Simple Measures Research Articles

(420) Assessing the Quality and Readability of Online Content on Shockwave Therapy for Erectile Dysfunction

Abstract Introduction In our current technology-driven society, patients and healthcare professionals alike are becoming increasingly reliant on online platforms for disseminating and obtaining health information. Previous research has shown that the quality of information available on the internet about novel medical therapies is generally poor and frequently misleading. Therefore, we hypothesized that online sources regarding novel erectile dysfunction treatment options, such as shockwave therapy, would be fraught with misleading claims and unreliable health information. Objective To evaluate the quality and readability of online health information on shockwave therapy as a treatment for erectile dysfunction. Methods Websites were generated using a Google search of “shockwave therapy for erectile dysfunction” with location filters disabled. Advertisements, scientific research articles, clinical trials, and websites that required subscriptions to access information were excluded from analysis. The websites included were from universities, private clinics, and news media outlets. Readability was analyzed using the Readable software (Readable.com, Horsham, UK). The content quality was graded using the DISCERN tool, a questionnaire that assesses the quality of written information on treatment choices for a health problem. Screening was done independently by 3 reviewers. Statistical analysis was conducted using the Student’s t-test. Results Nine articles that resulted from the Google search had mean readability scores as follows: Flesch-Kincaid grade level (10.8), Gunning-Fog Index (13.67), Coleman-Liau Index (12.74), Simple Measure of Gobbledygook (SMOG) Index (13.33), FORCAST Grade Level (11.33), and Automated Readability Index (11.08). The mean Flesch-Kincaid reading ease index was 46.4, which is difficult. No single article was at the 6th or 8th grade reading level, as recommended by the American Medical Association (AMA) and National Institutes of Health (NIH), respectively. There was no significant difference between the overall website ratings based on the DISCERN instrument (p= 0.565). The articles had a mean DISCERN score of 3.1, which refers to moderate quality (potentially important but not serious shortcomings). Four articles were from websites of private medical practices that each offered shockwave therapy for ED with a mean DISCERN score of 2.1. Five of the nine articles were from universities (n=2) or news sources (n=3) with a significantly higher mean DISCERN score of 4.0 (p<0.001). While the quality of content was significantly poorer, the mean automated readability grade level remained similar (p=0.607). A separate questionnaire was implemented to evaluate website content. Only two websites mentioned radial wave therapy, and both accurately dismissed its efficacy. Five websites mentioned that men with vasculogenic ED are the only candidates that should consider shockwave therapy. Two websites either mentioned the SMSNA statement or recommended that shockwave therapy "should only be used under strict research protocol." Five websites mentioned pricing (mean: $400 per session). Conclusions Overall, the quality of online information on shockwave therapy for ED is adequate. However, while articles from private clinics are just as readable as those from universities or news media, they are significantly more biased and misleading. The current online material may not support patients in making medical decisions and garnering knowledge, necessitating closer collaboration between the sources disseminating information and urologists. Disclosure Yes, this is sponsored by industry/sponsor: National Institutes of Health Grant R01 DK130991, American Cancer Society Clinician Scientist Development Grant. Clarification Industry funding only - investigator initiated and executed study.

(318) Evaluating the Readability of Online Testosterone Search Results

Abstract Introduction Patients and physicians are increasingly utilizing online platforms to disseminate health information. With the explosive interest and growth in testosterone therapy (TTh) amongst patients, providers and business interests, online health information plays a significant role in patients' healthcare decisions. Nearly all patients engage some form of online tool, search engine or resource when learning about a condition, treatment and alternatives that may exist. While the availability of information can be helpful, left unchecked it could preclude or even obstruct accurate and timely information dissemination to the very target audience. Objective Our study evaluated the source and readability of web-based information available to patients regarding TTh found through online search engine results. Methods The first 50 web results from Google search terms “Testosterone Therapy” (TTh) and “Testosterone Replacement” (TR) were analyzed. Sources were categorized as Academic, Commercial, Institutional, or Patient Support before being evaluated using validated readability and English language text assessment tools including the Flesch Reading Ease score, Flesch Kincade, Gunning Fog, Simple Measure of Gobbledygook (SMOG), Coleman-Liau Index and Automated Readability index. Results 77 unique sources were identified. The average grade level required for understanding academic sources was 16 (college senior); commercial, institutional, and patient support sources were 13 (college freshman); 8 and 5 grade levels, respectively above the average U.S. adult. Patient support sources were most prevalent, while commercial sources were the least at 35% and 14%, respectively. The average reading ease score was 36.8, indicative of difficult-to-read material overall. Academic sources utilized 296% and 228% more words compared to commercial and institutional/patient support sources, respectively. Conclusions The most immediate online sources for TTh information grossly exceeds the average reading level and understanding of most adults within the U.S. Within the growing realm of TTh, more attention should be taken to publish accurate, accessible, and readable material in order to improve patient health literacy and empower patients. Disclosure No

