Online Material Research Articles

A multimetric health literacy analysis of online gender affirmation surgery materials: From facial to genital surgery

The transgender patient population is expanding, and gender affirming surgery (GAS) volume is increasing. Accurate, comprehensive, and easily navigable resources on GAS are lacking. We aim to evaluate the readability of online materials for specific gender affirming surgical procedures to identify mechanisms of improving information access for transgender patients. "Facial feminization", "facial masculinization", "MTF breast augmentation", "FTM chest masculinization", "MTF vaginoplasty", "metoidioplasty", and "FTM phalloplasty" were searched on Google. Per keyword, the first 75 text-containing results were included. Text was analyzed for reading difficulty using the Flesch-Kincaid Reading-Ease (FKRE) test and grade level using the Flesch-Kincaid Grade Level (FKGL) formula, Gunning Fog Index (GFI), Simple Measure of Gobbledygook (SMOG), and Coleman-Liau Index (CLI). Scores were compared using independent t-and ANOVA tests (α=0.05). Mean readability scores (FKRE 37.44) and grade-levels (FKGL 12.87, GFI 15.61, SMOG 11.91, CLI 15.00) correlated with college-level difficulty. Masculinizing surgical materials were more difficult to read than feminizing ones (p≤0.023). Top surgery materials were easier to read than facial and genital surgery materials (p≤0.013). Specifically, chest masculinization resources were more difficult to read than those for breast augmentation (p≤0.006). No differences were found between facial feminization and masculinization surgery resources, nor between resources for different gender affirming genital surgeries. Online GAS materials are written above the recommended 6th grade reading-level, with resources for transgender men being significantly more challenging to understand. Improving readability of online resources can help overcome barriers to care for the transgender patient population.

Effect of Personalized Email-Based Reminders on Participants' Timeliness in an Online Education Program: Randomized Controlled Trial.

Postsecondary students need to be able to handle self-regulated learning and manage schedules set by instructors. This is particularly the case with online courses, as they often come with a limited number of social reminders and less information directly from the teacher compared to courses with physical presence. This may increase procrastination and reduce timeliness of the students. Reminders may be a tool to improve the timeliness of students' study behavior, but previous research shows that the effect of reminders differs between types of reminders, whether the reminder is personalized or general, and depending on the background of the students. In the worst cases, reminders can even increase procrastination. The aim of this study was to test if personalized email reminders, as compared to general email reminders, affect the time to completion of scheduled online coursework. The personalized reminders included information on which page in the online material the participants ought to be on at the present point in time and the last page they were on during their last session. The general reminders only contained the first part of this information: where they ought to be at the present point in time. Weekly email reminders were sent to all participants enrolled in an online program, which included 39 professional learners from three East African countries. All participants in the Online Education for Leaders in Nutrition and Sustainability program, which uses a question-based learning methodology, were randomly assigned to either personalized or general reminders. The structure of the study was AB-BA, so that group A received personalized reminders for the first unit, then general reminders for the rest of the course, while group B started with general reminders and received personalized reminders only in the third (and last) unit in the course. In total, 585 email reminders were distributed, of which 390 were general reminders and 195 were personalized. A Bayesian mixed-effects logistic regression was used to estimate the difference in the probability of being on time with one's studies. The probability of being on time was 14 percentage points (95% credible interval 3%-25%) higher following personalized reminders compared to that following general reminders. For a course with 100 participants, this means 14 more students would be on time. Personalized reminders had a greater positive effect than general reminders for a group of adults working full-time while enrolled in our online educational program. Considering how small the intervention was-adding a few words with the page number the student ought to be on to a reminder-we consider this effect fairly substantial. This intervention could be repeated manually by anyone and in large courses with some basic programming.

