Online Program Research Articles

Correlation between vaccine hesitancy, vaccine reliability and perceptions of infectious diseases

Abstract Background Vaccine hesitancy is a delay in vaccine acceptance or refusal despite the availability of vaccination services. In recent years, the rise in vaccine hesitancy has attracted attention. This study aimed to evaluate the perception of vaccine hesitancy, vaccine safety, and infectious diseases among parents. Methods This cross-sectional study was conducted with 503 parents who applied to the pediatrics outpatient clinic of a university hospital. The questionnaire used in the study included questions on sociodemographic characteristics, factors related to vaccine hesitancy, The Vaccine Hesitancy Scale (VAS), the Vaccine Safety Scale (VSS), and the Perception Scale for Infectious Diseases (PPSID). Multivariate Linear Regression Analysis was used to find the variables associated with vaccine hesitancy. Results The mean age of the parents was 37.6±7.6 years. Parents’ scores on the ATS ranged from 17-85, with a mean score of 20.1±6.6 points. A moderate negative correlation was found between parents’ VAS and VSS scores, and between VAS and PPSID scores (r=-0.412, p < 0.001; r=-0.409, p < 0.001, respectively). According to the multivariate linear regression analysis the variables found to be associated with vaccine hesitancy, income status, maternal education level, child’s age group, having information about childhood vaccination schedule, child’s immunization status, the necessity of childhood vaccines, having sufficient information about the safety of vaccines, vaccine safety level, and infectious disease perception level were found to be significant predictors of vaccine hesitancy (F: 12,844, p ≤ 0.001, R2: 0.334). Conclusions This study determined that vaccine hesitancy was higher in families with lower income, who have not completed the schedule nor been vaccinated, doubt the necessity of vaccines to prevent infectious diseases, lack of knowledge about the reliability of vaccines, and whose children are still in primary school. Key messages • Health professionals have a critical role in reducing vaccine hesitancy. • It would be appropriate to plan face-to-face or online programs with parents.

Efficacy of online japanese intensive cardiac rehabilitation for secondary prevention for coronary artery disease: a comprehensive program including exercise, nutrition, mindfulness, and group support

Abstract Background/Introduction While comprehensive programs for cardiac rehabilitation are recommended for patients with coronary artery disease (CAD), systematic programs including nutrition, stress-management, and behavior change have not been clearly established. Purpose To comprehensively change the lifestyle of patients with CAD as secondary prevention, we developed an online based educational program "intensive cardiac rehabilitation for Japanese patients with CAD (J-ICR)" modifying ICR, a regimen covered by health insurance in the United States, to the program that has affinity with Japanese. Methods Online J-ICR program is set up as sessions for maintenance-phase CAD patients using an online application. J-ICR has 12 sessions held weekly for 3 hours per session, total 36 hours, aimed to integrate 4 components: 1) exercise guidance based on exercise prescription which contain aerobic exercise, resistance training, and multi-component exercise through online platforms, 2) dietary education focusing on "the Japan Diet", 3) stress management utilizing mindfulness, and 4) group support to enhance patient and medical-staff interaction. Twenty-two participants were randomly separated to Early Phase group and Late phase group. For verification of the efficacy of this program, we survey the adherence to the program and compared the changes in risk factor of CAD at 3 months defining Early phase group as intervention group and Late phase group as control. (Fig.1). Results After excluding 3 participants who withdrawn to participate, the remaining 19 participants were conducted the evaluation and 10 participants were in intervention group and 9 participants in control group, respectively. As for patient characteristics, the mean age was 66 years old, and all participants were male. History of CVD was comprising 8 cases of myocardial infarction and 15 cases of angina pectoris. As for the risk factors of CVD, there were not significant differences in mean low density lipoprotein (LDL) cholesterol (Intervention group 71.5mg/dl vs Control group 83.4mg/dl; p=0.12) or systolic blood pressure (SBP) (126mmHg vs 130mmHg; p=0.40) at base line between two groups. The average participating rate in program was 93.8% and there was no dropped out participant during the program in investigation group. After 3months, LDL cholesterol was not significantly decreased in both groups (mean reduction of Intervention group -0.3mg/dl, p=0.93 and control group -3.8mg/dl, p=0.43, respectively). However, there was significant reduction of SBP in intervention group (mean reduction 5.6mmHg, p=0.02) but in control group (mean reduction 2.4mmHg, p=0.42). (Fig.2). Conclusions This randomized controlled study showed the good adherence of J-ICR program and it suggested that J-ICR program has the effect on lowering systolic blood pressure at 3 months. Longer follow up data and the results of more participants are warranted to clarify the efficacy in real world prevention of CVD.

