisation and conditions of care delivery. Routinely collected data may offer a credible driver for change. This study is registered at researchregistry.com (Ref: 5098). This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 17/05/26) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 46. See the NIHR Funding and Awards website for further award information.

A self-efficacy enhancement alcohol reduction intervention for men on-remand in prison: the APPRAISE feasibility pilot RCT.

As many as 70% of remand prisoners have admitted to being under the influence of alcohol when committing the crime leading to their imprisonment. Providing support and advice regarding alcohol consumption can be effective in some groups of people. There is little evidence regarding this for men on remand in prison. To pilot the study measures and evaluation methods to assess the feasibility of conducting a future definitive multicentre, pragmatic, parallel group, randomised controlled trial. A two-arm, parallel group, individually randomised pilot study of a self-efficacy-enhancing psychosocial alcohol intervention to reduce levels of alcohol consumption for males on remand in prison and on liberation. Two purposively selected prisons in Scotland and England. Adult men on remand in prison with an Alcohol Use Disorders Identification Test score of ≥8. The APPRAISE intervention delivery comprised four steps: Step 1: 1×40-minute face-to-face session, delivered by a trained practitioner from Change Grow Live in prison. Steps 2, 3 and 4: 20-minute sessions conducted by phone, on or as close as possible to days 3, 7 and 21 post liberation. Control: assessment, screening and referral onto further alcohol support options. Recruitment and retention rates, completion of follow-ups, outcome measures at 12 months and interventions delivered. The primary outcome for the pilot study was alcohol consumed in the 28 days prior to Time Point 2, assessed using the extended Alcohol Use Disorders Identification Test-C. Of 182 men on remand approached across two study sites, 132 were randomised (90 in England; 42 in Scotland) with 46 randomised to intervention and 44 to care as usual in England and 22 randomised to intervention and 20 to care as usual in Scotland. A total of 53 in-prison interventions were delivered. One day-3 post-liberation intervention was delivered, no day-7 and one day-21. At 12 months, of 132 randomised, 18 (13%) were followed up, 53 (40%) were not liberated; 47 (36%) were uncontactable and 14 (11%) had been released but could not be located. Data completeness was 96% at baseline and 8% at 12 months. The process evaluation reported good acceptability of the intervention with investment in time, capacity and space to support implementation identified. The economic study produced guidance on how to assess costs associated with implementing the APPRAISE intervention which could be applied more broadly. No adverse events or side effects were noted. A future definitive trial would be possible, but only if follow-up mechanisms can be addressed as well as full access to recidivism and health data. Collaboration with the probation service in future could offer the opportunity to develop a robust process and system to optimise follow-up post liberation. Dedicated resources to support the intervention delivery both in and out of the prison setting are recommended. Coronavirus disease discovered in 2019 impacted recruitment and follow-up, with access to prisons restricted. We were unable to deliver the post-liberation element of the intervention. We did not include probation services or other agencies in the trial. This trial is registered as Current Controlled Trials ISRCTN36066. This award was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (NIHR award ref: 17/44/11) and is published in full in Public Health Research; Vol. 12, No. 11. See the NIHR Funding and Awards website for further award information.

School food policy in secondary schools in England and its impact on adolescents' diets and dental health: the FUEL multiple-methods study.

