Initial Usage Research Articles

EFL University Students’ Acceptance and Readiness for e-Learning: A Structural Equation Modeling Approach

The use of information and communication technologies (ICTs) has become essential approach in the field of language learning especially for English as a foreign language (EFL) education. Because ICTs are widely use in higher education, students must be highly digitally proficient and have positive attitudes in order to efficiently manage their classes. Thus, the purpose of this study is to contribute to the literature on EFL university students’ perspectives regarding e-learning integration. In this study we extend the technology acceptance model (TAM) to investigate the factors that influence e-learning acceptance and readiness in the context of foreign language learning. Quantitative method was applied in this study, which involved 298 student teachers of English department at a state university in Indonesia. The instrument used in collecting the data was a questionnaire. The collected data were analyzed by using Partial Least Square-Structural Equation Modeling (PLS-SEM) with the SmartPLS3 program. PLS-SEM was used to analyze the proposed hypotheses developed in fulfilling the study objectives. The results indicated the complex relationships between the perceived usefulness, perceived ease of use, perceived enjoyment, motivation, self-efficacy, attitude and actual use of e-learning. Furthermore, the findings revealed that perceived enjoyment and self-efficacy did not have significant influence on actual use of e-learning through the mediating role of perceived usefulness. The findings can help both instructors and students adjust the integration of e-learning in English learning by implementing a learning curriculum and needs that are in line with the user's initial usage objectives, so that users can recognize the importance of e-learning's ease of use and usefulness. This study contributes to educational institutions and e-learning developers to consider developing e-learning apps that support student-centered learning with useful and ease of use to improve students' attitudes towards the use of e-learning. By incorporating e-learning into English language learning, students will have more time to practice and improve their English language skills.

Advancements in Metal Additive Manufacturing: A Comprehensive Review of Material Extrusion with Highly Filled Polymers

Additive manufacturing (AM) has attracted huge attention for manufacturing metals, ceramics, highly filled composites, or virgin polymers. Of all the AM methods, material extrusion (MEX) stands out as one of the most widely employed AM methods on a global scale, specifically when dealing with thermoplastic polymers and composites, as this technique requires a very low initial investment and usage simplicity. This review extensively addresses the latest advancements in the field of MEX of feedstock made of polymers highly filled with metal particles. After developing a 3D model, the polymeric binder is removed from the 3D-printed component in a process called debinding. Furthermore, sintering is conducted at a temperature below the melting temperature of the metallic powder to obtain the fully densified solid component. The stages of MEX-based processing, which comprise the choice of powder, development of binder system, compounding, 3D printing, and post-treatment, i.e., debinding and sintering, are discussed. It is shown that both 3D printing and post-processing parameters are interconnected and interdependent factors, concurring in determining the resulting mechanical properties of the sintered metal. In particular, the polymeric binder, along with its removal, results to be one of the most critical factors in the success of the entire process. The mechanical properties of sintered components produced through MEX are generally inferior, compared with traditional techniques, as final MEX products are more porous.

Enhanced recovery support for people with eating disorders during the COVID-19 pandemic: quality improvement using a web-based, stepped-care programme in Canada

BackgroundThroughout the COVID-19 pandemic, the number of individuals struggling with eating disorders (EDs) increased substantially. Body Brave (a not-for-profit) created and implemented a web-based stepped-care Recovery Support Programme (RSP) to...

The Impact of a Mental Health Game (eQuoo) on the Resilience of Young Adults: A Case Series Study

Background: mHealth apps are showing promise as an accessible means to improve mental health and wellbeing. However, there is limited evidence for their efficacy, particularly in periods after their initial usage, and in non-Western cultures. Objective: In this study, we explored the impact of eQuoo, an emotional fitness application which gamifies self-reflection and learning, in terms of its ability to build resilience in a sample of young people in Vietnam. Materials and Methods: Individuals (n = 264, M = 25.65 years, SD = 4.84; 52% female) completed self-reports consisting of three different measures of resilience (the Rugged Resilience Measure, Adult Resilience Measure, Brief Resilience Scale). Assessments were taken at the start and end of a five-week use period, and also three months after baseline. Results: Comparison tests indicated various improvements in resilience between baseline and five weeks and at three months, depending on the subgroup of participants (whether male or female or younger or older), as well as in terms of the way resilience was operationalised (e.g., ability to ‘bounce back’ or the protective factors associated with managing adversity). Conclusion: The study indicates that eQuoo can build resilience and can therefore provide a convenient means of supporting the mental health and wellbeing of young adults.