Effects of an online program about intimate and romantic relationships for people with mental disorders (AIRIKI): a study protocol for a randomized controlled trial

BackgroundThe concept of recovery has become internationally widespread. To promote personal recovery of individuals with mental disorders, it is important that they live life on their own terms. Many people with mental disorders wish to build intimate relationships and marry. However, people with mental disorders face obstacles in building such relationships and communicating with their partners. The program AIRIKI, which means “power to love,” was developed to help people with mental disorders gain confidence in building intimate relationships. The AIRIKI pilot study with one-group pre post test showed positive effects on self-esteem, hope, and communication. Therefore, the purpose of the proposed randomized controlled trial (RCT) is to determine the effects of the videoconferencing program on self-esteem, hope, and self-confidence in communication among un-married people with mental disorders.MethodsThe proposed randomized controlled trial has two arms (intervention group and control group). After baseline questionnaire assessment, participants will be allocated randomly. Within two months of allocation, the intervention group will participate in videoconferences about intimate relationships and marriage with 2–5 participants and 3 facilitators, which will last 3 h, for two days. Three facilitators will support participants in each session. The intervention group will complete a questionnaire for outcome assessment at termination and one month after the program. The control group will complete the outcome questionnaire at one month after baseline and two months after baseline. The questionnaire will include the Rosenberg Self-Esteem Scale (RSES), Herth Hope Index (HHI), and Self-confidence in Communication Scale (SCS). Control group members can participate in a videoconference program, which will be held separately from the intervention group, after completing their outcome assessments.DiscussionThis trial is the first randomized controlled trial of which we are aware to test the effects of an online program for un-married people with mental disorders to consider and discuss their romantic relationship and marriage. The results will provide information on the effectiveness of an online program for people with mental disorders to imagine their romantic relationships and marriages.Trial registrationThis trial has been registered with the UNIN Clinical Trials Registry (UMIN000052027; 2023/08/28).

The relationships between online program formatting, technology satisfaction, and course quality

This study aims to explore students’ perceived quality of graduate courses in relation to their satisfaction with the technological tools used in online master’s level courses. Invariance testing and structural equation modelling were used to demonstrate the validity of technology usage scales and effectively test links between course type, technology satisfaction, and course quality. The study participants included 364 graduate students enrolled at a large university in the Midwest who were taking blended and fully online courses. The participants responded to a scale regarding their experience with the course. Interestingly, program type (blended vs. fully online) did not significantly impact technology satisfaction or the perceived quality of the course, even after taking into account the technology satisfaction mediator on course quality. Program type is not related to course quality, although technology satisfaction does contribute to quality ratings. The implications for instructors suggest that the development of technology-centric activities is warranted to improve the quality of online education courses.

Patient Perspectives on Blended Internet-Based and Face-to-Face Cognitive Behavioral Therapy for Alcohol Use Disorder: Qualitative Study.

