This study investigates the enhancement of ozone adsorption on diverse TiO2 crystal interfaces through an innovative electrochemical modulation approach. The research focuses on the effects of applied electric field strength and reaction sites on ozone interfacial adsorption energies for Ti/Anatase TiO2 (0 0 1) and Ti/Rutile TiO2 (1 1 0) interfaces. The findings reveal that positive electric fields significantly enhance ozone adsorption on both interfaces, with adsorption energies increasing by up to 18% for Ti/Anatase TiO2 (0 0 1) and 15% for Ti/Rutile TiO2 (1 1 0). Notably, double water molecule sites (≡(H2O)2) play a crucial role in this enhancement process. The study demonstrates that the applied electric field alters the charge distribution at the TiO2 catalytic interface, thereby increasing interfacial charge density and promoting charge migration to ozone. Furthermore, this process leads to enhanced overlap and hybridization between ≡(H2O)2 sites and the s and p orbitals of ozone molecules, resulting in the formation of chemical bonds with lower Fermi levels. These comprehensive results demonstrate the broad applicability of the electrochemical interfacial ozone adsorption enhancement method across different crystal types and surfaces. Consequently, this study provides essential data to support the advancement of greener and more energy-efficient heterogeneous catalytic ozonation processes, potentially contributing to significant improvements in ozone-based water treatment technologies.

OBJECTIVE: The aim of the study was to explore the subjective views of general practitioners on the applicability of the Adult ADHD Self-Report Screening Scale for DSM-5 (ASRS-5) as a screening tool for attention-deficit/hyperactivity disorder (ADHD) in adults in general practice.
METHODS: Eleven general practitioners, who had participated in the validation study of the German version of the ASRS-5, were interviewed. For this purpose, a semi-structured interview guide was designed using the Consolidated Framework for Implementation Research (CFIR). The interviews were audio-recorded, transcribed, and analyzed using qualitative content analysis according to Kuckartz.
RESULTS: The ASRS-5 seems to work well in general medical practice. But there is evidence for a lack of knowledge about ADHD in adults among general practitioners and a demand for further training in this area. Moreover, insufficient possibilities for subsequent treatment after a positive ADHD screening were claimed.
CONCLUSIONS: In general medicine, the introduction of a screening using ASRS-5 in cases of clinical suspicion could be the first step towards improving the management of adult patients with ADHD.
CONCLUSIONS: Optimizing the management of adults with ADHD requires additional information and training initiatives to support early diagnosis especially in the primary care setting, and to reveal treatment options and care concepts for adults with ADHD.

Although many drought indices have been developed to monitor drought conditions, their applicability differs across climatic regions, which results in different characteristics of drought index assessments at different timescales and over different record lengths. Therefore, the applicability of precipitation-based and precipitation-evapotranspiration/temperature-based drought indices was examined in this study using the Generalized Extreme Value Index (GEVI), Homogeneity Index (HI) of precipitation and temperature, K index (K), precipitation anomaly percentage (Pa), Standardized Precipitation Evapotranspiration Index (SPEI), Standardized Precipitation Index (SPI), and China-Z Index (CZI) over different record lengths and at a timescale range of 1-24 months. In addition, the results that were obtained using these indices were compared with the Self-Calibrating Palmer Drought Severity Index (scPDSI). The stability, accuracy, and consistency of the different drought indices were evaluated using precipitation and evapotranspiration/temperature data (1-24 months) collected from different climatic regions in the arid area of northwest China in the 1961-2017 period. The results indicated that the Pa, CZI, K, and SPEI were more stable; the SPI, SPEI, and HI were more accurate; and the GEVI, SPI, HI, and SPEI were more consistent with the scPDSI. In addition, the results indicated that it is more appropriate to select a long record length (> 35 years) to monitor drought when sufficient data are available. However, defining constant drought classes may not be appropriate for all drought timescales. In fact, precipitation and evapotranspiration data from different timescales had different optimal distribution functions. The drought indices also demonstrated that they were applicable to a temperate arid area in the study region. In addition, the HI and SPEI better captured the precipitation and evapotranspiration/temperature characteristics, while the CZI, K, and Pa overestimated or underestimated the frequency of different drought classes at different timescales to some extent in the study region. The results of this study suggest that greater priority should be given to the precipitation-evapotranspiration-based indices. In addition, it is suggested to change the drought index class thresholds in future related studies on drought event recognition at different timescales to ensure more accurate drought monitoring.