(239) Readability Assessment of Online Educational Information on Premature Ejaculation

Abstract Introduction Approximately one-third of US adults have trouble reading and acting on health-related information. The American Medical Association (AMA) and National Institutes of Health (NIH) recommend that patient education materials should not exceed a sixth-grade reading level. Given the difficulty in defining premature ejaculation (PE) and the lack of a US Food and Drug Administration (FDA) - approved drug therapy, many patients may seek information about PE through online resources. We sought to assess the readability and quality of online educational information on PE in light of these standards. Objective To assess the quality and readability of available online educational information on premature ejaculation using a Google search. Methods The search term “premature ejaculation” was queried on Google and the first 100 web pages were assessed. Duplicate websites, scientific publications, sub-pages of identical websites, or websites with paywalls were excluded from the analysis. Readability was assessed by three validated indices: the Flesch-Kincaid grade level (FKG), the Simple Measure of Gobbledygook (SMOG), and the Coleman-Liau Index (CLI). The quality of websites was assessed using the DISCERN instrument and the presence of Health on the Net (HON) code certification. Results After applying the exclusion criteria, a total of 43 websites were included in the data analysis. There were 15/43 (36.6%) web pages with HON code certification. On average, patient education materials about PE were written at a grade level of 12.2 (range 8.1-17.9). The mean DISCERN score for all web pages was 48.9 out of 80, which is considered “fair” quality. Web pages with HON code certification had a higher mean DISCERN score of 51.7 versus 47.3, which was not found to be significantly different (P=0.19). Conclusions Most of the online educational information on PE is of mediocre quality. In addition, the average web page on PE is written at a senior high school level, exceeding the recommended readability standards set by the AMA and NIH. It is imperative to place an emphasis on improving the quality and readability of online health information on PE to optimize patients’ abilities to make informed decisions. Disclosure No

Ornamental ponds as Nature-based Solutions to implement in cities

Small waterbodies such as ponds are widely represented in cities, contributing to the blue-green infrastructure, improving human well-being. Ornamental ponds are particularly abundant in the densest urbanized areas, especially in parks, in private grounds such as gardens and also imbedded in the green infrastructure. However, their multifunctionality remains infrequent, as generally aesthetic enjoyment is the main ecosystem service targeted. The promotion of native biodiversity is rarely a priority, as are other ecosystem services (e.g. flood mitigation or water purification). It is nevertheless questionable if such mono-functional ponds could also be able to provide other services. Indeed, an innovative approach would be to increase the multifunctionality of ornamental ponds, especially for biodiversity. This was investigated in 41 ornamental ponds designed for providing aesthetic enjoyment in the city of Geneva (Switzerland). The biodiversity was assessed, as well as selected ecosystem services (water retention, phytopurification, cooling effect, carbon sequestration). A survey among the population was also conducted. This survey underlined a recognized contribution of ornamental ponds to well-being. However, the assessment of the ecosystem services evidenced a lack of multifunctionality for most of these ponds. They presented a low biodiversity, compared to more natural ponds and to unimpaired ponds. Furthermore, they performed poorly for most other ecosystem services investigated. There were nevertheless exceptions, with selected ponds displaying a multifunctionality, even for ecosystem services for which they were not designed. It was also shown that ornamental ponds could easily be optimized for biodiversity by simple low-cost management measures. Additional ecosystem services could also be promoted. The performance of small ornamental ponds is best when ponds are considered collectively, as pondscapes, with their cumulative benefits. New ornamental pond implementation is therefore encouraged, as their multifunctionality turns them into Nature-based Solutions able to contribute to solving several societal challenges and to improve human well-being.