A predominantly diurnal tropical mammal increases nocturnality in response to high temperatures

AbstractThe extent to which animals may compensate for rising temperatures through behavioral thermoregulation is an important unknown in predicting responses to climate change. Flexibility in temporal activity in particular may be an important factor in determining species' vulnerability. In this study, we examine whether the white‐lipped peccary, a predominantly diurnal Neotropical mammal, shifts its temporal activity and microclimate selection in response to daily temperature variation in the Pantanal biome of Brazil. From November 2021 to October 2022, we deployed camera traps and microclimate data loggers to record white‐lipped peccary activity and air temperature on a fine spatiotemporal scale. We found that the percentage of peccary activity that is nocturnal increased with maximum daily temperature at a rate of 3.7% per 1°C past a threshold of 31.2°C, and increased with maximum daily wet‐bulb temperature at a rate of 4.7% per 1°C past a threshold of 24.9°C. The afternoon period (i.e., solar noon to sunset) went from having the highest frequency of peccary activity at the lower end of our observed temperature range to having the lowest frequency of activity at the higher end. We did not find evidence of microclimate selection. Our findings indicate that white‐lipped peccaries in the Pantanal demonstrate substantial behavioral flexibility in their response to high temperatures, which may help to buffer them against the impact of rising temperatures caused by climate change.Abstract in Portuguese is available with online material.

How environmental factors affect the abundance and distribution of two congeneric species of Amazonian frogs

AbstractIn this study, we test the hypothesis that, at a fine‐scale, environmental variables influence differently sister species that live in sympatry and are phylogenetically closely related. We sampled two Amazonian anuran species, Phyzelaphryne miriamae and Phyzelaphryne sp., in 11 permanent sampling modules distributed across ~600 km in the Purus‐Madeira Interfluve between 2013 and 2014. Using mixed generalized linear models, we found that the species have distinct environmental associations, which may facilitate their coexistence in sympatry. Phyzelaphryne miriamae was more frequent in environments with low precipitation and low water tables, suggesting this species is better adapted to live in drier places. In contrast, Phyzelaphryne sp. appeared to be a generalist regarding to habitat and resource use. These patterns are in accordance with the hypothesis that environmental variables influence sister species differently on a fine scale. Phyzelaphryne miriamae is larger than Phyzelaphryne sp., which may make it more resistant to dehydration, allowing it to explore drier environments. In conclusion, our results are in concordance with the hypothesis that the evolution of characteristics resulting from selection may have reduced competition for resources between closely related species, thus facilitating coexistence in sympatry.Abstract in Portuguese is available with online material.

How will the Covid-19 pandemic shape the future of primary care undergraduate teaching? Understanding modifications and developments deployed by UK academic units of primary care, and their implications for the future

BackgroundPrimary care has been under-represented in its contribution to the academic literature base on Covid-19 developments. We sought to understand how teaching and learning was modified and developed by primary care academic leaders to support the continuation of primary care-orientated learning during the Covid-19 pandemic; and explore how these changes may shape future educational delivery in primary care.MethodsWe adopted a qualitative approach, using semi-structured interviews of seven General Practice Heads of Teaching (GP HoTs) from UK medical schools. We used mixed deductive and inductive coding to analyse interview transcripts. Modifications and developments were coded to four a priori themes (clinical off-site; clinical on-site; synchronous remote; asynchronous remote). We concurrently used inductive coding to identify developments that did not readily fit into these categories. To understand how participants perceived the developments may shape primary care teaching in the future, we carried out an inductive thematic analysis.ResultsA range of modifications and developments were described. Examples of developments include: GP practices being provided with increased flexibility to support ongoing provision of clinical placements (on-site clinical), examples of initiatives enabling students to consult remotely from their homes (off-site clinical), transfer of face-to-face teaching to remote formats (synchronous remote) and development of new, interactive on-line teaching materials (asynchronous remote). One additional theme arose inductively: collaboration and co-operation.For future implications, five themes arose: the evolution of flexible and hybrid clinical placement models; an increased role for telemedicine; increased networking and collaboration; increased active student involvement in patient care; and opportunities for community-based teaching afforded by the pandemic.ConclusionThis study highlights how teaching was modified to support the continuation of primary care-based learning during the Covid-19 pandemic, and implications for the future. Collaboration and placement flexibility were notable features in the response. Participants perceived that flexible placement models containing a mixture of clinical on-site with remote synchronous and asynchronous teaching and learning activities, may persist into the post-Covid era. Further research is required to understand which developments become routinely embedded into primary care teaching in the post-Covid era and explain how and why this occurs.