School food standards are a legal requirement for state-funded schools in England and are designed to promote healthy eating in pupils. However, state-funded academies/free schools established between 2010 and 2014 are exempt from this legislation. To complement the school food standards, the government launched the School Food Plan in 2013, which outlines voluntary actions that schools can take to support healthy eating and increase school meal uptake. There has been little evaluation of the school food standards and School Food Plan in secondary schools. To compare implementation and costs of the school food standards and School Food Plan, and pupil dietary and dental outcomes in two groups of secondary schools: those mandated and those not mandated to comply with the school food standards legislation. An observational, multiple-methods study. We sampled state-funded secondary school academies/free schools, pupils aged 11-15 years, and school staff/governors with a role in food provision/education from the Midlands. We collected qualitative data in four schools. The primary outcome was pupil free sugar intake at lunch; across the school day; and during 24-hours. Secondary outcomes were additional nutritional outcomes and dental caries measures. We assessed school food standards/School Food Plan implementation and costs using researcher observation, document analysis, and surveys with staff/governors, schools and pupils. Dietary intake and dental outcomes were measured online using 24-hour dietary recall and surveys, respectively. In the qualitative study we conducted staff/governor interviews and pupil focus groups in a subsample of schools. We used multilevel analyses to explore variation in pupil outcomes across the school food standards-mandated and school food standards-non-mandated school groups. Data were analysed using the Framework approach. Thirty-six schools (13 school food standards-mandated, 23 school food standards-non-mandated), 2453 pupils and 151 staff/governors participated. On average, schools were compliant with 64% of school food standards and implemented 41% of School Food Plan actions, with no differences across school food standards-mandated/non-mandated schools. There was a wide variation in annual costs of the school food standards and School Food Plan reported by schools (mean of £195 per pupil). Pupils in school food standards-mandated schools had lower lunch intakes of free sugar than those in school food standards-non-mandated schools (adjusted mean difference = -2.78 g, 95% confidence interval -4.66 to -0.90 g). After further adjustment for total energy intake, there was no significant difference in free sugar intake, but the school food standards-mandated group had lower fruit and vegetable intake at all time points, and higher consumption of confectionery during the school day and sugar-sweetened beverages over 24 hours. There were no differences in dental outcomes between the two groups. Twenty-one staff/governors and 137 pupils participated in the qualitative study. Staff described balancing school food standards compliance with conflicting priorities related to financial viability. Some pupils felt that school food did not meet their needs for convenience, speed, value for money and taste, and disliked the lunchtime experience. Little time was afforded to healthy-eating education within the curriculum. There were large numbers of missing data for some study elements, including assessment of some School Food Plan actions and cost data. In the secondary school context, the current school food standards are difficult to comply with and the School Food Plan has not achieved the desired outcomes. We found no evidence to show that school food standards legislation has positively influenced nutritional intake. We need to develop healthy secondary-school food provision models that meet pupils' preferences, and better understand how to situate the food and healthy-eating agenda in secondary schools. This trial is registered as ISRCTN68757496. This award was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (NIHR award ref: 17/92/39) and is published in full in Public Health Research; Vol. 12, No. 12. See the NIHR Funding and Awards website for further award information.

Early high-dose cryoprecipitate to reduce mortality in adult patients with traumatic haemorrhage: the CRYOSTAT-2 RCT with cost-effectiveness analysis.

Traumatic haemorrhage is common after severe injury, leading to disability and death. Cryoprecipitate, a source of fibrinogen, may improve outcomes for patients with traumatic haemorrhage. To investigate the effects of early fibrinogen supplementation in the form of 3 pools (15 units, approximately 6g of fibrinogen) of cryoprecipitate on 28-day mortality. A randomised, parallel-group, unblinded, multicentre, international trial and economic evaluation. Patients were randomised to either the intervention (early cryoprecipitate) or the comparator (standard major haemorrhage protocol) arm via opaque, sealed envelopes in the emergency department or the transfusion laboratory/blood bank. All analyses were performed on an intention-to-treat basis. A cost-effectiveness analysis was undertaken. Twenty-five major trauma centres in the UK and one level 1 trauma centre in the USA. Adults who had traumatic haemorrhage following severe injury requiring activation of the major haemorrhage protocol and had received a blood transfusion. Early cryoprecipitate - 3 pools (equivalent to 15 single units of cryoprecipitate or 6 g of fibrinogen supplementation), infused as rapidly as possible, within 90 minutes of arrival at hospital in addition to standard major haemorrhage protocol or standard major haemorrhage protocol only. The primary outcome was all-cause mortality at 28 days. The secondary outcomes were all-cause mortality at 6 hours, 24 hours, 6 months and 12 months from admission; death from bleeding at 6 hours and 24 hours; transfusion requirements at 24 hours from admission; destination of participant at discharge; quality-of-life measurements (EuroQol-5 Dimensions, five-level version and Glasgow Outcome Scale) at discharge/day 28 and 6 months after injury; and hospital resource use up to discharge or day 28 (including ventilator-days, hours spent in critical care and inpatient stays). Eight hundred and five patients were randomised to receive the standard major haemorrhage protocol (control arm). Seven hundred and ninety-nine patients were randomised to receive an additional three pools of cryoprecipitate in addition to standard care (intervention arm). Baseline characteristics appeared well matched. Patients had a median age of 39 (interquartile range 26-55) years, and the majority (79%) were male. All-cause 28-day mortality (n=1531 patients; intention to treat) was 25.3% in the intervention arm compared with 26.1% in the control arm (odds ratio 0.96; p=0.74). There was variability in the timing of cryoprecipitate administration, with overlap between the treatment arms, limiting the degree of intervention separation. There was no evidence that early empiric administration of high-dose cryoprecipitate reduced the risk of death in unselected patients with traumatic haemorrhage. There was also no difference in adverse events. The cost-effectiveness of the intervention was similar to that of standard care. Research to evaluate if fibrinogen replacement is more beneficial for selected patients, for example those with low fibrinogen blood levels, is needed, as is further exploration of whether there is a difference in outcome according to mechanism of injury. This trial is registered as ISRCTN14998314. This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 15/57/02) and is published in full in Health Technology Assessment; Vol. 28, No. 76. See the NIHR Funding and Awards website for further award information.