Meningitis and endocarditis as a sequela of streptococcus pneumonia mastoiditis: A case report

Key Clinical MessageAustrian Syndrome classically consists of meningitis, endocarditis, and pneumonia due to Streptococcus pneumonia bacteremia. A literature review, however, does not show variants of this triad. Our case highlights a unique variant of Austrian Syndrome with mastoiditis, meningitis, and endocarditis which requires immediate recognition and treatment to prevent devastating patient outcomes.AbstractStreptococcus pneumonia is responsible for more than 50% of all bacterial meningitis and has a case fatality rate of 22% in adults. In addition, Streptococcus pneumonia is also one of the most common causes of acute otitis media, a known cause of mastoiditis. However, in conjunction with bacteremia and endocarditis, limited evidence is able to be identified. This sequence of infections also closely relates to Austrian syndrome. Otherwise known as Osler's triad, Austrian syndrome is a rare phenomenon of meningitis, endocarditis, and pneumonia secondary to Streptococcus pneumonia bacteremia that was first delineated by Robert Austrian in 1956. The incidence of Austrian syndrome is reported to be less than <0.0001% per year and has decreased significantly since the initial usage of penicillin in 1941. Despite this, the mortality rate of Austrian syndrome is still around 32%. Despite an extensive literature review, we were unable to find any reported cases of variants of Austrian syndrome that include mastoiditis as the primary insult. As such, we present a unique presentation of Austrian syndrome with mastoiditis, endocarditis, and meningitis with complex medical management that led to resolution for the patient. To discuss the presentation, progression, and complex medical management of a previously undiscussed triad of mastoiditis, meningitis, and endocarditis occurring in a patient.

Five-year survival outcomes in patients with melanoma with complete response to immunotherapy who discontinue therapy.

e21503 Background: Immune checkpoint inhibitor (ICI) therapy for advanced melanoma in the first-line setting often results in durable responses and prolonged overall survival (OS) after achieving a complete response (CR). While generally well-tolerated, there are financial toxicities and treatment related adverse events (TRAEs) associated with ICI use. There are limited data to inform the optimal duration of therapy after CR, and how specific patient factors may lead to variable OS in patients (pts) with CR. Methods: Pts with locally advanced stage III or stage IV melanoma who started first-line ICI therapy with pembrolizumab, nivolumab, or ipilimumab/nivolumab (ipi/nivo) and achieved CR were identified at a single institution under an Institutional Review Board approved protocol. Pts were only included in the sample if they had initiated treatment by 2013 and discontinued therapy by February of 2021 and had documented follow-up at least 1 year after discontinuing ICI therapy. Recurrence rates were determined by the presence of any recurrence after CR. Pts were analyzed by baseline stage (III vs IV), BRAF status, use of steroids for TRAEs, time from treatment start to CR, and total duration of therapy. OS was determined by time from treatment start to death or date of last follow-up. Results: 78 Pts with CRs from ICI therapy who discontinued treatment were identified at the University of Pennsylvania. Median follow-up time was 63 months from ICI treatment start. Median age at treatment start was 65 years (range 33-94). 51 Pts (68%) had an ECOG performance status (PS) of 0 vs 24 (32%) with ECOG PS of 1-2. 21 Pts (27%) had locally advanced stage III and 57 (73%) had stage IV disease. Of stage IV pts, 8 were M1a, 16 M1b, 22 M1c, and 11 M1d. 61 (78%) pts were treated with pembrolizumab, 5 (6%) nivolumab, 12 (15%) ipi/nivo. 34 pts (44%) were treated with steroids for TRAEs. Of the 78 total pts, 13 (16.7%) developed a recurrence after stopping treatment. The median time to recurrence was 57 months (range 9-110). Melanoma specific survival was 96%. Of the pts with recurrence, 3 died of melanoma, 9 are disease free after additional local and/or systemic treatment and one patient is alive with disease. There was no significant difference ( p < 0.05) in OS based on baseline stage, BRAF status, or use of steroids for TRAEs. Pts were treated for a median of 6 months (range 1 day to 24 months). Conclusions: With over 5 years median follow-up time, the majority of pts with advanced melanoma who attain a CR from first-line ICI therapy remain disease free after treatment discontinuation. Patient factors including stage at treatment initiation, BRAF status, and steroid usage during treatment were not associated with significant variation in OS in this cohort. Most pts with recurrences remain disease free after additional local and/or systemic treatment. Few melanoma specific deaths occurred in pts with a CR to ICI who discontinued treatment.