Digitalization of MSMEs in Pelawi Utara District, Langkat Regency: Opportunities and Challenges

This study's goal was to outline the opportunities and challenges of how digitization will affect MSMEs. We combined publication trends from numerous papers using the qualitative methodology to find them. We found that the process of digitizing MSMEs involves switching from analog to digital technologies in order to improve the efficacy and efficiency of MSMEs business operations. The digitization of MSMEs has compelled stakeholders in MSMEs businesses to change corporate governance from outdated techniques to more contemporary ones. For MSMEs, becoming digital involves more than just utilizing technology to sell goods. Additionally, MSMEs will be able to manage their accounts, track their cash flow, and buy raw materials online as a result of digitization. As a result, digitization is crucial to the whole operation of MSMEs business activities.

A Research on Post-Covid-19 E-learning in Colleges Education:

E-learning is learning through digital materials. It is currently improving rapidly due to its relation with high technologies. The paper researches the difficulties in college E-learning and the solutions to them. The difficulties are unstable internet, including slow download velocity, lack of high-quality online materials, and scarcity of students’ motivation and plagiarism from the previous difficulty. The paper provides the solutions. It aims to help all students in their E-learning process and develop E-learning for the possible future epidemic.

Muted responses to heat in a nocturnal tropical rodent

AbstractWe measured the thermoregulatory characteristics of a common, tropical murid rodent, Sundamys muelleri. Subcutaneous body temperatures and evaporative water loss increased at ambient temperatures above 33°C, but no increases in metabolic rate were observed as high as 38.2°C, indicating tropical rodents may be resilient as climate change progresses.Abstract in Malay is available with online material.

Metaverse in the urban destinations in China: some insights for the tourism players

PurposeAlthough the metaverse has gained popularity in recent days, research on metaverse tourism in urban destinations is still lacking. Drawing on existing cases in Chinese urban destinations, this paper aims to provide valuable insights into the development of metaverse tourism in China and provides managerial implications for future urbanmetaverse tourismplayers.Design/methodology/approachLiterature from Chinese and international sources was reviewed to highlight the current status of metaverse tourism in the context of Chinese urban tourism. This paper also draws on information provided by online materials, especially the official websites of tour organizers and news media.FindingsThis paper outlines important aspects of metaverse in Chinese urban tourism. First, cities are the hotbeds of metaverse development, and the metaverse has become a new way to attract urban tourists and a significant element in various exhibitions. Second, the combination of metaverse with China’s extensive and profound traditional culture has made urban tourism full of vitality. Third, China’s game companies are progressively empowering the metaverse tourism industry.Originality/valueThis paper contributes to the existing knowledge on metaverse tourism based on the Chinese urban tourism context. Furthermore, it highlights the state of the metaverse in Chinese urban tourism during and after the pandemic situation. Lastly, it provides thoughtful implications for tourism players and future tourism development.

Situational Analysis of Human Development in Nepal

Human Development as progress towards greater human well-being, and provided country-level data for a comparing country status based on the well-being indicators. The main objective of the study is to analyze the overall human development status of Nepal. Data were collected through the national census and survey, UNDP HDI reports and online materials. According to the HDI report 2021\22 Nepal perform in the 143rd position with a 0.602 value. The trend of HDI is increasing despite 2021 \22. Nepal's HDI achieved the highest index in 2019 with 0.611 after 29 years. Nepal uplifted into medium development human development. In SAARC countries Nepal's HDI value is comparatively low compared with Sri Lanka, Bhutan, Maldives and India. Bagmati province ranks at the top and Madesh and Karnali provinces perform worst in HDI, GDI, GII and MPI indices according to the HDI Report 2020. Bagmati and Gandaki provinces have high literacy, life expectancy and GDP per capita. Between 1990 to 2022 Nepal's HDI value changed from 0.399 to 0.602 a change of 50.9%, during the period. For the improvement of the HDI indices, the government should formulate and implement appropriate policies which shape the regional and national targets.