REGULAÇÃO E PROTEÇÃO DE DADOS PESSOAIS NA INDÚSTRIA DE TELECOMUNICAÇÕES: A IMPLEMENTAÇÃO DA LEI GERAL DE PROTEÇÃO DE DADOS E A GESTÃO DA VIOLAÇÃO DE SIGILO

The present work aims to analyze Brazilian legislation aimed at protecting personal data and violations of these standards, especially in the telecommunications sector. For its idealization, consultations were carried out in articles, bibliographies, jurisprudence, legislation and informative websites based on a qualitative approach with a special focus on the analysis of the General Data Protection Law (LGPD) and the Marco Civil da Internet. The study examines how the sharing of personal data by mobile phone operators compromises consumer privacy, highlighting the responsibilities of companies and the consequences of data leaks. Despite efforts to adapt to standards, the confidentiality of personal data is constantly violated, as private telephone companies do not comply with legislative legalities to protect fundamental rights. This highlights the essential role of regulatory bodies, such as the National Telecommunications Agency (ANATEL), in ensuring data protection and building a relationship of trust between companies and consumers.

Accessibility of digital healthcare in 2023: insights from a Dutch national survey study

Abstract Background Digital technology is reshaping healthcare, offering potential improvements in accessibility, efficiency and quality. However, to realize potential benefits, ensuring equal access for all is crucial. We investigated digital healthcare usage and studied differences in use across age groups and educational backgrounds in the Netherlands. Methods Surveys were conducted among general healthcare users (n = 837, any citizen living in the Netherlands with access to healthcare) and healthcare users with chronic conditions (n = 1437). We studied their digital skills (can you independently use a computer, tablet or smartphone; digital applications; email and apps?) and their use of digital selfcare (did you use websites for health-related information or treatment?). Findings are stratified for educational level (low/medium/high) and age (15 -39, 40-64, over 65 years). Data collection occurred between April and August 2023, focusing on the twelve months preceding the survey. Results The majority of respondents use digital devices independently (range: 78-91%), but these percentages vary between subgroups, from 48-65% for users with lower education vs 86-99% for users with higher education. Similar differences exist across age groups: 98-100% of users aged 15-39 use a computer, tablet or smartphone, in contrast with 59-78% in the over 65 years age group. Similarly, the use of websites for health information is 22-31% among lower educated users to 68-70% among higher educated users; and 36-48% among those ≥65 years to 73-75% among respondents aged 15-39. Conclusions Substantial variation exists in the use of digital tools and digital selfcare across ages and educational levels. These findings underscore the urgency of addressing inequalities in access to digital healthcare, serving as a call to action for policymakers, healthcare providers, and developers to collectively strive for an accessible (digital) healthcare system for all. Key messages • Differences in use of digital tools and digital selfcare among people of different ages and educational levels warrants the need for co-creation and tailored development and implementation. • Differences in use of digital tools and digital selfcare among people of different ages and educational levels warrants the need for co-creation and tailored development and implementation.