The role of online game usage in the relationship between initial daily negative moods and subsequent positive moods: The moderating role of hedonistic motivation.

This study explores the relationship between initial daily negative mood, online game usage and subsequent positive mood; and examine the moderating roles of hedonistic motivation on the perspective of mood regulation theory. To gather data over five consecutive workdays, this study used the experience sampling method. We then obtained 800 valid daily data from 160 participants. The results of multilevel path analysis show that: (i) initial daily negative mood increases the usage of online games and further enhances subsequent positive mood; (ii) students with higher hedonic motivation will show a stronger positive correlation between initial daily negative mood and online game usage; (iii) students with higher hedonic motivation will show a stronger positive correlation between online game usage and subsequent positive mood. Theoretical and practical implications are also investigated in this study.

PC17. Implementation of an Enhanced Recovery after Surgery Protocol for Cleft Palate Repair

PURPOSE: Enhanced recovery after surgery (ERAS) protocols have been implemented across surgical disciplines, including cleft surgery, to decrease hospital stays and improve outcomes. The authors aim to describe the implementation of an ERAS protocol for cleft palate repair at a tertiary care hospital. METHOD: Patients undergoing cleft palate repair at the authors’ institution over a 10-year period were collected (n=242). Cleft demographics and operative details were collected. Primary outcome measures were hospital length of stay (LOS) and narcotic usage. Secondary outcome measures were fistula development and need for speech surgery. Chi-square tests and independent t-tests determined significance. RESULTS: Infiltration with bupivacaine was associated with decreased initial 24-hour morphine equivalent usage (p < 0.01) and decreased hospital LOS (p < 0.01). Utilization of the Furlow palatoplasty was associated with decreased hospital LOS (p < 0.01). Patients using the ERAS protocol experienced shorter LOS (p < 0.01). Fistula development was associated with increased 24-hour morphine equivalent usage (p < 0.01). Need for speech surgery was associated with increased 24-hour morphine equivalent usage (p < 0.01) and increased hospital LOS (p < 0.05). CONCLUSION: This study reiterates the benefit of an ERAS protocol for patients undergoing cleft palate repair. The protocol resulted in decreased LOS and narcotic use. The finding regarding fistula formation and need for speech surgery requiring increased narcotics may indicate that the initial postoperative period is vital to adequate wound healing and subsequent outcomes. This study has implications for ways to maximize hospital reimbursement, as well as potentially improve outcomes.

The Opioid-Sparing Effect of Acupuncture After Abdominal Surgery: A Systematic Review and Meta-Analysis Protocol.

