Autistic youth are at high risk of depression, but there are few psychological interventions that have been specifically designed for use with this population. Behavioural activation (BA) is a particularly promising approach for autistic adolescents, having an established evidence-base for the treatment of depression in non-autistic people, and with a strong focus on behavioural, rather than cognitive change, which is a challenge for some autistic people. In this study, we worked with autistic adolescents and clinicians to co-design a BA-informed intervention to be delivered in an online format. We then conducted a pilot case-series with seven autistic adolescents with depression. Our focus was on establishing the acceptability and feasibility of the intervention but clinical outcomes on both self- and parent-reported symptoms of depression and anxiety are also presented. Our results indicate the intervention to be acceptable and feasible for autistic adolescents, with six out of seven participants being retained to the end of the intervention. Qualitative feedback indicated that all participants found the intervention a positive experience and would recommend it to others. Similarly, all participants found the online format acceptable, with 64% preferring this format to face-to-face therapy. Qualitative feedback and suggestions for refinement will also be discussed.
Autistic youth are at high risk of depression, but there are few psychological interventions that have been specifically designed for use with this population. Behavioural activation (BA) is a particularly promising approach for autistic adolescents, which has been used previously with non-autistic people. BA-focusses on improving mood through increasing engagement in positive activities and is well suited to being adapted to meet the needs of autistic youth. In this study, we worked with autistic adolescents and clinicians to co-design a BA-informed intervention to be delivered in an online format. We then conducted a pilot case-series with seven autistic adolescents with depression. Our focus was on establishing the acceptability (can participants complete the intervention) and feasibility (can this be done again on a larger scale) of the intervention. Our results indicated that the intervention was acceptable and feasible for autistic adolescents, with six out of seven participants being retained to the end of the intervention. Feedback from young people and their parents indicated that all participants both found the intervention a positive experience and would recommend it to others. Similarly, all participants found the online format acceptable, with 64% preferring this format to face-to-face therapy. Qualitative feedback and suggestions for refinement will also be discussed.

A prospective observational case series included six patients who presented with discoloured upper and lower teeth extending from the right second premolar to the left second premolar. The photoactivation dosimetry and treatment protocol were as follows: λ 450 nm, 1 W, CW; flattop beam profile; 1 cm2; 15 J/spot; 10 irradiated spots; an irradiation time of 15 s/spot; three whitening cycles in a single session. Blanc One ULTRA+ was the bleaching agent. A visual analogue scale (VAS) was utilised to evaluate the pain intensity and dental hypersensitivity during treatment immediately after complete treatment (T1), 24 h (T2), and 8 h (T3) postoperatively, and at an 8-month follow-up timepoint (T4), whereas the dental colour shade change was assessed using the VITA colour shade guide pre-treatment (T0), T1, and T4. The Gingival index and modified Wong Baker faces scale were utilised to evaluate gingival inflammation and patients\' treatment satisfaction, respectively. Our findings revealed a reduction in the dental colour shade of the six cases between 2 and 10- fold (average of 3.5-fold) at T1 and maintained at T4, indicating significant improvement in the colour shade change with optimal outcomes. The percentage of this improvement for all the patients was ranged between 16.6% and 33.3%. At all timepoints, a \"0\" score was provided for pain intensity, dental hypersensitivity, and gingival inflammation. Our study demonstrates the feasibility and safety of a λ 450 nm laser delivered with a flattop handpiece to achieve optimal whitening outcomes without adverse effects. This offers a useful guide for dental clinicians for vital in-office tooth whitening. Extensive clinical studies with large data are warranted to validate our study protocol.

BACKGROUND: The prevalence of child and adolescent mental health issues is increasing faster than the number of services available, leading to a shortfall. Mental health chatbots are a highly scalable method to address this gap. Manage Your Life Online (MYLO) is an artificially intelligent chatbot that emulates the method of levels therapy. Method of levels is a therapy that uses curious questioning to support the sustained awareness and exploration of current problems.
OBJECTIVE: This study aimed to assess the feasibility and acceptability of a co-designed interface for MYLO in young people aged 16 to 24 years with mental health problems.
METHODS: An iterative co-design phase occurred over 4 months, in which feedback was elicited from a group of young people (n=7) with lived experiences of mental health issues. This resulted in the development of a progressive web application version of MYLO that could be used on mobile phones. We conducted a case series to assess the feasibility and acceptability of MYLO in 13 young people over 2 weeks. During this time, the participants tested MYLO and completed surveys including clinical outcomes and acceptability measures. We then conducted focus groups and interviews and used thematic analysis to obtain feedback on MYLO and identify recommendations for further improvements.
RESULTS: Most participants were positive about their experience of using MYLO and would recommend MYLO to others. The participants enjoyed the simplicity of the interface, found it easy to use, and rated it as acceptable using the System Usability Scale. Inspection of the use data found evidence that MYLO can learn and adapt its questioning in response to user input. We found a large effect size for the decrease in participants\' problem-related distress and a medium effect size for the increase in their self-reported tendency to resolve goal conflicts (the proposed mechanism of change) in the testing phase. Some patients also experienced a reliable change in their clinical outcome measures over the 2 weeks.
CONCLUSIONS: We established the feasibility and acceptability of MYLO. The initial outcomes suggest that MYLO has the potential to support the mental health of young people and help them resolve their own problems. We aim to establish whether the use of MYLO leads to a meaningful reduction in participants\' symptoms of depression and anxiety and whether these are maintained over time by conducting a randomized controlled evaluation trial.