Pain management following total shoulder arthroplasty: what are patients reading online?

BackgroundThis study aims to assess the quality and readability of online resources regarding postoperative pain control for patients having undergone total shoulder arthroplasty (TSA), along with identifying gaps among the types of information. MethodsThree search engines were used to conduct internet searches utilizing a combination of TSA and pain management search phrases. The top 20 web pages from each search engine were gathered, reviewed, and scored by five different evaluators. Scoring was performed using 30-point criteria, integrated into an overall quality of resource (QR) score considered significant for patient education about TSA and pain management according to American Pain Society and American Academy of Orthopaedic Surgeons’ published recommendations (Table I). Domain scores (route of administration, type of analgesia, opioid-specific, and general guidance) were calculated by summing the total points and dividing by the total possible score for each domain. The reading level of the Flesch-Kinkaid grade level, the Flesch reading ease, and the simple measure of gobbledygook index was also assessed. ResultsThe overall readability was low, with a mean Flesch-Kincaid grade level score of 10.3 ± 2.0 and Simple Measure of Gobbledygook score of 9.9 ± 1.5. According to this index, only one website (2.3%) was written below the suggested 6th grade reading level. There was a mean QR score of 9.6/30 points, ranging from 2 to 22 (Table II). Most resources (90.9%) did not achieve greater than 50% of the total available points (greater than 15 out of 30). Of the domains, the mean score for route of administration was 31.8%, types of analgesia was 43.6%, opioid-specific was 11.4%, and general guidance was 43.2%. Opioid-specific scores were lower than all three other domain scores (all P < .001). ConclusionAccording to our findings, current online resources for pain management following TSA are written above the average literacy level for adults in the United States and lack educational content, especially regarding opioid-specific discussion and recommendations. Resources must target gaps in online patient education to better inform patients of postoperative pain control, convey expectations, and encourage patient-physician conversations and decision-making.

P200 A POSITIVE CORRELATION BETWEEN THE OVERALL ECHOGENICITY OF CAROTID INTIMA MEDIA COMPLEX AND ARTERIAL STIFFNESS OF HYPERTENSIVE PATIENTS: BEYOND THE INTIMA MEDIA THICKNESS ASSESSMENT

Abstract According to the latest ESC guidelines on CVD prevention (2021) arterial stiffness (AS) still has a role in predicting future CVD risk and defining patients’ CVD risk level. However, significative measurement difficulties make a widespread evaluation of the AS problematic, especially in the ambulatorial outpatient setting. The IMT measurement is no longer recommended in the CVD risk assessment due to lack of standardization in measurement protocol and low power to reclassify patients toward higher CV risk. Understanding the correlation between the structure and function of the large arteries can lead to an optimization of cardiovascular disease prevention strategies. At present, indices of arterial stiffness have not been associated with qualitative morphological characteristics of intima–media complex. The IM GSM is a relatively simple measurement that can be acquired during a carotid color–Doppler ultrasound exam. The aim of this study was to investigate the relationship between indices of arterial stiffness and echogenicity of intima media complex (IM GSM) of the common carotid arteries in subjects with arterial hypertension. In our study population of 421 hypertensive patients, subjects with IM GSM &amp;gt; 30 showed a significantly increased arterial stiffness and LVMI (P &amp;lt; 0.001). A weak positive correlation was found between IM GSM and SBP (r =0.35, P&amp;lt; 0.001), and duration of hypertension (r = 0.31, P &amp;lt; 0.01). Our study suggests that increased stiffness observed in hypertensives is associated with qualitative changes in carotid arterial wall.

A more accurate method to estimate muscle mass: A new estimation equation.