Harmful alcohol consumption has been identified as a major contributor to disease, mortality, and social harm, accounting for 5.3% of worldwide deaths annually. In Denmark, an estimated 150,000 people suffer from alcohol use disorder (AUD), but a low proportion seek treatment due to person- and treatment-related barriers. Internet-based cognitive behavioral therapy (iCBT) has shown positive effects on the treatment gap, with patients reporting benefits such as increased knowledge and flexibility. However, there is a lack of research on blended cognitive behavioral therapy (bCBT), which combines face-to-face CBT (FtF CBT) and iCBT for AUD. This study aims to investigate user experiences of bCBT. More specifically, it seeks to explore the advantages and disadvantages that users have experienced with bCBT for AUD, as well as their motivations for choosing this treatment format. A total of 30 patients who had participated in the Blend-A (Blending Internet Treatment into Conventional Face-to-Face Treatment for AUD) study and received the intervention were contacted and offered the opportunity to participate in semistructured individual telephone interviews. Of these, 12 patients consented to participate. Furthermore, an additional participant was approached at a municipal clinic and agreed to engage in an individual FtF interview. Thus, the final sample consisted of 13 patients. The interviews explored their background, experiences with digital technology, motivations for choosing internet-based treatment, and experiences with the program during AUD treatment. The interviews were audio-recorded and transcribed in full length and analyzed using thematic analysis. All data were anonymized and securely stored. We found that users experienced several advantages of iCBT over a larger part of the treatment course, including increased anonymity and privacy. Most importantly, it offered flexibility, allowing patients to focus on their rehabilitation process at their own pace. Patients appreciated the availability of written text in the online program, finding it helpful for gaining knowledge and understanding of AUD and its impact on the individual with the condition. They emphasized how the assignments helped them fully engage in treatment by first acknowledging their problem with alcohol and then dedicating time to self-reflection before FtF sessions, allowing for more in-depth discussions with the therapist. They also appreciated the reminders, which motivated them to complete their assignments. Overall, patients perceived more benefits than disadvantages in using bCBT. Essentially, bCBT offers a form of assisted autonomy that cannot be fully achieved through iCBT or FtF CBT alone. It is only through their combination that patients can fully appreciate the benefits of the treatment, as they have time for self-reflection, with guidance from the therapist between FtF CBT sessions. ClinicalTrials.gov NCT04535258; https://clinicaltrials.gov/ct2/show/NCT04535258.

Gatekeeper training for youth suicide prevention: A mixed method comparative analysis of two online programs

AbstractThe overriding aim of this study was to conduct a side‐by‐side comparative evaluation of two online suicide prevention gatekeeper‐training programs: Question, Persuade, Refer (QPR) and Making Educators Partners in Youth Suicide Prevention (MEP). Specific aims included identifying program components, instructional methods, and technology elements that are well received by school personnel and that increase knowledge and self‐efficacy. QPR and MEP were directly assessed following levels one and two of Kirkpatrick's Model (i.e., reactions to training, program efficacy), and indirectly assessed at levels three and four (i.e., future gatekeeper behaviors, potential school community impact). QPR and MEP produced positive outcomes with respect to reactions, knowledge, and self‐efficacy (i.e., Kirkpatrick levels one and two). MEP and QPR also produced partial support with respect to behavior and impact (i.e., Kirkpatrick levels three and four), given the limited objective data demonstrating consistent application of gatekeeper skills that reduce community suicidal behaviors. Taken together, future research should evaluate inclusion of innovative pedagogical approaches and strategic online classroom design, which may enhance learning motivation, attitudes, and self‐efficacy. Research should also objectively evaluate intermediate and longer‐term behavioral outcomes to identify population‐level impact.

Evaluation of an Orientation Program for Adjunct Clinical Instructors in Nursing

Abstract Part-time clinical nurse instructors teach students in many nursing schools in the United States. They are often unprepared for this role and require instruction in teaching methods. We developed and evaluated an online orientation program to provide the knowledge and skills necessary for nurses to become confident clinical instructors. For this project, 55 nurses completed the program; 28 were part-time faculty. Significant statistical differences were noted after completing the orientation program. Part-time faculty notably benefited from the online program and felt more confident in their ability to work with students.

A randomized clinical trial of emotional freedom techniques for chronic pain: Live versus self-paced delivery with 6-month follow-up.