Routine overprescribing of postoperative opioid analgesics may induce side effects and correlate with chronic opioid use following surgery. This review aims to evaluate the effectiveness and safety of acupuncture for opioid-sparing effects in patients who underwent abdominal surgery. Eleven databases in different languages, including English (Ovid MEDLINE, CENTRAL, EMBASE, CINAHL), Chinese, Korean, and Japanese, will be searched. Randomized controlled trials using acupuncture for postoperative pain control in adult patients undergoing abdominal surgery will be screened. All randomized controlled trials comparing acupuncture with no treatment, sham acupuncture, and conventional treatments will be included. The Cochrane risk of bias tool will be used to assess the risk of bias. The primary outcome will consist of a cumulative opioid consumption. Additionally, the number of cumulative opioid analgesic demands/requests, the time to initial opioid analgesic usage, postoperative pain, opioid-related side effects, and adverse events of acupuncture will be assessed. The mean differences or risk ratios with a 95% confidence interval will be calculated to estimate the pooled effect of acupuncture when it is possible to conduct a meta-analysis. This study could confirm the effect of opioid-sparing on acupuncture after abdominal surgery. This study would evaluate the evidence on the effectiveness of acupuncture after abdominal surgery with a focus on opioid intake. It provides evidence to support decision-making on applying acupuncture for postoperative management. CRD42022311155.

Association between digital literacy, internet addiction, and cyberloafing among higher education students: A structural equation modeling

The current study aims to examine the association between digital literacy (DL), Internet addiction (IA) and cyberloafing (CL) levels of higher education students in Turkey. In addition, the study examined the correlation between “daily Internet use,” “initial Internet usage,” and “purpose of Internet use” with the variables of DL, IA, and CL. The study groups consisted of 1220 higher education students including all faculties and all grades of a state university. The “Digital Literacy Scale,” “Internet Addiction Scale,” and “Cyberloafing Scale” were used as data collection instruments. The study’s findings revealed initial Internet usage to be a predictor of DL, IA, and CL. Similarly, participants who spent more than 6 h using the Internet during a day have a higher level of DL, CL, and IA. Results from structural equation modeling reported a positive association between DL and IA, a negative association between DL and CL, and a positive relationship between IA and CL. Moreover, an indirect effect was revealed from DL to CL through IA. The study suggests improving students’ DL skills, as they form the basis of avoiding CL behavior, and using the Internet mostly for educational purposes.

The impact of early empirical antibiotics treatment on clinical outcome of very preterm infants: a nationwide multicentre study in China

BackgroundInfants with rule-out infections are responsible for the majority of empirical antibiotics treatment (EAT) in neonatal intensive care units (NICUs), particularly very preterm infants (VPIs). Antibiotic overuse has been linked to adverse outcomes. There is a paucity of data on the association between EAT and clinical outcomes (containing the nutritional outcomes) of VPIs without infection-related morbidities.MethodsClinical data of VPIs admitted in 28 hospitals in 20 provinces of China from September 2019 to December 2020 were collected. EAT of VPIs was calculated as the number of days with initial usage in the first week after birth, and then categorized into 3 groups (antibiotic exposure: none, 1-4 days, and > 4 days). Clinical characteristics, nutritional status , and the short-term clinical outcomes among 3 groups were compared and analyzed.ResultsIn total, 1834 VPIs without infection-related morbidities in the first postnatal week were enrolled, including 152 cases (8.3%) without antibiotics, 374 cases (20.4%) with EAT ≤4 days and 1308 cases (71.3%) with EAT > 4 days. After adjusting for the confounding variables, longer duration of EAT was associated with decreased weight growth velocity and increased duration of reach of full enteral feeding in EAT > 4 days group (aβ: -4.83, 95% CI: − 6.12 ~ − 3.53; aβ: 2.77, 95% CI: 0.25 ~ 5.87, respectively) than those receiving no antibiotics. In addition, the risk of feeding intolerance (FI) in EAT > 4 days group was 4 times higher than that in non-antibiotic group (aOR: 4.14, 95%CI: 1.49 ~ 13.56) and 1.8 times higher than that in EAT ≤4 days group (aOR: 1.82, 95%CI: 1.08 ~ 3.17). EAT > 4 days was also a risk factor for greater than or equal to stage 2 necrotizing enterocolitis (NEC) than those who did not receive antibiotics (aOR: 7.68, 95%CI: 1.14 ~ 54.75) and those who received EAT ≤4 days antibiotics (aOR: 5.42, 95%CI: 1.94 ~ 14.80).ConclusionsThe EAT rate among uninfected VPIs was high in Chinese NICUs. Prolonged antibiotic exposure was associated with decreased weight growth velocity, longer duration of reach of full enteral feeding, increased risk of feeding intolerance and NEC ≥ stage 2. Future stewardship interventions to reduce EAT use should be designed and implemented.