Implementasi Metode CRM (Customer Relationship Management) pada Sistem Informasi Website Nadu Screen Printing

This research aims to implement the CRM (customer relationship management) method on the Nadu Screen Printing website information system which is useful for simplifying customer orders and processing customer databases. This research uses the Agile software development method. The evaluation results with the System Usability Scale (SUS) show that this system meets the standards with a final score reaching 86.5 in the "Acceptable" category with a grade scale of "A" and a rating of "Best Imaginable".

Design and Development of a Website for Village Services and Information in Watesnegoro Village Government, Ngoro District, Mojokerto Regency

The development of information technology is now experiencing rapid progress. Therefore, these technological developments reflect the transformation of society towards a deeper engagement with digital tools, especially through internet access and the increasing popularity of website usage. In Watesnegoro Village, the creation of a village website acts as an up-to-date information channel that appeals to internet users. This research aims to help digitize services and also promote the potential of the village through the information system on the website. The methods used in this research are observation and interview. The result of this research is the creation of the Watesnegoro village website consists of observation, data collection, website creation, testing, training. However, the process of digitizing services at the Watesnegoro village office is still not perfect. This is due to the low skills of village officials who are not familiar with online services. In addition, the socialization of the website has not been carried out evenly in the community

What do they look for and what do they find? A coproduced qualitative study on young people's experiences of searching for mental health information online.

Many young people (YP) struggle with their mental health and look online for help. To capitalise on their digital presence, we need to better understand how and where they seek information online and what they think of what they find. We recruited 24 YP (aged 13-18 years). Online interviews were co-conducted by research team members and trained young researchers. We presented a persona with depression symptoms and asked about potential sources of information/support they might seek. They were also asked to think aloud while searching online and reviewing mental health resources (NHS, Young Minds). We used reflexive thematic analysis. Analysis generated four themes: (1) the online help-seeking process, showcasing where YP look for information and why; (2) the mismatch between the information YP expected to find and the reality; (3) the strategies YP employed to determine a source's trust and credibility and (4) individual differences that can influence help-seeking. Participants initiated their online search by Googling symptoms. They trusted NHS websites for basic medical information, while charities provided detailed content. Despite scepticism about content, social media offered validation. Online resources should prioritise visual appeal, user-friendliness, age-appropriate and personalised content and peer insights. Codesign is imperative to ensure high-quality, impactful research.

Enhancing ePaper Reader Intentions through Website Design, Information Quality, and Usefulness

This study examines how website design, information quality, and utility affect ePaper use, with brand trust and attitude as mediators. This study examines the factors that influence ePaper readers’ intentions to use the service. The quantitative study uses a survey questionnaire to collect data. A convenience sample of ePaper readers was selected. Structural Equation Modelling (SEM) was used to analyses data and determine variable relationships. The study found that website design, information quality, and usability affect brand trust, attitude, and ePaper use. A well-designed website with high-quality information and handy features boosts brand trust and attitude, which affects ePaper service use. This study adds to the literature by examining the relationships between website design, information quality, utility, brand trust, attitude, and ePaper use. The results suggest that ePaper suppliers should priorities website design, high-quality content, and useful features to build brand confidence and reader loyalty. It will boost their desire to use the service. Future investigations should aim to examine the potential effects of supplementary variables that could potentially influence individuals’ intents to utilized ePaper, including those related to user experience and social dynamics.

Does the Special Allocation Fund Reduce Rural Poverty?