Chronic pain represents a major global healthcare crisis, and current treatments are limited in effectiveness and safety. Emotional freedom techniques (EFTs) show promise as a potential psychological treatment. The current study investigated the effect of a randomized clinical trial of EFT for chronic pain in a sample of 147 adult chronic pain sufferers (89.9% female; mean 54.63 years). Participants engaged in a 6-week EFT programme (either online self-paced or in-person). The per-protocol analysis indicated pain severity and interference scores were significantly lower at the end of treatment for the EFT group compared to waitlist, and these were sustained at follow-up. There were no differences between the in-person or self-paced programmes at follow-up for pain severity and interference. Somatic symptoms were significantly lower after EFT, although no further differences at follow-up. Quality of life scores were significantly higher after EFT, which were sustained at follow-up, and no differences between two styles of programme. No significant effects were found for anxiety, depression, happiness or satisfaction with life across the 6-week programmes for either style of delivery or at follow-up. These are discussed in terms of clinical score meanings. Intent-to-treat analysis was consistent with the per-protocol analyses. Limitations of the study are identified and future directions are discussed. Findings offer early promise for EFT as a potentially effective pain management strategy, as well as support for online intervention without compromising treatment outcomes. An emerging body-based intervention for chronic pain may be a possible solution for remote clients who cannot attend in-person sessions. In this clinical trial Emotional Freedom Techniques (EFT) significantly reduced chronic pain severity and interference, and there were no differences between and online self-paced program toan online in-person EFT intervention. Both were equally effective, also enhancing quality of life without compromising outcomes. The results were significant at 6-month follow-up/. These findings highlight a body-based approach as a promising, accessible pain management strategy, and highlights that online programs may be part of the solution for chronic pain patients.

Multiple Truths and Many Roads: Leading Graduate Study Abroad

This panel will feature presentations from faculty from three universities with programs that offer study abroad opportunities for master’s-level Library and Information Science (LIS) students. This panel is designed to open a larger discussion pertaining to study abroad and will focus on the following objectives: To provide examples of creative study abroad initiatives. To generate discussion on the value of international experiences. To discuss the importance of cultivating an experience that fosters understanding of the “other” culture(s) through engagement and learning. To provide examples of in-person extended experience for students who may be in online programs. Marie L. Radford and Lilia Pavolvsky will describe study abroad opportunities at Rutgers. Radford leads a Master of Information (MI) hybrid course “British Collections and Archives.” This is a three-credit summer session course with nine days at Wroxton College in England in addition to online modules. It includes visits to libraries and archives in London and surrounding areas, such as the British Library, The National Archives, the Bodleian Library at Oxford University, the Library and Archives of the Shakespeare Center at Stratford-upon-Avon, and Bletchley Park. The course involves lectures by noted British scholars and librarians on trends in academic and public libraries, digital preservation, and archival studies. Students learn about how libraries and archives function with different systems of government, different funding models, and different credentialing practices. Additionally, Rutgers offers study abroad for an International Children’s Literature course, that includes a visit to the annual Bologna Children’s Book Fair, in Italy. This event attracts global book publishers and member organizations of "ibby" the International Board on Books for Young People. Graduate students have the unique opportunity to explore ways of creating text, art, and design for children and teenagers while meeting experts on youth literacy from many nations. Also, we will share plans to offer international experiences to graduate students that include professional conferences and other opportunities for open discourse to discover many truths beyond the boundaries of their local professional and scholarly communities. These experiences will be designed to offer travel to environments in which students have the opportunity to engage in dialogue that is not only inclusive of perspectives of international LIS scholars, practitioners, and students, but which also enables an exchange of cross-cultural ideas to promote mutual understandings. Lisa O’Connor will discuss the origins of her study abroad course to Northern Ireland and Ireland, which she first developed at the University of Kentucky. Frustrated with her predominately white, middle-class students’ intractable view of their culture as innocuous, she hoped that a study abroad experience would help students gain the distance and objectivity they needed to see patterns of domination and repression in another culture and, as a result, better see these patterns in their own. Her course examines whose culture is preserved and whose is not, and who controls the dissemination of information (and thus the narrative) surrounding cultural conflict. Students examine the narrative on “The Troubles” as it was promulgated by mainstream, pro-British American media prior to their in-country experience. Students are able to contrast (1) the treatment of indigenous Irish culture with colonized British culture, and (2) messages disseminated about Irish resistance with those of the colonizer, in order to understand the roles information and information policy play in reproducing cultural hegemony, Data gathered from students indicate that the study abroad experience does in fact increase cultural humility and provide a transformative experience that helps them see “truth” as conditional rather than absolute and to ask, “who controls the narrative” in cultural conflict. Matthew Saxton will describe the International Exploration Seminar program and how MLIS graduate students have engaged in study abroad for over 10 years in multiple countries (Netherlands, South Korea, New Zealand, Ghana, Denmark, United Kingdom, Austria, Ethiopia, and Portugal). Themes of seminars have included urban informatics, cross-cultural adoption of information technology, polarization and inclusion in different societies, information literacy, and children’s literature and “own voices” in publishing. The presentation will focus in depth on the South Korea seminar as a case study that has run for 12 years and engaged over 180 US students and an equal number of Korean students. Students examine the interaction of culture, adoption of information technology, and use of social media, and consider such questions as: Do US and Korean students use social media in similar or different ways? How do they communicate, share, and validate information? We examine the cultural, economic, social, and political factors that shape the online information environment of both societies. Presenters will engage the audience in lively discussion and exchange of ideas. Discussion topics will center on the purpose and value of international experiences in graduate study, planning and investment on part of the institution, incentives for student recruitment, preparation of faculty, and building effective international partnerships.

