A Digital Microintervention Supporting Evidence-Based Parenting Skills: Development Study Using the Agile Scrum Methodology.

BACKGROUND: Conduct disorder increases risks of educational dropout, future mental illness, and incarceration if untreated. First-line treatment of conduct disorder involves evidence-based parenting skills programs. Time-outs, a frequent tool in these programs, can be effective at improving behavior, and recent apps have been developed to aid this process. However, these apps promote the use of time-outs in inconsistent or developmentally inappropriate ways, potentially worsening behavior problems. Digital microinterventions like these apps could guide parents through high-quality time-outs in the moment, but current time-out apps lack features promoting adherence to the evidence-based best practice. Agile scrum is a respected approach in the software development industry. OBJECTIVE: We aimed to explore the feasibility of using the agile scrum approach to build a digital microintervention to help parents deliver an evidence-based time-out. METHODS: The agile scrum methodology was used. Four sprints were conducted. Figma software was used for app design and wireframing. Insights from 42 expert stakeholders were used during 3 sprint reviews. We consulted experts who were identified from councils around the Midlands region of the United Kingdom and charities through personal contacts and a snowballing approach. RESULTS: Over 4 development sprints from August 2022 to March 2023, the app was iteratively designed and refined based on consultation with a diverse group of 42 experts who shared their knowledge about the content of common parenting programs and the challenges parents commonly face. Modifications made throughout the process resulted in significant app enhancements, including tailored timer algorithms and enhanced readability, as well as an onboarding zone, mindfulness module, and pictorial information to increase inclusivity. By the end of the fourth sprint, the app was deemed ready for home use by stakeholders, demonstrating the effectiveness of our agile scrum development approach. CONCLUSIONS: We developed an app to support parents to use the evidence-based time-out technique. We recommend the agile scrum approach to create mobile health apps. Our experience highlights the valuable role that frontline health and social care professionals, particularly those working with vulnerable families, can play as experts in scrum reviews. There is a need for research to both evaluate the impact of digital microinterventions on child behavioral change and also create digital microinterventions that cater to non-English speakers and individuals who participate in parenting programs in settings outside the United Kingdom.

Technology Matters: Digital micro interventions to support parenting: Evaluating time out apps.

Digital interventions to support parenting skills are popular but engagement can be low. Digital micro interventions such as apps targeting specific aspects of parenting are a novel development with the potential to overcome this challenge. Time out is an evidence-based component of many parenting skills training programmes and is an appropriate target for digital micro intervention. We describe the eight requirements of high-quality time out according to the literature and how these can be supported by an app. Searches of the App Store, Google Play, and Alexa Skills in the UK identified six apps designed to support time out. Current time out apps all promoted consistency, but they all risked low-quality time out through inappropriate initiation, duration, and termination. Professionals in child and adolescent mental health should explore the details of any digital micro interventions being used by parents for time out and provide appropriate counselling. We recommend that all future digital micro interventions in this area should incorporate evidence-based guidance.

Institutional investors and cost of capital: The moderating effect of ownership structure.

Guiding institutional investors to actively participate in corporate governance is a hot issue to improve the internal governance of China's listed companies. This study seeks to provide a comprehensive understanding of the mechanism that underlies the governance effects of the heterogeneity of institutional investors on the cost of capital, and the influence of ownership structure on the relationship between them. Using an unbalanced panel data on A-share listed companies of Shanghai and Shenzhen in China's capital market during the 2014-2019 period, this study reveals how institutional investors with longer holding period and higher shareholding ratio are negatively associated with the cost of capital in China's capital market. Furthermore, this study successfully confirms the moderating effect of ownership structure in the relationship between institutional investors and the cost of capital. China's state-owned enterprises are more likely to introduce improvements at the corporate governance level, and ownership concentration weakens the negative influence of institutional investors on the cost of capital. The research contributes to a deeper understanding of the impacts of institutional investor's heterogeneity and ownership structure on the cost of capital in China. In the process, the study yields useful implications for the theory and practice of corporate governance.

High-altitude pulmonary edema.

Lay summary: High Altitude Pulmonary Edema (HAPE) is a potentially fatal disease of altitude, in which the lungs can become filled with fluid. In this article we explore the mechanisms causing this condition and how it can be viewed as a condition of a mismatch between current environment and evolutionary experience.

Engaging patients and family members to design and implement patient-centered kidney disease research.