Facing the challenges of motorised traffic, many cities around the globe started implementing measures to transform their urban transport systems. One of the major challenges for the success of adequate policies is not only their effectiveness but also whether they are accepted by city residents. With a quantitative case study in four neighbourhoods in Frankfurt am Main (N = 821), this article investigates the acceptability of three measures: (i) parking management, (ii) the conversion of car lanes into cycle lanes and (iii) the closure of an inner city arterial road to car traffic. The results show a surprisingly high acceptability for all measures if the benefits for local residents are tangible. Thus, successful policy packages may combine push measures with either pull measures, as suggested frequently in the literature, or with improvements for other land uses (e.g. re-using former car-parking spaces for non-transport purposes, such as greenery or seating areas). Furthermore, the perceived effectiveness, daily travel practices and intentions to reduce car use, the built environment and, to a lesser degree, socio-demographics explain differences in acceptability by population group.

Digital health tools may facilitate the continuity of care. Enhancement of digital aid is imperative to prevent information gaps or redundancies, as well as to facilitate support of flexible care plans.
The study presents Health Circuit, an adaptive case management approach that empowers health care professionals and patients to implement personalized evidence-based interventions, thanks to dynamic communication channels and patient-centered service workflows; analyze the health care impact; and determine its usability and acceptability among health care professionals and patients.
From September 2019 to March 2020, the health impact, usability (measured with the system usability scale; SUS), and acceptability (measured with the net promoter score; NPS) of an initial prototype of Health Circuit were tested in a cluster randomized clinical pilot (n=100) in patients with high risk for hospitalization (study 1). From July 2020 to July 2021, a premarket pilot study of usability (with the SUS) and acceptability (with the NPS) was conducted among 104 high-risk patients undergoing prehabilitation before major surgery (study 2).
In study 1, Health Circuit resulted in a reduction of emergency room visits (4/7, 13% vs 7/16, 44%), enhanced patients\' empowerment (P<.001) and showed good acceptability and usability scores (NPS: 31; SUS: 54/100). In study 2, the NPS was 40 and the SUS was 85/100. The acceptance rate was also high (mean score of 8.4/10).
Health Circuit showed potential for health care value generation and good acceptability and usability despite being a prototype system, prompting the need for testing a completed system in real-world scenarios.
ClinicalTrials.gov NCT04056663; https://clinicaltrials.gov/ct2/show/NCT04056663.

Background Contact tracing applications were introduced during the COVID-19 pandemic to mitigate the spread of the infection in several countries. In Saudi Arabia, the Tawakkalna application was developed. The Tawakkalna application is a mobile health solution aimed to track infection cases, save lives, and reduce the burden on health facilities. This study aims to explore the public\'s attitude to and acceptance levels of the Tawakkalna application and to evaluate its effectiveness regarding privacy and security. The main objective of this study is to investigate the user acceptability of contact tracing applications and explore the safety and privacy effectiveness of the COVID-19 contact tracing application, the Tawakkalna application. In addition, the study analyzes factors associated with acceptance levels and compares the results obtained to similar studies in other countries using similar applications. Methodology This study used a valid and reliable online survey that was used in similar studies conducted in other countries to assess the acceptability of the application. The survey was conducted from September to November 2021, and the final dataset included 205 participants. To investigate the privacy and security performance of the Tawakkalna application, we followed the investigation method used by similar research that investigated 28 contact tracing applications across Europe. Results Out of the 205 participants, 84.87% were in favor of the opt-in voluntary installation of the Tawakkalna application, and 49.75% of the participants were in favor of the opt-out automatic installation. Individuals\' trust in the government had a huge impact on acceptance, with 60.98% of the participants supporting the application because they believed that the Tawakkalna application would help them stay healthy during the COVID-19 pandemic. Overall, 49% of the participants supporting the application also agreed to the de-identification of their collected data and providing it for research. The Tawakkalna application ranked at the top compared to other contact tracing applications regarding privacy and security. Conclusions The Tawakkalna application developed by the Saudi Data and Artificial Intelligence Authority was a response to the COVID-19 pandemic, which is considered the biggest public health crisis in recent times. The Saudi Arabian government gained the population\'s acceptance through effective endorsement and the spread of educational content through media channels. By complying with privacy policies, the Tawakkalna application is an effective tool to combat public health infectious diseases.