Integrating experiential learning into online facilitation at the National Open University of Nigeria

ABSTRACT This paper underscores the significance of experiential learning, emphasising active engagement and practical application, particularly in the realm of online education. This research is focused on the National Open University of Nigeria (NOUN). The study employs a survey research design involving internal and external online facilitators. The research explores the perceptions, benefits, challenges, and potential strategies for integrating experiential learning into online facilitation. With a sample size of 276, data collection utilised a structured questionnaire, and analysis involved descriptive and inferential statistics. The study’s findings have practical implications, informing policy decisions, instructional design practices, and faculty development initiatives at NOUN, ultimately aiming to enhance the holistic and immersive learning experience for online learners. The conclusion emphasises the potential of integrating experiential learning to elevate the quality, effectiveness, and real-world preparedness of NOUN’s online programmes, fostering student engagement and critical thinking.

Variability in Causal Effects and Noncompliance in a Multisite Trial: A Bivariate Hierarchical Generalized Random Coefficients Model for a Binary Outcome.

Within each of 170 physicians, patients were randomized to access e-assist, an online program that aimed to increase colorectal cancer screening (CRCS), or control. Compliance was partial: of the experimental patients accessed e-assist while no controls were provided the access. Of interest are the average causal effect of assignment to treatment and the complier average causal effect as well as the variation of these causal effects across physicians. Each physician generates probabilities of screening for experimental compliers (experimental patients who accessed e-assist), control compliers (controls who would have accessed e-assist had they been assigned to e-assist), and never takers (patients who would have avoided e-assist no matter what). Estimating physician-specific probabilities jointly over physicians poses novel challenges. We address these challenges by maximum likelihood, factoring a "complete-data likelihood" uniquely into the conditional distribution of screening and partially observed compliance given random effects and the distribution of random effects. We marginalize this likelihood using adaptive Gauss-Hermite quadrature. The approach is doubly iterative in that the conditional distribution defies analytic evaluation. Because the small sample size per physician constrains estimability of multiple random effects, we reduce their dimensionality using a shared random effects model having a factor analytic structure. We assess estimators and recommend sample sizes to produce reasonably accurate and precise estimates by simulation, and analyze data from a trial of a CRCS intervention.

Improving Mental Health Knowledge and Reducing Mental Health Stigma Among Public Safety Personnel: Comparison of Live vs. Online Psychoeducation Training Programs

This study evaluates the effectiveness of a brief psychoeducation training program in reducing mental health stigma, both toward others and oneself, among public safety personnel, while also comparing the relative effectiveness of in-person and online training modalities. In total, 1686 public safety personnel in Florida received psychoeducation on the mental health impacts of public safety work. Participants completed pre- and post-training questionnaires assessing demographics, mental health knowledge, and mental health stigma toward others and themselves. Among the participants, 871 completed the training online, and 44 completed the training in-person. A paired samples t-test assessed changes in knowledge from pre- to post-test, and 2 × 2 repeated measures ANOVAs analyzed stigma-related data. Mental health knowledge increased and mental health stigma toward others decreased post-training, with no differences between training modalities. No changes in mental health self-stigma were found. Police officers reported significantly greater self-stigma than firefighters. Firefighters and dispatchers reported significantly less stigma toward others than police officers. This study found that both in-person and online psychoeducation can similarly improve mental health knowledge and reduce stigma toward others, which may help reduce barriers to seeking care.