Psychological predictors of consumer-level virtual reality technology adoption and usage.

In recent years, virtual reality (VR) technology has been mainstreamed for at-home use, with various consumer-oriented devices released by media firms such as Meta, Google, Samsung, and HTC. The present research investigates the role of psychological traits-including immersive tendencies, absorption, sensation seeking, need for cognition, neophobia, and belief in science-as well as trait levels of individual innovativeness, self-perception of social well-being, and owner demographics, in predicting VR adoption rates and sustained use over time. Separate analyses were conducted for different classes of VR device (fixed, mobile, and standalone devices). In general, psychological factors generally emerged as more determinative of adoption than did demographics. Users' immersive tendencies predicted earlier adoption of VR technology while absorption was associated with later adoption, with both predictive of higher overall initial usage of different types of devices. Additionally, perceiving oneself as socially successful was associated with higher initial VR usage, while a tendency to see one's emotions as influenced by in-person rather than online contacts was negatively associated with usage. Finally, belief in science predicted greater consistency in usage over time while higher levels of absorption were associated with unstable usage patterns. These findings expand upon the limited work previously investigating the role of individual differences in adoption of VR and mark the promise of psychometrics for understanding the diffusion and continued usage of consumer-facing VR devices.

Feasibility of edoxaban for asymptomatic cancer-associated thrombosis in Japanese patients with gastrointestinal cancer: ExCAVE study

BackgroundAlthough initial therapy with a parenteral anticoagulant is required before edoxaban, this strategy is frequently avoided in actual clinical practice because of its complexity. This study assessed the feasibility of edoxaban without initial heparin usage for asymptomatic cancer-associated thrombosis (CAT) in Japanese patients with gastrointestinal cancer (GIC) at high risk of bleeding.MethodsIn this multicenter prospective feasibility study conducted at 10 Japanese institutions, patients with active GIC who developed accidental asymptomatic CAT during chemotherapy were recruited. Edoxaban was orally administered once daily without initial parenteral anticoagulant therapy within 3 days after detecting asymptomatic CAT. The primary outcome was the incidence of major bleeding (MB) or clinically relevant non-major bleeding (CRNMB) during the first 3 months of edoxaban administration.ResultsOf the 54 patients enrolled from October 2017 to September 2020, one was excluded because of a misdiagnosis of CAT. In the remaining 53 patients, the primary outcome occurred in six patients (11.3%). MB occurred in four patients (7.5%), including gastrointestinal bleeding in three patients and intracranial hemorrhage in one patient. CRNMB occurred in two patients (3.8%), including bleeding from the stoma site and genital bleeding in one patient each. There were no deaths attributable to bleeding, and all patients who experienced MB or CRNMB recovered.ConclusionsThe risk of bleeding after edoxaban without heparin pretreatment was acceptable, demonstrating new treatment options for asymptomatic CAT in patients with GIC.

MyStay – Development of nurse-facilitated condition-specific multimedia resources to facilitate patient participation in postoperative care