UNASSIGNED: Even if giving birth at health facility is vital for both the mothers and their newborns, the coverage of institutional delivery in Ethiopia is very low (50%). In that regard, several studies have shown the possible factors of low delivery service uptake from the patients\' side, but evidences on delivery services at the health centers are meagre. This study aimed to evaluate the process of delivery services in public health centers of northwest Ethiopia.
UNASSIGNED: A case study evaluation design with an embedded mixed-method was used to evaluate institutional delivery in public health centers of Gondar city. Dimensions from the access (availability, accommodation, and acceptability) and implementation fidelity (compliance) frameworks were used. A total of 363 mothers, 32 document reviews, 32 direct observations, and 17 key informants were included. The qualitative data were transcribed, translated, coded, and analysed using a thematic analysis approach. The overall process of institutional delivery services was measured based on pre-determined judgmental criteria.
UNASSIGNED: The overall facility delivery process was 75.1%, judged by availability (78.5%), compliance (70.6%), accommodation (68.8%), and acceptability (80.2%) of services. Essential medicines in some of the health centers were stockout, insufficient delivery rooms and inadequate training of health workers on obstetric and newborn care were observed. Using partograph and examining vulval-perineal region for possible laceration during intrapartum period were less practiced. Residence (AOR: 0.13, 95% CI: 0.06-0.30), ANC 1 to 3 visits (AOR: 2.65, 95% CI: 1.05-6.74) and ANC4+ (AOR: 5.57, 95% CI: 2.09, 14.84) were factors affected acceptability of delivery services.
UNASSIGNED: Major constraints were in the accommodation of delivery services which needs a holistic effort from all stakeholders. Therefore, implementors with other stakeholders shall improve delivery rooms, facilitate training, and provide parenteral drugs as part of the obstetric and newborn care to improve the facility delivery services in Ethiopia.

BACKGROUND: Transmission of drug-resistant tuberculosis (DR-TB) is ongoing. Finding individuals with DR-TB and initiating treatment as early as possible is important to improve patient clinical outcomes and to break the chain of transmission to control the pandemic. To our knowledge systematic reviews assessing effectiveness, cost-effectiveness, acceptability, and feasibility of different case-finding strategies for DR-TB to inform research, policy, and practice have not been conducted, and it is unknown whether enough research exists to conduct such reviews. It is unknown whether case-finding strategies are similar for DR-TB and drug-susceptible TB and whether we can draw on findings from drug-susceptible reviews to inform decisions on case-finding strategies for DR-TB.
OBJECTIVE: This protocol aims to describe the available literature on case-finding for DR-TB and to describe case-finding strategies.
METHODS: We will screen systematic reviews, trials, qualitative studies, diagnostic test accuracy studies, and other primary research that specifically sought to improve DR-TB case detection. We will exclude studies that invited individuals seeking care for TB symptoms, those including individuals already diagnosed with TB, or laboratory-based studies. We will search the academic databases including MEDLINE, Embase, The Cochrane Library, Africa-Wide Information, CINAHL, Epistemonikos, and PROSPERO with no language or date restrictions. We will screen titles, abstracts, and full-text articles in duplicate. Data extraction and analyses will be performed using Excel (Microsoft Corp).
RESULTS: We will provide a narrative report with supporting figures or tables to summarize the data. A systems-based logic model, developed from a synthesis of case-finding strategies for drug-susceptible TB, will be used as a framework to describe different strategies, resulting pathways, and enhancements of pathways. The search will be conducted at the end of 2021. Title and abstract screening, full text screening, and data extraction will be undertaken from January to June 2022. Thereafter, analysis will be conducted, and results compiled.
CONCLUSIONS: This scoping review will chart existing literature on case-finding for DR-TB-this will help determine whether primary studies on effectiveness, cost-effectiveness, acceptability, and feasibility of different case-finding strategies for DR-TB exist and will help formulate potential questions for a systematic review. We will also describe case-finding strategies for DR-TB and how they fit into a model of case-finding pathways for drug-susceptible TB. This review has some limitations. One limitation is the diverse, inconsistent use of intervention terminology within the literature, which may result in missing relevant studies. Poor reporting of intervention strategies may also cause misunderstanding and misclassification of interventions. Lastly, case-finding strategies for DR-TB may not fit into a model developed from strategies for drug-susceptible TB. Nevertheless, such a situation will provide an opportunity to refine the model for future research. The review will guide further research to inform decisions on case-finding policies and practices for DR-TB.
UNASSIGNED: DERR1-10.2196/40009.