Exploring the perceptions of New Zealand Chinese dementia carers on the adapted world health organization iSupport manual: A qualitative study.

Across countries, most dementia carers report a lack of adequate information about dementia and local services. To address this issue, the World Health Organization developed the iSupport programme to provide information and support to dementia carers. The iSupport online programme was found to be feasible and acceptable by dementia carers. However, the potential of using the iSupport manual (iSupport) specifically for Chinese dementia carers in New Zealand remains unknown. This study aimed to (1) identify refinements to adapt iSupport by eliciting the perspectives of Chinese dementia carers; and (2) explore the educational needs of Chinese dementia carers, which can inform the development of support programmes tailored to their specific requirements. This was a qualitative descriptive study using semistructured interviews. The data were analysed using thematic analysis. Twelve Chinese dementia carers were interviewed (mean age 58.0years, 100% female, and mean caring experience of 2.2years). Emerging themes were identified within three domains: (1) usefulness, (2) complexities of using iSupport, and (3) suggestions for improvement. The findings suggest that Chinese dementia carers generally found iSupport to be valuable, providing valuable insights into how to tailor and enhance support for this population. However, further research is required to empirically validate the effectiveness of the adapted iSupport for Chinese dementia carers in New Zealand. These findings have implications for the development of future interventions that can more effectively address the specific needs of Chinese dementia carers.

Online Parenting Programs for Children's Behavioral and Emotional Problems: a Network Meta-Analysis.

Online parenting programs to support parents of children with behavioral problems and emotional problems have become widely available in recent years. Research has consistently shown their positive effects on child development, parents' adaptive parenting practices, and parents' mental health. However, knowledge is lacking on which type of content is more suitable to be delivered online. Our work addresses this knowledge gap by conducting traditional and network meta-analyses to improve our understanding of (1) how effective online parenting programs are to improve children's behavior and emotional problems, and (2) what clusters of components are most likely to yield the strongest effects. Following the PROSPERO preregistration, we systematically searched PsycINFO, MEDLINE, Web of Science, and Cochrane. Of the 8292 records retrieved, 28 records on 27 randomized controlled trials (N = 5,312) met the inclusion criteria. Results show moderate effect sizes of online parenting programs on reduced child behavioral and emotional problems, parents' ineffective parenting practices, and parents' mental health problems. Online programs adopting a learning theory perspective, either with or without additional parental self-care and parents as therapist approaches, are most likely to yield the strongest effects on child behavioral problems. Online programs adopting a learning theory perspective, parental self-care and parents as therapist approaches, with or without additional relationship perspectives, are most likely to yield the strongest effects on child emotional problems. Online parenting programs seem promising tools for improving child behavioral and emotional problems. Future research should identify the circumstances that allow parents and children to benefit more from specific components in these programs.

Addressing rural health disparities by optimizing “high-touch” intervention components in digital obesity treatment: The iREACH Rural study

BackgroundRural residents are more impacted by obesity and related comorbidities than their urban counterparts. Digital weight management interventions may produce meaningful weight loss among rural residents. ObjectivesThe iREACH Rural Study aims to identify “high-touch” component(s) that contribute to meaningful weight loss (≥1.5 kg) at 6-months, over and above what the 24-week core online program produces. Three treatment components are assessed: group video sessions (yes/no); self-monitoring feedback (counselor-crafted/pre-scripted, modular); and individual coaching calls (yes/no). DesignThe iREACH Rural Study is a factorial experiment (n = 616). MethodsParticipants receive up to 3 “high-touch” components (weekly synchronous facilitated group video sessions, weekly counselor-crafted self-monitoring feedback, and individual coaching calls) to determine which contribute meaningfully to 6-month weight loss. Participants complete assessments at baseline, 2 months, 6 months, and 12 months. Weight loss at 6 months (primary outcome) and 12 months (secondary outcome) is measured by Bluetooth-enabled scales. The study seeks to identify the weight loss approach for underserved rural residents which optimizes weight change outcomes and also examines costs associated with delivering different treatment constellations. SummaryThe iREACH Rural Study is the first of its kind to isolate digital weight loss intervention components to determine which meaningfully contribute to long-term weight loss among rural residing individuals. The results may be used to refine digital weight loss programs by enhancing their effectiveness to allow broad dissemination.