This study aims to analyze the effect of special allocation funds for thematic poverty reduction assignments in the fields of water, sanitation, and the field of settlement and housing on poverty in rural areas. The data collected by secondary data is number of poor people in rural areas is accessed through the BPS website, and special allocation funds for thematic poverty reduction assignments in the fields of water, sanitation, and settlement and housing are collected by accessing the Simtrada website (Information System Transfer to Regions and Village Funds) https://djpk.kemenkeu.go.id//simtrada/. The population of 34 provinces and the sample of 25 provinces in Indonesia that experienced a decrease in rural poverty were analyzed in this research. The data were analyzed by multiple regression analysis techniques. The results showed that special allocation funds for thematic poverty reduction assignments in the water sectors, and in the field of sanitation sector, did not significantly affect poverty reduction, (sig p-value 0.461>0.05 and sig p-value 0.751 > 0.05 respectively). The value of special allocation funds for thematic poverty reduction assignments in the field of the housing sector had a significant effect on reducing rural poverty (sig p-value (0.007< 0.05). This study recommends that poverty reduction funds in rural areas, especially in the field of housing, continue to be distributed and managed appropriately, so that poverty in rural areas is alleviated.

A scoping review to map public-facing websites for non-traumatic wrist disorders with quality evaluation.

Public-facing resources for non-traumatic wrist disorders (NTWD) exist, but care recipients and healthcare professionals alike are uncertain where to access the most useful resources and have raised concerns over the quality of information provided. Previous studies involving stakeholders highlight a need for quality evaluation of these resources. The aim of this study was to identify website resources accessible to UK-based online health seekers and explore their content through quality assessment. A scoping review of public-facing websites was conducted in accordance with Joanna Briggs Institute guidelines and PRISMA-ScR checklist. An a-priori search strategy was performed of publicly accessible websites using lay terms were entered into a simple Google search. The DISCERN tool was used to appraise the quality of health information with additional data charted to pre-determined criteria. The 82 websites meeting inclusion criteria scored an average of 2/5 DISCERN. Nine funding categories existed with private service websites were the most common. 18 different diagnoses were found with twenty different management interventions were recommended. Considerable variation was found in the quality of websites providing information which people with NTWD are likely to access. Quality and trustworthiness of website information on NTWD are not the preserve of any sector or organisation and we identified potential for improvements across the board.

Conservation of Hindu Religious Lontar Manuscripts Through Lontar Digitization Website Information System in Tabanan Regency

Lontar as a cultural product is rich in meaning and raised the image of balinese traditions in the world civilization. The existence of lontar tradition nowadays in Tabanan Regency has a long and old history complemented by historical, religious, philosophical, medicinal, literary, and other great scientific values. This research aims to 1) conserve and digitize lontar in Tabanan Regency, and 2) create a website information system for digitizing lontar in Tabanan Regency. The research methods employed are palm conservation, system analysis, system planning, system design and system testing. The results of the research showed that 1) the conservation and digitalization of lontar was carried out in Tabanan can save the lontar, to keep it in a good condition, not damaged by termites or rodents, so it can continue to be passed on to the next generation as a reflection of the past about the medicine, ceremonies, religion, arts, and culture. 2) The lontar digitization website information system can be used as a guide for the public regarding lontar information and contents. In conclusion, the saving of Hindu religious lontar manuscripts through the lontar digitalization website information system in Tabanan Regency is carried out in the form of conservation and the creation of a lontar digitalization website information system, to make it accessible for the entire community online. In terms of culture, it can be passed down to the next generation as a form of cultural and religious preservation including medicine, ceremony, religion, art, and culture. The development of information system for the lontar digitization website is very good and important to save Hindu religious lontar manuscripts.

Implementing an artificial intelligence command centre in the NHS: a mixed-methods study.