We need more research projects that partner and engage with patients and family members as team members. Doing this requires that patients and family members set research priorities and fully participate in research teams. Models for this patient and family member engagement as research partners can help increase patient centered outcomes research. In this article, we describe how we have successfully engaged patients with kidney disease and family members as Co-Investigators on a 5-year research project testing a health system intervention to improve kidney disease care. Background This article describes a method for successful engagement of patients and family members in all stages of a 5-year comparative effectiveness research trial to improve transitions of care for patients from chronic kidney disease to end-stage kidney disease. Methods This project utilized the Patient-Centered Outcomes Research Institute's conceptual model for engagement with patients and family members. We conducted a qualitative analysis of grant planning meetings to determine patient and family member Co-Investigators' priorities for research and to include these engagement efforts in the research design. Patient and family member Co-Investigators partnered in writing this paper. Results Patients and family members were successfully engaged in remote and in-person meetings to contribute actively to research planning and implementation stages. Three patient-centered themes emerged from our data related to engagement that informed our research plan: kidney disease treatment decision-making, care transitions from chronic to end-stage kidney disease, and patient-centered outcomes. Conclusions The model we have employed represents a new paradigm for kidney disease research in the United States, with patients and family members engaged as full research partners. As a result, the study tests an intervention that directly responds to their needs, and it prioritizes the collection of outcomes data most relevant to patient and family member Co-Investigators. Trial registration NCT02722382 .

Exosomes Derived from Bone Marrow Mesenchymal Stem Cells as Treatment for Severe COVID-19.

This prospective nonrandomized open-label cohort study addresses the safety and efficacy of exosomes (ExoFlo™) derived from allogeneic bone marrow mesenchymal stem cells as treatment for severe COVID-19. During April 2020, ExoFlo was provided to 24 SARS-CoV-2 polymerase chain reaction-positive patients at a single hospital center, all of whom met criteria for severe COVID-19 as well as moderate-to-severe acute respiratory distress syndrome. Patients received a single 15 mL intravenous dose of ExoFlo and were evaluated for both safety and efficacy from days 1 to 14 post-treatment. All safety endpoints were met with no adverse events observed within 72 h of ExoFlo administration. A survival rate of 83% was observed. In total, 17 of 24 (71%) patients recovered, 3 of 24 (13%) patients remained critically ill though stable, and 4 of 24 (16%) patients expired for reasons unrelated to the treatment. Overall, after one treatment, patients' clinical status and oxygenation improved with an average pressure of arterial oxygen to fraction of inspired oxygen ratio (PaO2/FiO2) increase of 192% (P < 0.001). Laboratory values revealed significant improvements in absolute neutrophil count [mean reduction 32% (P value <0.001)] and lymphopenia with average CD3+, CD4+, and CD8+ lymphocyte counts increasing by 46% (P < 0.05), 45% (P < 0.05), and 46% (P < 0.001), respectively. Likewise, acute phase reactants declined, with mean C-reactive protein, ferritin, and D-dimer reduction of 77% (P < 0.001), 43% (P < 0.001), and 42% (P < 0.05), respectively. In conclusion, owing to its safety profile, capacity to restore oxygenation, downregulate cytokine storm, and reconstitute immunity, ExoFlo is a promising therapeutic candidate for severe COVID-19. Future randomized controlled trials (RCTs) are needed to determine ExoFlo therapeutic potential.

Comparison of averaging techniques for the calculation of the 'European average exposure indicator' for particulate matter.

A comparison of various averaging techniques to calculate the Average Exposure Indicator (AEI) specified in European Directive 2008/50/EC for particulate matter in ambient air has been performed. This was done for data from seventeen sites around the UK for which PM(10) mass concentration data is available for the years 1998-2000 and 2008-2010 inclusive. The results have shown that use of the geometric mean produces significantly lower AEI values within the required three year averaging periods and slightly lower changes in the AEI value between the three year averaging periods than the use of the arithmetic mean. The use of weighted means in the calculation, using the data capture at each site as the weighting parameter, has also been tested and this is proposed as a useful way of taking account of the confidence of each data set.

Infrared differential absorption Lidar (DIAL) measurements of hydrocarbon emissions.

We report the application of an infrared (IR) differential absorption Lidar (DIAL) system (also capable of ultra violet measurements) built at the National Physical Laboratory (NPL), UK, to field measurements of total site emissions (controlled and fugitive) from petrochemical and landfill installations. The validation of the IR-DIAL was carried out via a series of controlled field experiments including comparison to GC analysis and tests against controlled methane releases from a test stack, all detailing agreements on the order of ±20%. In volatile organic compound (VOC) measurements at a UK petrochemical site it was found that the American Petroleum Institute's methodology of the time for calculating the emitted flux underestimated by a factor of 2.4. Also, in a similar field trial it was found that scaling traditional point measurements at easily accessible flanges and valves to represent all flanges and valves on a site led to an underestimation by a factor of 6. In addition to petrochemical examples we also report field measurements from a landfill site to demonstrate the advantageous of the DIAL technique for monitoring area emission sources. In this case study it was found that active (still being filled) cells resulted in significantly greater VOC emission rates (30 kg h(-1)) than closed (≤ 10 kg h(-1)).

Designing and implementing a large-scale automated -80 degrees C archive.