Measurement of muscle mass is important in the diagnosis of sarcopenia. Current measurement equipment are neither cost-effective nor standardized and cannot be used in a variety of medical settings. Some simple measurement tools have been proposed that are subjective and unvalidated. We aimed to develop and validate a new estimation equation in a more objective and standardized way, based on current proven variables that accurately reflect muscle mass. Cross-sectional analysis with The National Health and Nutrition Examination Survey database for equation development and validation. Overall, 9875 participants were included for development (6913 participants) and validation (2962 participants), for whom the database included demographic data, physical measurements, and main biochemical indicators. Appendicular skeletal muscle mass (ASM) was estimated by dual-energy x-ray absorptiometry (DXA) and low muscle mass was defined by reference to five international diagnostic criteria. Linear regression was used to estimate the logarithm of the actual ASM from demographic data, physical measurements, and biochemical indicators. This study of 9875 participants comprised 4492 females (49.0%), with a weighted mean (SE) age of 41.83 (0.36) years and range of 12 to 85years. The estimated ASM equations performed well in the validation data set. The variability in estimated ASM was low compared with the actual ASM (R2 : Equation 1=0.91, Equation 4=0.89), with low bias (median difference: Equation 1=-0.64, Equation 4=0.07; root mean square error: Equation 1=1.70 [1.69-1.70], Equation 4=1.85 [1.84-1.86]), high precision (interquartile range of the differences: Equation 1=1.87, Equation 4=2.17), and high efficacy in diagnosing low muscle mass (area under the curve: Equation 1=0.91 to 0.95, Equation 4=0.90 to 0.94). The estimated ASM equations are accurate and simple and can be routinely applied clinically to estimate ASM and thus assess sarcopenia.

Санитарные условия, медицинское обслуживание и инфекционные болезни в Коми крае во второй половине XIX-начале XX века

The paper examines the sanitary conditions and medical care of the population in the Komi region in the second half of the XIX-early XX centuries and summarizes the factual material on incidence of infectious diseases among the inhabitants of the region. The paper presents factors that influenced morbidity and mortality from infectious diseases, analyzes measures to improve the sanitary and epidemic situation in the region.&#x0D; The general situation with infectious diseases and morbidity strongly influenced the life time and mortality rate of population in the study period. The introduction of sanitary and hygienic concepts and rules, development of the system of medical institutions, vaccination and control of epidemics apparently started to have a decreasing effect on the mortality from infectious diseases. The total mortality rate of the population remained high but the mortality of the urban population by the beginning of the XX century began to decrease gradually. Such relatively simple measures as the abandonment of surface water consumption, construction of public wells and improvement of principal sanitary and hygienic conditions, significantly contributed to the decreased mortality cases from infectious diseases.

Pediatric paragonimiasis: a retrospective analysis of cases from a county in south-west China.

The clinical manifestations of paragonimiasis are diverse and non-specific, and can easily lead to misdiagnosis. We aimed to analyze the clinical manifestations, laboratory features, treatment, and clinical outcome of children with paragonimiasis in order to improve recognition of this disease and avoid misdiagnosis. Children diagnosed with paragonimiasis from August 2016 to July 2022 were included in the study. Information on population informatics, medical history, and laboratory features was extracted from case data. The clinical features of paragonimiasis were retrospectively analyzed. A total of 45 children were included in this study. All children had, at least, one risk factor. The clinical features mainly included fever, cough, pleural effusion, peritoneal effusion, and subcutaneous nodules. The main imaging findings were alveolar exudation, peritoneal effusion, pleural thickening, and local nodules. The "tunnel sign" finding on computed tomography (CT)/magnetic resonance imaging (MRI) was helpful in establishing the diagnosis of paragonimiasis. After praziquantel treatment, most of the children improved, and one child with cerebral paragonimiasis experienced sequelae. Most children with paragonimiasis have a good prognosis, but few children can experience sequelae. Avoidance of untreated water and raw food is a simple, feasible, and effective preventive measure.

SARS-CoV-2 RT-qPCR Ct values in saliva and nasopharyngeal swab samples for disease severity prediction

ABSTRACT Background Comparison of clinical value of RT-qPCR-based SARS-CoV-2 tests performed on saliva samples (SSs) and nasopharyngeal swab samples (NPSs) for prediction of the COVID-19 disease severity. Methods Three paired SSs and NPSs collected every 3 days from 100 hospitalised COVID-19 patients during 2020 Jul-2021 Jan were tested by RT-qPCR for the original SARS-CoV-2 virus and compared to 150 healthy controls. Cases were divided into mild+moderate (Cohort I, N = 47) and severe disease (Cohort II, N = 53) cohorts and compared. Results SARS-CoV-2 was detected in 65% (91/140) vs. 53% (82/156) of NPSs and 49% (68/139) vs. 48% (75/157) of SSs collected from Cohort I and II, respectively, resulting in the total respective detection rates of 58% (173/296) vs. 48% (143/296) (P = 0.017). Ct values of SSs were lower than those of NPSs (mean Ct = 28.01 vs. 30.07, P = 0.002). Although Ct values of the first SSs were significantly lower in Cohort I than in Cohort II (P = 0.04), it became negative earlier (mean 11.7 vs. 14.8 days, P = 0.005). Multivariate Cox proportional hazards regression analysis showed that Ct value ≤30 from SSs was the independent predictor for severe COVID-19 (HR = 10.06, 95% CI: 1.84–55.14, P = 0.008). Conclusion Salivary RT-qPCR testing is suitable for SARS-CoV-2 infection control, while simple measurement of Ct values can assist in prediction of COVID-19 severity.