Evaluating the impact of a specialized and centralized online medical consultation system for paramedics: pilot study.

There are many limitations to utilizing on-duty emergency department (ED) physicians as Base Hospital Physicians for paramedic telephone consultations. We aimed to examine the impact of a specialized and centralized Online Medical Consultation program for paramedic consultations on system-relevant performance. This is a before-after study with concurrent control using health record review of audio recordings over a 6-month period before and after implementation of the Online Medical Consultation program. The primary outcome was the duration of paramedic consultation calls. The secondary outcomes included number of calls with orders that contradicted existing medical directives, number of calls with orders outside of paramedic scope of practice, number of calls with Base Hospital Physician requiring clarification on medical directives, and number of calls with Base Hospital Physician interrupting the paramedic during the call. We included 220 consultation calls. The patients' mean age was 54.5years. Most consultation calls (70.5%) were for mandatory consultations and 22.7% were voluntary. Most consultations were related to cardiac arrest (43.6%), combative patients (15.0%), and analgesia (13.6%). Before-after comparisons for total call duration showed that mean call duration decreased in Ottawa from 4:28 to 4:05min (p = 0.77) and decreased in Kingston from 4:50 to 4:13min (p = 0.49). There were no significant differences in our secondary outcomes. The Online Medical Consultation program was implemented and removed the responsibility of responding to online medical consultations for on-duty emergency physicians in Ottawa. The total call duration was not significantly different between groups. Additional time intervals and adherence to protocol benefits were also not statistically significant due to low baseline incidence.

Generative AI-based knowledge graphs for the illustration and development of mHealth self-management content.

Digital therapeutics (DTx) in the form of mobile health (mHealth) self-management programs have demonstrated effectiveness in reducing disease activity across various diseases, including fibromyalgia and arthritis. However, the content of online self-management programs varies widely, making them difficult to compare. This study aims to employ generative artificial intelligence (AI)-based knowledge graphs and network analysis to categorize and structure mHealth content at the example of a fibromyalgia self-management program. A multimodal mHealth online self-management program targeting fibromyalgia and post-viral fibromyalgia-like syndromes was developed. In addition to general content, the program was customized to address specific features and digital personas identified through hierarchical agglomerative clustering applied to a cohort of 202 patients with chronic musculoskeletal pain syndromes undergoing multimodal assessment. Text files consisting of 22,150 words divided into 24 modules were used as the input data. Two generative AI web applications, ChatGPT-4 (OpenAI) and Infranodus (Nodus Labs), were used to create knowledge graphs and perform text network analysis, including 3D visualization. A sentiment analysis of 129 patient feedback entries was performed. The ChatGPT-generated knowledge graph model provided a simple visual overview with five primary edges: "Mental health challenges", "Stress and its impact", "Immune system function", "Long COVID and fibromyalgia" and "Pain management and therapeutic approaches". The 3D visualization provided a more complex knowledge graph, with the term "pain" appearing as the central edge, closely connecting with "sleep", "body", and "stress". Topical cluster analysis identified categories such as "chronic pain management", "sleep hygiene", "immune system function", "cognitive therapy", "healthy eating", "emotional development", "fibromyalgia causes", and "deep relaxation". Gap analysis highlighted missing links, such as between "negative behavior" and "systemic inflammation". Retro-engineering of the self-management program showed significant conceptual similarities between the knowledge graph and the original text analysis. Sentiment analysis of free text patient comments revealed that most relevant topics were addressed by the online program, with the exception of social contacts. Generative AI tools for text network analysis can effectively structure and illustrate DTx content. Knowledge graphs are valuable for increasing the transparency of self-management programs, developing new conceptual frameworks, and incorporating feedback loops.