BACKGROUND: This article describes an automated facility for storing biological samples at -80 degrees C, designed to meet the needs of The UK Biobank. No store of this size has previously used liquid nitrogen as refrigerant, and so it was important to confirm the storage compartments could achieve and maintain uniform conditions with efficient use of the coolant. In addition, the store incorporates a novel system of drawers designed to allow robotic access whilst maintaining storage conditions. Experiments were undertaken to prove the performance of both these factors in maintaining the temperature of stored samples, both in steady-state conditions and during sample access. METHODS: Sample tubes containing water were placed in key locations within a prototype storage compartment. Thermocouples inside these sample tubes were used to together with automated data loggers to accumulate continuous records of the temperature of the samples during the experiments. RESULTS: Results show that the design of refrigeration system and storage compartment, using LN(2) as refrigerant, enables efficient use of coolant and maintains uniform temperature over the entire compartment. The results also show that samples within the compartment remain at the intended storage temperature during automated retrieval operations, including the situation when an access drawer remains open indefinitely. CONCLUSIONS: These results confirm that the store design meets the requirements for the UK Biobank, and have given both the manufacturer (The Automation Partnership) and the UK Biobank the confidence to proceed with the implementation of a full sized automated store to hold 10 million samples.

Twenty-five years of nationwide ambient metals measurement in the United Kingdom: concentration levels and trends.

Ambient air quality has been an important issue for humans and the environment for hundreds of years. More recently, definitive links have been identified between pollutants and adverse effects on human health and on environmental sustainability. Of particular concern since the last quarter of the twentieth century has been the presence of toxic 'heavy metals' in ambient air. In order to measure the concentrations of pollutants, including 'heavy metals', in ambient air, to assess human and environmental exposure, comply with developing legislation, and assess newly introduced abatement strategies, the UK government established nationwide air quality measurement networks in the late 1970s. The nationwide measurement of 'heavy metals' in ambient air began in the late 1970s, and in 1980 was developed into several national networks, aimed at different metals and different emissions sources. These networks were rationalised into the current UK Heavy Metals Monitoring Network in 2003. The data produced by the current scientific operator of the Network, the National Physical Laboratory (NPL), in 2005, marked 25 years of ambient 'heavy metals' measurement in the UK at a nationwide level. This paper celebrates this milestone and provides a novel and critical examination of Network operations, measured concentration levels, and trends, over the last quarter of a century.

Development, deployment and usability of a point-of-care decision support system for chronic disease management using the recently-approved HL7 decision support service standard.

Clinical decision support is recognized as one potential remedy for the growing crisis in healthcare quality in the United States and other industrialized nations. While decision support systems have been shown to improve care quality and reduce errors, these systems are not widely available. This lack of availability arises in part because most decision support systems are not portable or scalable. The Health Level 7 international standard development organization recently adopted a draft standard known as the Decision Support Service standard to facilitate the implementation of clinical decision support systems using software services. In this paper, we report the first implementation of a clinical decision support system using this new standard. This system provides point-of-care chronic disease management for diabetes and other conditions and is deployed throughout a large regional health system. We also report process measures and usability data concerning the system. Use of the Decision Support Service standard provides a portable and scalable approach to clinical decision support that could facilitate the more extensive use of decision support systems.

A novel approach to determine water content in DMSO for a compound collection repository.

The quality of a corporate compound collection can be significantly affected by a complex combination of storage and operational processing factors. Water content in DMSO solutions is one factor that is of great interest as it can affect solubility, degradation, and freeze-thaw cycle parameters. To the authors' knowledge, this is the first report of using near-infrared (NIR) spectroscopy to assess water content in DMSO compound stock solutions within the common storage vessel format of polypropylene microtubes. The precision and accuracy of the NIR technique was benchmarked against a Karl Fisher titration method, and a correlation coefficient was determined to be 0.985 over a range of 1% to 10% water in DMSO by weight. The advantages of the NIR technique include accuracy, precision, speed, nondestructiveness, and the capability of assessing compounds under in situ storage conditions within microtubes. In this report, the authors demonstrate the accuracy and precision of using NIR to assess water content in DMSO solutions and present a case study to demonstrate the utility of the technique to aid in assessing a pharmaceutical compound collection.

Child homicide.

Between 1967 and 1988, 69 cases of single perpetrator/single victim child homicide resulted in remands into custody in the Yorkshire region. Sixty-four of these cases were examined retrospectively to identify the characteristics of the perpetrators and of victims under 16 years, the relationship of the victim to the accused and the circumstances of the offence. Sixty-four men singly accused of killing a single child victim are described in detail. They were characterized by relatively young age and a lack of long-term stable relationships. Previous psychiatric contact and/or a history of self-harm was noted in one-third of cases. Over half of the group had a criminal record and previous violence to children was noted in 28% of cases. Fathers or surrogate fathers accounted for nearly two-thirds of the accused. In terms of the victims, children under six months were at greatest risk. Nearly one-third of victims were the biological offspring of the accused. Sexually motivated homicide accounted for approximately 18.7% of deaths. Victim behaviours and domestic disharmony acted as precipitants in 64% of the cases, with 54.7% of the victims dying as a result of physical beatings. Alcohol consumption at the material time was more common than noted in previous studies of child homicide.