Hospital 'command centres' use digital technologies to collect, analyse and present real-time information that may improve patient flow and patient safety. Bradford Royal Infirmary has trialled this approach and presents an opportunity to evaluate effectiveness to inform future adoption in the United Kingdom. To evaluate the impact of the Bradford Command Centre on patient care and organisational processes. A comparative mixed-methods study. Operational data from a study and control site were collected and analysed. The intervention was observed, and staff at both sites were interviewed. Analysis was grounded in a literature review and the results were synthesised to form conclusions about the intervention. The study site was Bradford Royal Infirmary, a large teaching hospital in the city of Bradford, United Kingdom. The control site was Huddersfield Royal Infirmary in the nearby city of Huddersfield. Thirty-six staff members were interviewed and/or observed. The implementation of a digitally enabled hospital command centre. Qualitative perspectives on hospital management. Quantitative metrics on patient flow, patient safety, data quality. Anonymised electronic health record data. Ethnographic observations including interviews with hospital staff. Cross-industry review including relevant literature and expert panel interviews. The Command Centre was implemented successfully and has improved staff confidence of better operational control. Unintended consequences included tensions between localised and centralised decision-making and variable confidence in the quality of data available. The Command Centre supported the hospital through the COVID-19 pandemic, but the direct impact of the Command Centre was difficult to measure as the pandemic forced all hospitals, including the study and control sites, to innovate rapidly. Late in the study we learnt that the control site had visited the study site and replicated some aspects of the command centre themselves; we were unable to explore this in detail. There was no significant difference between pre- and post-intervention periods for the quantitative outcome measures and no conclusive impact on patient flow and data quality. Staff and patients supported the command-centre approaches but patients expressed concern that individual needs might get lost to 'the system'. Qualitative evidence suggests the Command Centre implementation was successful, but it proved challenging to link quantitative evidence to specific technology interventions. Staff were positive about the benefits and emphasised that these came from the way they adapted to and used the new technology rather than the technology per se. The COVID-19 pandemic disrupted care patterns and forced rapid innovation which reduced our ability to compare study and control sites and data before, during and after the intervention. We plan to follow developments at Bradford and in command centres in the National Health Service in order to share learning. Our mixed-methods approach should be of interest to future studies attempting similar evaluation of complex digitally enabled whole-system changes. The study is registered as IRAS No.: 285933. This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR129483) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 41. See the NIHR Funding and Awards website for further award information.

What happens between first symptoms and first acute exacerbation of COPD - observational study of routine data and patient survey.

Chronic obstructive pulmonary disease affects nearly 400 million worldwide - over a million in the United Kingdom - and is the third leading cause of death. However, there is limited understanding of what prompts a diagnosis, how long this takes from symptom onset and the different approaches to clinical management by primary care professionals. Map out the clinical management and National Health Service contacts from symptom presentation to chronic obstructive pulmonary disease diagnosis and first acute exacerbation of chronic obstructive pulmonary disease in three time periods; construct risk prediction for first acute exacerbation of chronic obstructive pulmonary disease. Retrospective cohort study and cross-sectional survey. Primary care. Patients with incident chronic obstructive pulmonary disease aged > 35 years in England. None. First acute exacerbation of chronic obstructive pulmonary disease. Clinical Practice Research Datalink Aurum; new online survey. Forty thousand five hundred and seventy-seven patients were diagnosed between April 2006 and March 2007 (cohort 1), 48,249 between April 2016 and March 2017 (cohort 2) and 4752 between March and August 2020 (cohort 3). The mean (standard deviation) age was 68.3 years (12.0); 47.3% were female. Around three-quarters were diagnosed in primary care, with a slight fall in cohort 3. Compliance with National Institute for Health and Care Excellence diagnostic guidelines was slightly higher in cohorts 2 and 3 for all patients; 35.8% (10.0% in the year before diagnosis) had all four elements met for all cohorts combined. Multilevel modelling showed considerable between-practice variation in spirometry. The survey on the charity website had 156 responses by chronic obstructive pulmonary disease patients. Many respondents had not heard of the condition, hoped the symptoms would go away and identified various healthcare-related barriers to earlier diagnosis. Clinical Practice Research Datalink analysis showed notable changes in post-diagnosis prescribing from cohort 1 to 2, such as increases in long-acting muscarinic antagonist (21.7-46.3%). Triple therapy rose from 2.9% in cohort 2 to 11.1% in cohort 3. Documented pulmonary rehabilitation rose from just 0.8% in cohort 1 to 13.7% in cohort 2 and 20.9% in cohort 3. For all patients combined, the median time to first acute exacerbation of chronic obstructive pulmonary disease in patients who had one was 1.4 years in cohorts 1 and 2. Acute exacerbation of chronic obstructive pulmonary disease prediction models identified some consistent predictors, such as age, deprivation, severity, comorbidities, post-diagnosis spirometry and annual review. Models without post-diagnosis general practitioner actions had a c-statistic of around 0.70; the highest c-statistic was 0.81, for cohort 2 with post-diagnosis general practitioner actions and 6-month follow-up. All models had good calibration. The three most important predictors in terms of their population attributable risks were being a current smoker and offered smoking cessation advice (32.8%), disease severity (30.6%) and deprivation (15.4%). The highest population attributable risks for variables with adjusted hazard ratios < 1 were chronic obstructive pulmonary disease review (-27.3%) and flu vaccination (-26.6%). Symptom recording and chronic obstructive pulmonary disease diagnosis vary between practice; predicted forced expiratory volume in 1 second had many missing values. There has been some improvement over time in chronic obstructive pulmonary disease diagnosis and management, with large changes in prescribing, though patient and system barriers to further improvement exist. Data available to general practitioners cannot generate risk prediction models with sufficient accuracy. It will be important to expand the COVID-era cohort with longer follow-up and augment general practitioner data for better prediction. This study is registered as Researchregistry.com: researchregistry4762. This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 17/99/72) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 43. See the NIHR Funding and Awards website for further award information.