Improved postoperative outcomes and the global drive toward the provision of patient-centred care underpins efforts to enhance the nature and capacity of patient participation in acute postoperative hospital care. In this paper, we describe the design, framework and processes used to develop a modular, procedure-specific, digital health intervention platform aimed at improving the patient experience and patient participation in care following surgery. The intervention, a multimedia application MyStay, uses bedside delivery of audio-visual and text-based information to engage postoperative patients to better participate in their care. MyStay modules are developed using an iterative, multi-method approach intended to balance procedure-specific best evidence, current clinical practice, and patient preferences. Development involves six key elements: (1) Empathise with target users, (2) Ground in evidence and behavioural theory, (3) Specify target behaviours, (4) Integration of health service standards and clinical care pathways/guidelines, (5) Build and refine the multimedia product and, (6) Pilot implementation to assess potential effectiveness and usability. To-date, we have developed four procedure-specific MyStay modules and an additional three are under development. Initial patient usage data for the Total Knee Replacement (TKR) and cardiac surgery applications indicated that users accessed a wide range of text-based and audio-visual information, most frequently recovery goals and exercises following TKR, and postoperative recovery information for the intensive care unit following cardiac surgery. As previous research that tested MyStay indicated its efficacy in optimising clinical postoperative outcomes, this framework may be useful in the development of other digital health innovations. Further research is required to assess patient and clinician engagement and determine whether MyStay is associated with improved patient outcomes across varied clinical contexts.

Just Who Should Pay for What? Vertical Equity, Transit Subsidy and Road Pricing: The Case of New York City

In this paper, equity and cross-subsidization issues associated with the congestion pricing scheme proposed as part of New York City’s PlaNYC are examined, as are initial usage patterns, user income distribution, and revenue distribution. We find that equity concerns surrounding the proposal are supported by economic analysis. If New York City is to revisit congestion pricing in the future and make it more politically palatable, it will need to find a way to mitigate these equity concerns.

Initial Trust and Usage Intention: A Study on Mobile Payment Adoption in Bangladesh

Mobile payment (m-payment) still lacks widespread acceptance among Bangladeshi users despite its enormous possibilities. Previous studies have identified the reasons behind such reluctant usage intentions based on the data collected from regular m-payment users in Bangladesh. However, in Bangladesh, no study has considered the first-time user experience, which reflects initial trust yet. Therefore, the study was undertaken to identify the factors determining initial trust and their impact on m-payment usage intention in Bangladesh. We applied the structural equation modelling method to conduct an analysis of 284 first-time m-payment user data in Bangladesh. Initial trust was found positively influenced by perceived ubiquity, perceived security and perceived ease of use; perceived usefulness and the intention to use m-payments were found positively affected by initial trust. The study also revealed the positive association of users’ personal innovativeness and the negative association of perceived cost on m-payment usage intention. The mediation effects of initial trust were also found significant. The study recommends building initial user trust and service provider measures to encourage m-payment usage intention.

Radiographic Evidence of Early Posttraumatic Osteoarthritis following Tibial Plateau Fracture Is Associated with Poorer Function.

To determine if radiographic evidence of posttraumatic osteoarthritis (PTOA) following tibial plateau fracture correlates with poorer clinical and functional outcomes, patients with tibial plateau fractures were followed at 3, 6, and 12 months. All patients had baseline radiographs and computed tomography scan. Radiographs obtained at each follow-up were reviewed for healing, articular incongruence, hardware positional changes, and the development of postinjury arthritic change. Cohorts were determined based on the presence (PTOA) or absence (NPTOA) of radiographic evidence of PTOA. Demographics, fracture classification, complications, additional procedures, and functional status were compared between cohorts. Sixty patients had radiographic evidence of PTOA on follow-up radiographs at a mean final follow-up of 24.2 months. The NPTOA cohort was composed of 210 patients who were matched to the PTOA cohort based on age and Charlson comorbidity index. Mean time to fracture union for the overall cohort was 4.86 months. Cohorts did not differ in Schatzker classification, time to healing, injury mechanism, or baseline Short Musculoskeletal Function Assessment (SMFA). Patients with PTOA had a greater degree of initial depression and postoperative step-off, higher incidence of initial external fixator usage, higher rates of reoperation for any reason, and higher rates of wound complications. Associated soft tissue injury and meniscal repair did not coincide with the development of PTOA. Range of motion and SMFA scores were significantly worse at all time points in patients with PTOA. Although fracture patterns are similar, patients who required an initial external fixator, had a greater degree of initial depression or residual articular incongruity, underwent more procedures, and developed an infection were found to have increased incidence of PTOA. Radiographic evidence of osteoarthritis correlated with worse functional status in patients. The goal of surgery should be restoration of articular congruity and stability to mitigate the risk of PTOA, although this alone may not prevent degenerative changes. Patients with early loss of range of motion should be aggressively treated as this may precede the development of PTOA.