Tiers of Engagement: Achieved Learning From Business Simulations Reflected in Economics Students’ Experiences

This article investigates the impact of a business simulator in an online economics course, focusing on the relationship between student engagement and reflections on learning. Utilizing a mixed-methods approach, our study analyzes responses from 328 students who used the "Hubro Business Simulator" in a flexible online bachelor's program in economics and administration. Students provided reflections on the simulator as a learning activity, application of theoretical concepts and practical relevance. Qualitative analysis of 1640 responses further explored the depth of students' reflections, categorized into different tiers of engagement based on their responses. This analysis builds on Self-Regulated Learning (SRL) and motivational theory. The study sought to determine whether students reporting higher levels of engagement exhibited deeper metacognitive reflections compared to their less engaged peers. Findings support a link between the level of engagement and the depth of reflection. Students with higher engagement levels were more likely to reflect on specific ways in which the simulator had supported their learning and understanding of theoretical concepts. This paper discusses the limitations and implications of these findings for enhancing game-based learning interventions, emphasizing the need to foster higher engagement levels to improve educational outcomes in online learning environments. The study contributes to the literature on game-based learning by providing a large empirical study on how business simulators can foster higher-order thinking and deeper learning reflections among economics students. It also highlights the role of engagement in using business simulators as learning tools, offering insights that could improve the learning design and implementation in similar online and flexible learning program contexts.

PASS Assisted Prediction and Meta-analysis of Active Phytoconstituents of <i>Guggul</i> for the Treatment of Chronic Prostatitis: A Gateway to Cure Prostate Cancer

Background: Mostly men are particularly prone to prostate cancer as well as chronic prostatitis the underlying causes behind prostate cancer as well as chronic prostatitis are multifaceted as well as diverse a spike in serum prostate-specific antigen characterises both diseases. Chronic prostatitis is prostate inflammation independent of the source inflammation and is linked to a variety of malignancies in general along with prostate inflammatory reactions that are thought to have a contributing influence on the advancement and growth of prostate cancer. Aim: This study aims to identify different phytoconstituents of Guggulu for treating chronic prostatitis along with meta-analysis. Meta-analysis is used as an analytical technique to aggregate results of separate inferential statistics investigations of clinical data on chronic prostatitis. Methods: Phytochemical ingredients were analyzed using PASS estimates. Canonical SMILES were identified to determine Pa values. PASS software was then used to forecast activities. Doxycycline, a conventional drug for chronic prostatitis, was selected for comparison. Data was collected using the PASS online program to estimate physiological and biochemical parameters. The activities of all constituents were then compared against doxycycline. Results: The results indicate that Guggul sterone Z shows promise as a candidate for further investigation in medication therapy for chronic prostatitis. A meta-analysis aims to identify clinical trials for this phytoconstituent, which has yielded the highest number of results. PASS prediction findings reveal that Guggul sterone Z, followed by Mansumbinone, 16-dehydroprogesterone, and alpha-pinene, exhibit the most significant activities. Conclusion: The study forecasted that Guggul sterone Z, Mansumbinone, 16-dehydroprogesterone and alpha-pinene are the potential phytoconstituents that can play a vital role in the development of novel treatments for chronic prostatitis-induced prostate cancer.

Provider Perspectives: Feasibility, Acceptability, and Appropriateness of Online Parent Training With Therapist Coaching in a Community Practice Setting

A considerable body of evidence documents the detrimental impact of disruptive behavior disorders (DBDs) in childhood and their longstanding effects across development and into adulthood. While research has yielded evidence-based interventions for DBDs, such as parent management training, disparities in access to care persist. The growing ubiquity of consumer technologies underscores the potential to provide evidence-based treatments through online programs; however, structural barriers continue to impede dissemination in community settings. This paper examines clinic staff’s perspectives on the implementation of an online parent management program in a community mental health center (CMHC) to integrate novel programming with existing therapeutic care to maximize resource efficiency in treatment delivery and increase family adherence and engagement. Quantitative and qualitative data were collected from 16 staff members who were trained to deliver the intervention at a CMHC. Quantitative data indicated positive perceptions across various domains, while qualitative findings highlighted feasibility, acceptability, and appropriateness. Facilitators to feasibility included program ease, integration into sessions, and flexible access. Time constraints and technology access were barriers. Acceptability was high, with videos reinforcing therapy and promoting family connection. The program’s structure and psychoeducation were appreciated, while quiz format and time constraints were concerns. Appropriateness was positive, with broad relevance, insight-building impact, comprehensive coverage, evidence-based strategies, and support. Barriers existed for specific patient characteristics. Implications for implementation in practice and future directions of research are discussed.