Antidepressants for pain management in adults with chronic pain: a network meta-analysis.

Chronic pain is common and costly. Antidepressants are prescribed to reduce pain. However, there has not been a network meta-analysis examining all antidepressants across all chronic pain conditions, so effectiveness and safety for most antidepressants for pain conditions remain unknown. To assess the efficacy and safety of antidepressants for chronic pain (except headache) in adults. Our primary outcomes were as follows: substantial pain relief (50%), pain intensity, mood and adverse events. Our secondary outcomes were as follows: moderate pain relief (30%), physical function, sleep, quality of life, Patient Global Impression of Change, serious adverse events and withdrawal. This was a systematic review with a network meta-analysis. We searched CENTRAL, MEDLINE, EMBASE, CINAHL, LILACS, AMED and PsycINFO databases for randomised controlled trials of antidepressants for chronic pain conditions up until 4 January 2022. The review was registered in PROSPERO (CRD42020171855), and the protocol was published in the Cochrane Library (https://doi.org/10.1002/14651858.CD014682). We analysed trials from all settings. We included trials in which participants had chronic pain, defined as longer than 3 months, from any condition excluding headache. We included all antidepressants. Our primary outcome was substantial pain relief, defined as a reduction ˃ 50%. We also measured pain intensity, mood and adverse events. Secondary measures included moderate pain relief (above 30% reduction), physical function, sleep, quality of life, Global Impression of Change, serious adverse events, and withdrawal from trial. We identified 176 studies with a total of 28,664 participants. Most studies were placebo-controlled (n = 83) and parallel armed (n = 141). The most common pain conditions examined were fibromyalgia (59 studies), neuropathic pain (49 studies) and musculoskeletal pain (40 studies). The average length of randomised controlled trials was 10 weeks. Most studies measured short-term outcomes only and excluded people with low mood and other mental health conditions. Across efficacy outcomes, duloxetine was consistently the highest-ranked antidepressant with moderate- to high-certainty evidence. Standard dose was equally efficacious as high dose for the majority of outcomes. Milnacipran was often ranked as the next most efficacious antidepressant, although the certainty of evidence was lower than that for duloxetine. There was insufficient evidence to draw robust conclusions for the efficacy and safety of any other antidepressant for chronic pain. The evidence for antidepressants other than duloxetine is poor. For duloxetine, it is not clear whether the effect applies to groups with both pain and low mood, since these groups were excluded from trials. There is also insufficient evidence on long-term outcomes and on adverse effects. There is only reliable evidence for duloxetine in the treatment of chronic pain. Duloxetine was moderately efficacious across all outcomes at standard dose. There is also promising evidence for milnacipran, although further high-quality research is needed to be confident in these conclusions. Data for all other antidepressants were of low certainty. However, the findings should not be read as an encouragement to prescribe antidepressants where other non-pharmacological intervention could be equally effective, especially in the absence of good evidence on side effects and safety. There is a need for large, methodologically sound trials testing the effectiveness of antidepressants for chronic pain. These trials should examine long-term outcomes (> 6 months) and include people with low mood. There should also be better reporting of adverse events, tolerance of drugs, and long-term compliance. This study is registered as PROSPERO CRD42020171855. This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: NIHR128782) and is published in full in Health Technology Assessment; Vol. 28, No. 62. See the NIHR Funding and Awards website for further award information.