BACKGROUND: Story recall is a simple and sensitive cognitive test that is commonly used to measure changes in episodic memory function in early Alzheimer disease (AD). Recent advances in digital technology and natural language processing methods make this test a candidate for automated administration and scoring. Multiple parallel test stimuli are required for higher-frequency disease monitoring.
OBJECTIVE: This study aims to develop and validate a remote and fully automated story recall task, suitable for longitudinal assessment, in a population of older adults with and without mild cognitive impairment (MCI) or mild AD.
METHODS: The \"Amyloid Prediction in Early Stage Alzheimer\'s disease\" (AMYPRED) studies recruited participants in the United Kingdom (AMYPRED-UK: NCT04828122) and the United States (AMYPRED-US: NCT04928976). Participants were asked to complete optional daily self-administered assessments remotely on their smart devices over 7 to 8 days. Assessments included immediate and delayed recall of 3 stories from the Automatic Story Recall Task (ASRT), a test with multiple parallel stimuli (18 short stories and 18 long stories) balanced for key linguistic and discourse metrics. Verbal responses were recorded and securely transferred from participants\' personal devices and automatically transcribed and scored using text similarity metrics between the source text and retelling to derive a generalized match score. Group differences in adherence and task performance were examined using logistic and linear mixed models, respectively. Correlational analysis examined parallel-forms reliability of ASRTs and convergent validity with cognitive tests (Logical Memory Test and Preclinical Alzheimer\'s Cognitive Composite with semantic processing). Acceptability and usability data were obtained using a remotely administered questionnaire.
RESULTS: Of the 200 participants recruited in the AMYPRED studies, 151 (75.5%)-78 cognitively unimpaired (CU) and 73 MCI or mild AD-engaged in optional remote assessments. Adherence to daily assessment was moderate and did not decline over time but was higher in CU participants (ASRTs were completed each day by 73/106, 68.9% participants with MCI or mild AD and 78/94, 83% CU participants). Participants reported favorable task usability: infrequent technical problems, easy use of the app, and a broad interest in the tasks. Task performance improved modestly across the week and was better for immediate recall. The generalized match scores were lower in participants with MCI or mild AD (Cohen d=1.54). Parallel-forms reliability of ASRT stories was moderate to strong for immediate recall (mean rho 0.73, range 0.56-0.88) and delayed recall (mean rho=0.73, range=0.54-0.86). The ASRTs showed moderate convergent validity with established cognitive tests.
CONCLUSIONS: The unsupervised, self-administered ASRT task is sensitive to cognitive impairments in MCI and mild AD. The task showed good usability, high parallel-forms reliability, and high convergent validity with established cognitive tests. Remote, low-cost, low-burden, and automatically scored speech assessments could support diagnostic screening, health care, and treatment monitoring.

Canine-assisted activities in schools can benefit students\' educational, emotional, and social needs. Furthermore, they could be an effective form of non-clinical mental health treatment for children and adolescents. In the United Kingdom, school dogs are growing in popularity, however, little is known about how parents perceive canine-assisted activities as a treatment option. This is important as parental perceptions can influence engagement, whilst lack of awareness can become a barrier to treatment. This study uses a cross-sectional design to quantitatively explore the acceptability of canine-assisted activities amongst UK-based parents (n = 318) of children aged six to 16 (M = 10.12, SD = 3.22). An online survey used a treatment evaluation to determine acceptability across three use-cases. These included a child reading to dogs to improve literacy skills, a child interacting one-to-one to foster greater self-esteem and social skills, and a classroom dog to improve student behaviour and motivation. Additionally, the scale for generalised anxiety disorder was used to rank child anxiety as high or low, where high was a score equal to or above the UK clinical borderline threshold. The results found canine-assisted activities were less acceptable for the behavioural than the reading and social use-cases. Furthermore, parents of children with high anxiety had higher acceptability scores than parents of children with low anxiety for the reading and social use-cases but not for the behavioural use case. These findings suggest that UK parents\' acceptability of canine-assisted activities in schools is mediated by child anxiety score. Furthermore, that parents may be less aware of the benefits of classroom dogs than other types of school-based canine-assisted activities.