Efficacy of Public Extension and Advisory Services for Sustainable Rice Production

Agriculture is an integral constituent of Pakistan’s economy and the primary source of livelihood for nearly 65% of the population living in rural areas. Rice is the second major staple food after wheat and a significant source of foreign exchange earnings through Basmati exports. Pakistan has established an extensive network of agricultural extension to educate the farming community about modern agricultural practices for enhancing the agricultural productivity of major food crops grown in the country. The present study was undertaken to evaluate rice farmers’ views about public extension services and to identify their perspective regarding various ways of enhancing rice production in Pakistan. A multi-stage simple random sampling technique was employed, and data were collected from 193 rice farmers with the help of structured interviews using a pre-tested questionnaire. The findings revealed that a vast majority of the rice farmers were poorly satisfied with the public extension services. The results of the Spearman Rank-Order Correlation showed that landholding size had a significant effect on deciding extension contact; public extension agents are more likely to visit and serve those rice farmers who possess large landholders and therefore have the tendency to intentionally neglect small-scale rice farmers. For enhancing rice production in Pakistan, farmers believed that the provision of subsidized agricultural inputs and a minimum support price for rice is indispensable. Based on our findings, we suggest that to make public extension services more effective, public extension agents should particularly focus on the capacity building of small-scale farmers rather than large-scale farmers. Moreover, there is a need to broaden the scope of public extension services from simple crop protection measures to a set of comprehensive sustainable agricultural practices for increasing agricultural productivity, resource-use efficiency, as well as resilience toward adverse impacts of climate change.

A kinetic approach to the mechanism of formation of mesoporous silica nanoparticles

The synthesis of mesoporous silica nanoparticles (MSNs), widely investigated for application in nanomedicine, depends on many experimental factors and lacks reproducibility. Furthermore, its mechanism is not fully understood, in particular for the chemistry of the hydrolysis and condensation of tetraethoxysilane (TEOS). We coupled simple pH measurements with light diffusion monitoring directly within the reaction vessel in order to understand the early stages of the synthesis until the formation of nanoparticles. We found that two regimes of hydrolysis can be detected before the nanoparticles are formed. At the turning point, only 28% of the TEOS molecules are singly hydrolyzed and the condensation reaction only starts after the aggregation of the silicate-surfactant micelles. Experimental factors such as stirring strength or presence of carbonates of sodium hydroxide exert a strong influence on the kinetics of MSNs formation and on their size, and must be carefully controlled for reproducibility. Based on all our experimental evidence and on previous literature reports, a formation mechanism was proposed in order to highlight the importance of the interplay between chemical and physicochemical processes in such a complex system.

Triboelectric charge-separable probes for quantificationally charge investigating at the liquid-solid interface

Thoroughly researching liquid-solid contact electrification can significantly enhance our understanding of liquid energy harvesting, chemical processes, and geological mechanisms. However, this research is challenging because liquid changes dynamically, the interface chemistry is complex, and there are few rapid and simple measurement methods available. In this study, a liquid-solid triboelectric nanogenerator was developed as a probe to successfully quantify the charges with varying polarities at the liquid-solid interface. Owing to the design of two spatially arranged electrodes, this proposed probe was able to quantify the interfacial charges within a mere 50 ms propelled by the significant electrical potential difference between the liquid and the electrodes. By concomitantly analyzing the charge signal and short-circuit current signal, the probe is utilized for detecting the flow state of the liquid. Finally, the probe has been demonstrated to be applicable for liquid energy harvesting. This study presents a promising approach to address the challenges of liquid-solid contact electrification research and provides a novel perspective for enhancing our understanding of the chemical processes at liquid-solid contact electrification.