The efficacy of sildenafil therapy in dismal prognosis early-onset intrauterine growth restriction: the STRIDER RCT

Background Severe early-onset intrauterine growth restriction is associated with stillbirth, neonatal death and neurodevelopmental impairment. There is no treatment for intrauterine growth restriction with timely delivery being the only management option. Placentas from intrauterine growth restriction pregnancies often show failure to remodel maternal spiral arteries leading to a persistent vasoactive responsiveness. Sildenafil, a phosphodiesterase type 5 inhibitor, potentiates naturally occurring nitrous oxide, encouraging vasodilation of vasoactive vessels. Previous studies in animal models and humans show recovery of placental function and improvement in fetal growth. The STRIDER trial aimed to address whether treatment with sildenafil is beneficial to fetal growth and perinatal and toddler outcomes. Methods The STRIDER trial was a superiority, randomised double-blind placebo-controlled trial that was carried out in 19 fetal medicine units in the United Kingdom. Women with a singleton pregnancy between 22+0 and 29+6 weeks’ gestation, with severe early-onset intrauterine growth restriction, were asked to participate. Women were randomised (1 : 1) to receive either sildenafil 25-mg three times daily or placebo until 31+6 weeks’ gestation or delivery. Women were stratified by site and their gestational age at randomisation (before 26+0 or at 26+0 weeks or later). Severe intrauterine growth restriction was defined as a combination of estimated fetal weight or abdominal circumference below the 10th percentile and absent or reversed end-diastolic blood flow in the umbilical artery on Doppler velocimetry. The primary outcome was the time from randomisation to delivery, measured in days with a 1-week difference deemed to be clinically significant. The phase 2 study followed up all babies alive at discharge to assess for cardiovascular function and neurodevelopment at 2 years of age. Results Between 21 November 2014 and 6 July 2016, a total number of 135 women were recruited to the study, of these 70 were assigned to sildenafil and 65 to the placebo. No difference was found in the median randomisation to delivery interval between sildenafil [17 days (interquartile range 7–24)] and placebo [18 days (8–28), p = 0.23]. Live births [relative risk 1.06, 95% confidence interval 0.84 to 1.33; p = 0.62], fetal deaths (relative risk 0.89, 95% confidence interval 0.54 to 1.45; p = 0.64), neonatal deaths (relative risk 1.33, 95% confidence interval 0.54 to 3.28; p = 0.53), and birthweight [mean difference −14 g (95% confidence interval −100 to 126); p = 0.81] did not differ between the treatment arms and no differences were found for other maternal or perinatal secondary outcomes. Eight serious adverse events were reported during the study (six in the placebo group and two in the sildenafil group); none of these were attributed to sildenafil. Seventy-five babies were discharged alive from the neonatal unit and of those 61 were available for follow-up with 32 treated with sildenafil and 29 with placebo. Of those that did not have a follow-up 1 baby died (placebo) and 3 declined follow-up and 10 were uncontactable. There was no difference in neurodevelopment, or blood pressure for infants treated with sildenafil versus placebo. Infants who received sildenafil had a greater head circumference compared to those who received placebo (median difference 49.25 cm, interquartile range 46.4–50.26 vs. 47.17 cm, 95% confidence interval 44.71 to 48.95). Conclusion Sildenafil did not prolong pregnancy or improve pregnancy outcomes. There was no effect from sildenafil treatment on infant neurodevelopment. Our data show that sildenafil should not be prescribed for fetal growth restriction. Trial registration This trial is registered as ISRCTN39133303. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Efficacy and Mechanism Evaluation (EME) programme (NIHR award ref: 12/62/109) and is published in full in Efficacy and Mechanism Evaluation; Vol. 11, No. 18. See the NIHR Funding and Awards website for further award information.