Microclimate and seed bank under Pithecellobium keyense (Fabaceae) in a coastal scrubland

AbstractMicroclimatic conditions affect seeds' survival, dormancy, and germination, which are determinants in vegetation succession and recovery. The semiarid coastal scrublands of Yucatan, Mexico are very important because of the environmental services they provide thus, studies are needed in disturbed sites in relation to seed viability and microclimate. In this study, we characterized the microclimate and seed bank under Pithecellobium keyense shrubs, during the rainy and dry seasons. We collected soil samples and measured microenvironmental variables under adult P. keyense at three different positions under the canopy of every studied individual (“open” or completely sunny, “half‐shaded,” placed at the border of the canopy, and “fully shaded” placed under the canopy, next to the stem of the shrub). Photosynthetic photon flux density (PPFD), minimum night‐time temperature, and maximum daytime temperature behaved differently among positions under the canopy both in rainy and dry seasons. During the rainy season, seed viability was no different among microenvironments, while in the dry, the highest was found in the fully shaded and the lowest in the open position. Microclimatic variables under the canopy of P. keyense had an effect on the probability of seed viability in Chuburná; and this effect was stronger in the dry season.Abstract in Spanish is available with online material.

THE EFFECT OF MODERN DIY TECHNIQUES TRANSFORMING CONSUMERS INTO DESIGNERS

In the last ten years, networking, global communications, and technology have all advanced quickly. By enabling consumers to easily use new materials with the right procedures, technological improvements paved the path for clever interior design solutions and eventually began challenging interior design pros. This includes the introduction of Artificial Intelligence and Augmented Reality technology, Interior planning apps, user-friendly designing software, and online material information along with mediatization, which is expanding the possibilities regarding both the end product and the process of making directly from B to C marketers. Therefore, the phenomenon of Do It Yourself arises in this era where the internet handles everything and provides accessibility to the consumer. In short, DIY bypasses the Interior Designing professionals for home styling activity by making things for home independently and not spending much on Interior Designers.

Through the Lens of EFL Teachers: Teaching Online on Lockdown

There has been a growing interest in online EFL teaching studies after the COVID-19 outbreak. However, the majority of the studies have centered around students’ perspectives. The studies examining the issue from EFL teachers’ perspectives, on the other hand, are relatively scarce. Therefore, this study qualitatively investigated EFL teachers’ perceptions and experience in this critical process to bridge the gap in the literature. For the study, the data were collected through written semi-structured interviews with 25 EFL teachers in Turkey. Five themes with several categories emerged based on the thematic analysis of the data with MAXQDA 2020 package program. The teachers commonly focused on the challenges of emergency online teaching and suggested potential solutions. The primary stemmed from the poor communication between teachers and students due to low engagement levels and technology-related issues. The teachers also struggled to find proper online EFL teaching materials since they had no or little experience in online education and did not know how find teaching resources. They suggested providing EFL teachers with workshop opportunities to learn how to tackle technology-related problems and improve their online material developing skills. This study may extend the relevant literature by providing a deeper insight into EFL teachers’ practices and recommendations for practitioners of online teaching

SLEEPexpert+: Blending Internet-Based Cognitive Behavioral Therapy for Insomnia with In-Person Psychotherapy—A Feasibility Study in Routine Care

Insomnia is characterized by frequent and persistent difficulties initiating and maintaining sleep, along with impaired daytime functioning. Blended treatments are increasingly popular for treating psychological disorders such as depression. Blended treatments combine elements of face-to-face therapy and online interventions. A single-arm pre-post study investigated the feasibility of a blended treatment combining face-to-face cognitive behavioral therapy for insomnia and internet-based cognitive behavioral therapy for insomnia (SLEEPexpert+). The findings show that the therapists have a positive attitude toward blended CBT-I (b-CBT-I) and that they feel supported by the online components of the treatment. Possible barriers to implementing blended treatments are integrating the online materials into the face-to-face sessions and adapting one’s therapeutic style to the blended treatment approach. No definitive statements about the effectiveness of the b-CBT-I treatment can be made. However, of the six presented cases, five patients showed notably higher sleep efficiency and fewer insomnia symptoms at the end of the therapy. Program usage data indicate that participants mainly used the online components at the beginning of their treatment. Future studies should investigate the effectiveness of b-CBT-I with a sufficiently powered randomized controlled trial comparing b-CBT-I with an adequate control group in routine care.