Readability assessment of patient educational materials for pediatric spinal conditions from top academic orthopedic institutions.

The Internet has become a popular source of health information for patients and their families. Healthcare experts recommend that the readability of online education materials be at or below a sixth grade reading level. This translates to a standardized Flesch Reading Ease Score between 81 and 90, which is equivalent to conversational English. However, previous studies have demonstrated that the readability of online education materials of various orthopedic topics is too advanced for the average patient. To date, the readability of online education materials for pediatric spinal conditions has not been analyzed. The objective of this study was to assess the readability of online educational materials of top pediatric orthopedic hospital websites for pediatric spinal conditions. Online patient education materials from the top 25 pediatric orthopedic institutions, as ranked by the U.S. News and World Report hospitals for pediatric orthopedics, were assessed utilizing multiple readability assessment metrics including Flesch-Kincaid, Flesch Reading Ease, Gunning Fog Index, and others. Correlations between academic institutional ranking, geographic location, and the use of concomitant multimedia modalities with Flesch-Kincaid scores were evaluated using a Spearman regression. Only 32% (8 of 25) of top pediatric orthopedic hospitals provided online health information at or below a sixth grade reading level. The mean Flesch-Kincaid score was 9.3 ± 2.5, Flesch Reading Ease 48.3 ± 16.2, Gunning Fog Score 10.7 ± 3.0, Coleman-Liau Index 12.1 ± 2.8, Simple Measure of the Gobbledygook Index 11.7 ± 2.1, Automated Readability Index 9.0 ± 2.7, FORCAST 11.3 ± 1.2, and Dale-Chall Readability Index 6.7 ± 1.4. There was no significant correlation between institutional ranking, geographic location, or use of video material with Flesch-Kincaid scores (p = 0.1042, p = 0.7776, p = 0.3275, respectively). Online educational material for pediatric spinal conditions from top pediatric orthopedic institutional websites is associated with excessively complex language which may limit comprehension for the majority of the US population. Economic and Decision Analysis/level III.

Analysis of the quality, accuracy, and readability of patient information on polycystic ovarian syndrome (PCOS) on the internet available in English: a cross-sectional study

BackgroundOnline information about PCOS lacks reliability for patients seeking information about the disease. Thus, we aimed to perform an updated analysis of the quality, accuracy, and readability of patient information on PCOS available online.MethodsWe conducted a cross-sectional study using the top five Google Trends search terms in English associated with PCOS, including “symptoms,” “treatment,” “test,” “pregnancy,” and “causes.” Five separate searches in Bing, Yahoo, and Google were performed to obtain the first 10 unique webpages for each term that was categorized as commercial, non-profit organization, scientific resources, or private foundation. We used the 16-item DISCERN with Likert-responses (minimum 1, maximum 5) where the total is 80 and lowest is 16, clarity with the 32-item EQIP, where responses of no = 0 and yes = 1 (minimum 0, maximum 32), and accuracy scores with 1 denoting poor and 5 completely accurate information; low scores of each corresponded to poorly reported information. We assessed readability with Flesch-Kincaid reading ease index, where higher scores correspond to reading ease, and lower grades correspond to easier readability with Flesch-Kincaid grade level, Gunning-Fog, Coleman-Liau index, automated readability index, New Dale-Chall Readability, and simple measure of gobbledygook. We additionally assessed word and sentence characteristics. We used Kruskal-Wallis test to compare scores according to webpage categories.ResultsOut of 150 webpages, most were commercial (n = 85, 57%), followed by non-profit organizations (n = 44, 29%), scientific resources (n = 13, 9%) and private foundations (n = 6, 4%). Google webpages had higher median DISCERN score ([Md] = 47.0) than Bing ([Md] = 42.0) and Yahoo ([Md] = 43.0) webpages; P = 0.023. No difference in EQIP scores according to search engine was found (P = 0.524). Predominantly, webpages from private foundations had higher DISCERN and EQIP scores, although comparisons were not statistically significant (P = 0.456) and P = 0.653.). Accuracy and readability were similar across search engines and webpage categories (P = 0.915, range 5.0–5.0) and (P = 0.208, range 4.0–5.0).ConclusionsQuality and clarity of the data were fair according to search engine and category. Accuracy of information was high, showing that the public may encounter accurate information about PCOS. However, the readability of the information was high, reflecting a need for more readable resources about PCOS.