Hypoglossal nerve stimulator patient usage: Patterns and trends over time.

ObjectiveHypoglossal nerve stimulation (HNS) is an effective treatment for obstructive sleep apnea (OSA) patients intolerant of continuous positive airway pressure but is only effective if used regularly. Usage patterns have not been studied in detail. In this study, we aimed to characterize granular HNS usage patterns.MethodsPatients implanted by a single surgeon at an academic medical center from August 2016 to January 2021 were identified from a prospective database, which was merged with the Inspire Cloud usage database. Patient, OSA, and usage characteristics were summarized, and patient‐ and OSA‐related characteristics were associated with usage characteristics by Wilcoxon rank‐sum analyses. Usage trends over time were summarized in the overall cohort and stratified by initial usage.ResultsFifty patients were included. Median usage was 94% of nights (interquartile range [IQR]: 82%–98%) for 5.8 h per night (IQR: 4.9–6.4). Higher post‐operative apnea–hypopnea index predicted fewer nights used (92% [IQR: 82%–97%] vs. 96% [IQR: 91%–99%]). No other characteristics examined were significantly associated with usage. Median hours used per night decreased from 6.80 h (IQR: 5.32–7.94) on Day 1 to 5.76 (IQR: 1.81–7.13) on Day 361. This decrease was most pronounced in the quartile with the lowest initial usage.ConclusionThis study found that most patient and OSA characteristics were not associated with HNS usage, and that usage generally decreased over time. This decrease in usage over time was most pronounced in patients with the lowest initial usage. Further work should identify interventions to improve usage patterns to optimize clinical outcomes. Level of Evidence: 4.

The IeDEA harmonist data toolkit: A data quality and data sharing solution for a global HIV research consortium

We describe the design, implementation, and impact of a data harmonization, data quality checking, and dynamic report generation application in an international observational HIV research network. The IeDEA Harmonist Data Toolkit is a web-based application written in the open source programming language R, employs the R/Shiny and RMarkdown packages, and leverages the REDCap data collection platform for data model definition and user authentication. The Toolkit performs data quality checks on uploaded datasets, checks for conformance with the network’s common data model, displays the results both interactively and in downloadable reports, and stores approved datasets in secure cloud storage for retrieval by the requesting investigator. Including stakeholders and users in the design process was key to the successful adoption of the application. A survey of regional data managers as well as initial usage metrics indicate that the Toolkit saves time and results in improved data quality, with a 61% mean reduction in the number of error records in a dataset. The generalized application design allows the Toolkit to be easily adapted to other research networks.

Initial Usage of Fish Community to Assess Water Quality in Van Long Wetland Nature Reserve, Ninh Binh Province

Van Long Wetland Nature Reserve is the 9th Ramsar of Vietnam, which has high biodiversity. To assess water quality in this area, the present study initially used the Shannon-Wiener Diversity Index (H') and IBI (Index of Biotic Integrity) of fish community collected in two field surveys in September 2019 and May 2020. A total of 33 fish species belonging to 18 families, 8 orders were determined. The H' index was 1.983 and IBI as 32 indicated that the water quality in the Van Long Wetland Nature Reserve was poor, probably influencing on aquatic organisms. In general, physical-chemical analysis methods revealed that most of the water parameters in the surface layer are good, but many parameters ranged from B1 to A2 levels, especially for TP (Phosphate calculated as P) being at poor level of pollution (B1-B2). Thus, results obtained from both bio-indices and physical-chemical analysis seem similar and indicate that the water in Van Long Wetland Nature Reserve was not completely clean. This finding will contribute to providing data for the conservation of biodiversity and ecotourism development in the reserved area.