The psychological impacts of content moderation on content moderators: A qualitative study

Content moderation generally refers to the practice of monitoring user generated content and applying a set of rules defining what is acceptable. As a result, Content Moderators (CMs) are responsible for reviewing and removing harmful online material, which has the potential to cause psychological harm. However, little is known about the perceived impacts of the job. Semi-structured interviews were conducted with 11 commercial CMs who were exposed to child sexual abuse material (CSAM) as part of their job. Interviews were analysed using framework analysis to investigate any psychological impacts. Results demonstrated that CMs manifested with a range of symptoms consistent with experiencing repeated trauma. This included experiencing intrusive thoughts of CSAM, triggered by situations with similar contexts to those encountered at work, avoidance of children and negative cognitive and emotional effects such as cynicism, anxiety and detachment. These symptoms fit into a framework of post traumatic and secondary traumatic stress and suggest CMs wellbeing and exposure to stressful stimuli may be comparable to professionals working in the emergency services or caring professions, such as social workers. These personnel are at heightened risk of various problems including compassion fatigue, vicarious trauma and burnout. Companies which employ moderators should learn from these comparable professions and provide psychoeducation and trauma-informed care to CMs which have been demonstrated to help mitigate these challenges.

Readability Analysis of Online Breast Cancer Surgery Patient Education Materials from National Cancer Institute-Designated Cancer Centers Compared with Top Internet Search Results.

The National Institutes of Health (NIH) recommends patient education materials reflect the average reading grade level of the US population. Due to the importance of shared decision-making in breast cancer surgery, this study evaluates the reading level of patient education materials from National Cancer Institute-designated cancer centers (NCI-DCC) compared with top Internet search results. Online materials from NCI-DCC and top Internet search results on breast cancer, staging, surgical options, and pre- and postoperative expectations were analyzed using three validated readability algorithms: Simplified Measure of Gobbledygook Readability Formula, Coleman-Liau index, and Flesch-Kincaid grade level. Mean readability was compared across source groups and information subcategories using an unpaired t-test with statistical significance set at p < 0.05. Mean readability was compared using a one-way analysis of variance. Mean readability scores from NCI-DCC and Internet groups ranged from a 9th-12th grade level, significantly above the NIH recommended reading level of 6th-7th grade. There was no significant difference between reading levels from the two sources. The discrepancy between actual and recommended reading level was most pronounced for "surgical options" at a 10th-12th grade level from both sources. Patient education materials on breast cancer from both NCI-DCC and top Internet search results were written several reading grade levels higher than the NIH recommendation. Materials should be revised to enhance patient comprehension of breast cancer surgical treatment and guide patients in this important decision-making process to ultimately improve health outcomes.

Co-production of online educational resources for adolescent and young adult females with epilepsy

ObjectiveTo develop online patient education materials about epilepsy for adolescent and young adult females with epilepsy through co-production in partnership with patients, parents or caregivers, and multi-disciplinary healthcare providers who care for this population. MethodsWe recruited participants from Western/Central Pennsylvania, comprised of females with epilepsy ages 18–26 or parents of children with epilepsy ages 12–26. Healthcare providers who participated in the study were recruited nationally from disciplines of pediatric epilepsy, adult epilepsy, women’s neurology, and adolescent medicine. We held three series of meetings to create the online materials from July to August 2021. ResultsFive adolescent and young adult females with epilepsy (ages 18–26, median age 22) and two parents of children with epilepsy were recruited and participated in meetings. The physician group was comprised of two adolescent medicine physicians, one adult neurologist with a specialization in women’s neurology, one adult epileptologist, and one pediatric epileptologist. All participants were female. Several sets of meetings were held, which involved the creation of an empathy map to evaluate the needs and desires of our participants, topic list development, and specific content and formatting recommendations. After these meetings, content was created for the online materials and published on the Center for Young Women’s Health (CYWH) website. ConclusionOur team utilized co-production with a diverse group of partners to create educational materials that met the interests of adolescent and young adult females with epilepsy. This is a structured and reproducible methodology that could inform future educational intervention development in epilepsy.