What Our Patients and Their Families Are Reading: Quality and Readability of Internet Information About Electroconvulsive Therapy.

The Internet is now more widely used than before by psychiatric patients and their families to search for medical conditions and treatments. To our knowledge, no study has addressed the quality and readability of online information about electroconvulsive therapy (ECT). We aimed to examine the quality and readability of English-language Internet information related to ECT. An advanced search of Internet Web sites containing information about ECT was conducted by using the search term "ECT or electroconvulsive therapy." The resulting Web sites were categorized into 1 of 3 categories (commercial, nonprofit, or professional organizations). Their quality was evaluated using Health on the Net code certification, the Journal of the American Medical Association (JAMA) benchmark criteria, and the DISCERN tool. The readability of the Web sites was assessed using the Flesch Reading Ease, Flesch-Kincaid Grade Level Formula, Simple Measure of Gobbledygook, and Gunning Fog indexes. A total of 86 Web sites were included in the analysis. Of all these Web sites, 18 (20.9%) had a Health on the Net code certificate, and 16 (18.6%) were accepted as high quality (JAMA total score ≥3). The commercial Web sites had significantly lower DISCERN and JAMA benchmark scores compared with the other Web sites. A total of 30.23% of all the Web sites reached the recommended readability level (Flesch-Kincaid Grade Level Formula ≤ 8). Moreover, only 4 scored at the grade 5 to 6 reading level, which is considered ideal for patient educational materials. Our study indicates that both the quality and readability of online information about ECT are not at the desired level. Physicians, patients, and their families should consider this failure in relation to online information about ECT. In addition, Web site creators and health authorities should be aware of their responsibilities for providing quality and readable health information to the public.

Do Turkish firms benefit from GVC participation?

PurposeThe study evaluates the effects of GVC participation on firm productivity and profitability. Hence this study aims to find evidence whether there is a clear difference between the productivity and profitability effects of simple and complex backward and forward participations for Turkish firms.Design/methodology/approachThe authors employ a firm level data from the Türkiye's both first and second top 500 industrial enterprises from 1993 to 2019. In addition, the authors calculate country-sector level both backward and forward GVC participation indices with their simple and complex sub-indices for each year from 1990 to 2015 from the Full Eora data of the Eora Global Supply Chain Database. The authors estimate the model with OLS and fixed effects. To understand the role of the 2008 global crisis, the authors also undertake estimations for the pre-crisis and post-crisis. The authors also divide the data by R&amp;D intensity of sectors.FindingsWhile backward GVC participation lowers both labor productivity and profitability growth, forward GVC participation promotes both. Moreover, simple and complex backward participation have similarly negative effects on productivity and profitability growth, simple and complex forward participation have the completely opposite effects though. The authors then provide substantial evidence for the differing effects of participation on productivity and profitability growth between pre-crisis and post-crisis periods. Interestingly, backward participation has a negative impact for both hi-tech and low-tech firms while forward participation boosts the productivity growth only for low-tech firms, probably due to the relatively more upstream position of low-tech firms.Originality/valueTo the best of the knowledge, no previous study has yet examined the profitability effects of GVC for firms. Second, in addition to overall backward and forward GVC participation rates, the authors also calculate and utilize simple and complex GVC measures in the estimations. Third, to reveal whether the global financial crisis leads to a shift in the productivity and profitability effects of GVCs, the authors separately run the regressions for the pre- and post-crisis periods. Fourth, the authors then investigate the argument that hi-tech sectors/firms could benefit more from joining GVCs compared to firms in low-tech technology sectors.

Risk factors associated with post-weaning diarrhoea in Austrian piglet-producing farms

Post-weaning diarrhoea (PWD) is a frequent, multifactorial disease of piglets leading to increased mortality rates and high economic losses. Due to the emergence of multi-resistant Escherichia coli isolates and the ban of zinc oxide (ZnO) in the EU since June 2022, alternative measures to prevent PWD are urgently needed. While an abundance of feed supplements is described to prevent PWD, there are hardly any studies reflecting the current situation of PWD in the field. Thus, we aimed to identify differences in management practices, housing and feeding strategies between farms with PWD and farms without PWD. Data were personally collected using a semi-structured questionnaire in 257 Austrian piglet-producing farms. Farms with PWD in more than 10% of all weaned groups within twelve months prior to data collection were defined as case farms (n = 101), while the remaining 136 farms were defined as control farms. Data from 237 farms and 69 explanatory variables were analysed via penalized binary logistic regression using elastic-net in 100 different splits into randomly selected training and test datasets (80:20). Treatment with ZnO and/or colistin (136 farms) was negatively associated with PWD in all splits and had the biggest estimated absolute log odds ratio out of all tested variables. Implementation of an all-in/all-out system in the nursery units and administration of probiotics or horseradish also had preventive effects in most splits (≥ 97%). A higher number of feeding phases for piglets within the first seven weeks of life and housing on fully slatted floors was associated negatively with the occurrence of PWD as well in > 95% of all splits. PWD was more likely to occur on farms having problems with neonatal diarrhoea or postpartum dysgalactia syndrome. While our data demonstrate that treatment with ZnO or colistin had the biggest statistical effect on PWD, we were able to identify other preventive measures like supplementation with probiotics or horseradish. Since implementation of all-in/all-out measures and fully slatted floors were also negatively associated with the occurrence of PWD on visited farms, we assume that reduction of bacterial load by the implementation of simple hygiene measures are still crucial to prevent PWD.

Effects of implementation of healthcare associated infection surveillance and interventional measures in the neonatal intensive care unit: Small steps matter

PurposeNeonatal sepsis has been a global concern considering the mortality and morbidity. This study was undertaken to determine the effects of implementation of interventions namely healthcare associated infection (HAI) surveillance and hand hygiene (HH) monitoring in the neonatal intensive care unit (NICU). Materials and methodsThe cohort study was conducted in the NICU of a tertiary care hospital over a period of June–September 2021 (pre-intervention) to October–March 2022 (post-intervention). HAI surveillance of primary bloodstream infections (BSI) and HH monitoring was initiated as interventions post outbreak due to non-albicans Candida (NAC). The primary outcome of the interventions was to record any improvement in HH rates or any change in HAI rates in the 6 months intervention period. Characteristics of the pre- and post-intervention period were compared by Fisher exact test. ResultsThere was significant reduction in BSI cases in the post-intervention period (p ​< ​0.05). Mortality and BSI due to NAC were significantly more in the pre-intervention period even though low birth weight neonates (<2500 ​g) were significantly more in the post-intervention period (p ​< ​0.05). The HAI rate for primary BSI in the NICU was 10.82 per 1000 patient days. The overall adherence rate to HH was 10.68% (complete) and 73.35% (partial). HAI rates were seen to change reciprocally with changes in HH rates. ConclusionsHAI rates of primary BSI in the NICU could be regulated by the effective implementation of HAI surveillance, HH monitoring, feedback meetings with the NICU staff and other simple interventional measures even in resource-limited setups.

Measurement of Electric Charge in a Charged Hydroxyapatite Dielectric Using Pendant Drop.

A simple noninvasive measurement method which allows one to determine the trapped charge in a biocompatible hydroxyapatite dielectric is developed. The hydroxyapatite samples are charged by electron beam with energy 30 keV and total irradiated charge ranging from 2 × 10-9 C to 2 × 10-7 C. The value of the trapped charge is determined by analyzing the shape change of a liquid droplet hanging from a needle in proximity of the charged sample surface. The shape change of the pendant drop in the field of gravity is commonly utilized in the measurements of the surface free tension (SFT) of liquids. The external electric field leads to a further modification of the droplet shape and to an effective change of the SFT. The change of the SFT as a function of distance between the droplet and sample and the critical distance at which the droplet detaches from the needle are measured for various values of the irradiated charge. These two quantities are also derived theoretically by considering the trapped charge as a single fitting parameter. We can thus determine the trapped charge in two independent noninvasive ways. It is noteworthy that our method is easily implementable into the standard pendant drop setups. As a practical application of the method, a long-term charge stability of the charged hydroxyapatite is demonstrated, thus paving the way toward quantitative studies of its bioactivity in dependence on the value of the trapped charge.