How to Recover the Supply Chain under COVID-19 Period Through Recovery Its Resilience

The paper describes how the COVID-19 pandemic led to a worldwide supply and demand crunch for medical supplies such as masks and Personal protective equipment (PPE), causing a break in the supply chain. The application of circular economy concepts to supply chains creates resilient supply chains by reducing dependence on external inputs and outputs to help business cope with unforeseen disasters. The resilient supply chain is enhanced by applying the "3R" principle of value recapture in the circular economy model, i.e. reduce, reuse and recycle, and also by drawing on economic models such as platform economy and sharing economy. The paper references are taken from academic databases such as Google Scholar, as well as online materials such as official websites and news websites, and publications such as Supply Chain Guide.

Research on the Current Situation and Impact of China's "Digital Economy"

Over the last two decades, China, the world's second-largest economy, has flourished and boomed in its digital economy. China's digital industry is currently a world leader in the value of numerous digital applications, technologies, and integrated new ecosystems, especially the communications industry, e-commerce, automobile manufacturing, and mobile payment. It is second only to the United States. Since this rapid development has had a profound impact on various industries and even the world, the paper will analyze the phenomenon of the "digital economy" in China and its impact on the global economy by reading literature and online materials. It can be concluded that 5G technology is the foundation of China's digital economy, e-commerce and electronic payment are flourishing in the Chinese market, and the Chinese government has also carried out timely supervision. Similarly, the digital economy has also brought different impacts including development in industries, innovate in technology, and other negative impacts like monopoly, data leakage and larger gap between rich and poor.

Lower Back Pain Imaging: A Readability Analysis.

The internet provides access to a myriad of educational health-related resources which are an invaluable source of information for patients. Lower back pain is a common complaint that is discussed extensively online. In this article, we aim to determine if the most commonly accessed articles about lower back pain imaging use language that can be understood by most patients. According to the American Medical Association (AMA) and National Institute of Health (NIH), this corresponds to a sixth-grade reading level. Online searches were conducted from the most commonly used search engine, Google, to assess the present state of readability on radiograph imaging for LBP. Then the top 20 populated URL links from each search were utilized based on "health & fitness" search trendsand click-through rates (CTRs). The readability of various websites was evaluated with WebFX online software that analyzed the unique websites' text when put into reader view on Firefox web browser version 116.0.3 (64-bit). Evaluation occurred via five common readability indices: the Automated Readability Index (ARI), the Coleman Liau Index (CLI), the SMOG index, the Gunning Fog Score Index (GFSI), and the Flesch Kincaid Grade Level Index (FKGLI). In addition, the Flesch Kincaid Reading Ease Index (FKREI) was also used but was excluded from the calculation due to its measuring scale outside of US grade levels. The number of samples was analyzed via health and fitness-specific CTRfrom an open-access database from July 2022 to July 2023. This was used to calculate the number of persons clicking and visiting positional URLs (first URL to the 20th URL) from each unique keyword search and the rational criteria for selecting the first 20 websites for each query. Online material that included LBP imaging information was calculated to have an overall readability score of 10.745 out of the 23 websites obtained from unique searches. The range was a mean readability score of 8 to 14. Notably, 17 websites were excluded from a total of 40 websites due to duplication of the same data (URLs that resulted from both unique searches) and accessibility requiring payment (specifically, an UpToDate link). A readability score of 10.745 refers to an 11th-grade reading level. That is to say, the most commonly visited sites on Google that contain information about lower back pain imaging are, on average, five grade levels higher than the sixth-grade reading level recommended by the AMAand the NIH. Most internet content regarding lower back pain imaging is written at a reading level that is above the recommended limit defined by the AMA and NIH. To improve education about lower back pain imaging and the patient-physician relationship, we recommend guiding patients to online material that contains a reading levelat the sixth-grade level as suggested by the AMA and NIH.