Neonatal jaundice (NNJ) or hyperbilirubinemia is a ubiquitous condition in newborn infants. Currently, the transcutaneous bilirubinometer is used to screen for NNJ in health care facilities, where neonates need to be physically present (ie, a centralized model of care for NNJ screening). Mobile health (mHealth) apps present a low-cost, home-based, and noninvasive system that could facilitate self-monitoring of NNJ and could allow mothers the convenience of screening for NNJ remotely. However, end users\' acceptability of such mHealth apps is of fundamental importance before the incorporation of such apps into clinical practice.
The study aimed to explore the perception of postpartum mothers toward self-monitoring of NNJ using a novel mHealth app.
Mothers attending video consultations for early postpartum care at 2 Singapore primary care clinics watched an instructional video for a hyperbilirubinemia-screening mHealth app (HSMA). An independent researcher used a semistructured topic guide to conduct in-depth interviews with 25 mothers, assessing their views on HSMAs. All interviews were audio recorded, transcribed verbatim, and checked for accuracy before data analysis. Two researchers independently analyzed the transcripts via thematic analysis. Data were managed using NVivo qualitative data management software.
The identified themes were grouped under perceived usability and utility. Mothers valued the convenience and utility of HSMAs for remote monitoring of NNJ. They appreciated the objectivity the app readings provided compared to visual inspection. However, they perceived that the app\'s applicability would be restricted to severe jaundice, were concerned about its accuracy and restriction to the English language, and lacked confidence in using it. Nevertheless, they were willing to use it once its accuracy was proven and when they received adequate guidance from health care professionals. They also suggested including an action plan for the measured readings and clinical signs within the app. Mothers proposed pairing teleconsultations with HSMAs to boost their confidence and enhance adoption.
Mothers were receptive to using HSMAs but had concerns. Multiple languages, proof of accuracy, and resources to guide users should be incorporated into the app in the next phase to increase its successful adoption. Complementing such apps with a teleconsultation service presents a plausible and pragmatic NNJ care delivery model in general practice.

Usability evaluation both by experts and target users is an integral part of the process of developing and assessing digital solutions. Usability evaluation improves the probability of having digital solutions that are easier, safer, more efficient, and more pleasant to use. However, despite the widespread recognition of the importance of usability evaluation, there is a lack of research and consensus on related concepts and reporting standards.
The aim of the study is to generate consensus on terms and procedures that should be considered when planning and reporting a study on a usability evaluation of health-related digital solutions both by users and experts and provide a checklist that can easily be used by researchers when conducting their usability studies.
A Delphi study with 2 rounds was conducted with a panel of international participants experienced in usability evaluation. In the first round, they were asked to comment on definitions, rate the importance of preidentified methodological procedures using a 9-item Likert scale, and suggest additional procedures. In the second round, experienced participants were asked to reappraise the relevance of each procedure informed by round 1 results. Consensus on the relevance of each item was defined a priori when at least 70% or more experienced participants scored an item 7 to 9 and less than 15% of participants scored the same item 1 to 3.
A total of 30 participants (n=20 females) from 11 different countries entered the Delphi study with a mean age of 37.2 (SD 7.7) years. Agreement was achieved on the definitions for all usability evaluation-related terms proposed (usability assessment moderator, participant, usability evaluation method, usability evaluation technique, tasks, usability evaluation environment, usability evaluator, and domain evaluator). A total of 38 procedures related to usability evaluation planning and reporting were identified across rounds (28 were related to usability evaluation involving users and 10 related to usability evaluation involving experts). Consensus on the relevance was achieved for 23 (82%) of the procedures related to usability evaluation involving users and for 7 (70%) of the usability evaluation procedures involving experts. A checklist was proposed that can guide authors when designing and reporting usability studies.
This study proposes a set of terms and respective definitions as well as a checklist to guide the planning and reporting of usability evaluation studies, constituting an important step toward a more standardized approach in the field of usability evaluation that may contribute to enhancing the quality of planning and reporting usability studies. Future studies can contribute to further validating this study work by refining the definitions, assessing the practical applicability of the checklist, or assessing whether using this checklist results in higher-quality digital solutions.

BACKGROUND: Fatigue is an important symptom for many patients, including patients with kidney disease. Cognitive biases, such as attentional bias and self-identity bias, are thought to influence fatigue. Cognitive bias modification (CBM) training is a promising technique to counter fatigue.
OBJECTIVE: We aimed to evaluate a CBM training among patients with kidney disease and health care professionals (HCPs) and assess acceptability and applicability in the clinical setting using an iterative design process to evaluate expectations and experiences with the training.
METHODS: This was a longitudinal, qualitative, and multiple stakeholder-perspective usability study in which we interviewed end users and HCPs during the prototyping phase and after the end of training. We conducted semistructured interviews with 29 patients and 16 HCPs. The interviews were transcribed and analyzed thematically. Next to a general evaluation of the training, the acceptability of the training was evaluated using the Theoretical Framework of Acceptability, and applicability was assessed by evaluating obstacles and solutions for implementation in the kidney care setting.
RESULTS: Generally, participants were positive about the training and its applicability. The biggest negatives were doubts about effectiveness and annoyance about the repetitive character of CBM. Acceptability was judged with a mixed evaluation, with a negative evaluation of perceived effectiveness; mixed results for burden, intervention coherence, and self-efficacy; and positive results for affective attitude, ethicality, and opportunity costs. Barriers for applicability were patients\' varying computer skills, subjectivity of fatigue, and integration with regular treatment (eg, the role of HCPs). Possible solutions included assigning representatives among nurses, offering training on an app, and providing assistance via a help desk. The iterative design process, including repeated waves of testing user expectations and experiences, yielded complementary data.
CONCLUSIONS: To the best of our knowledge, this study is the first to introduce a CBM training targeting fatigue. Furthermore, this study provides one of the first user evaluations of a CBM training, both among patients with kidney disease and their care providers. Overall, the training was evaluated positively, although acceptability showed mixed results. Applicability was positive although barriers were identified. The proposed solutions require further testing, preferably following the same frameworks, as the iteration in this study contributed positively to the quality of the training. Therefore, future research should follow the same frameworks and consider stakeholders and end users in eHealth intervention design.

This Grading of Recommendations Assessment, Development and Evaluation (GRADE) concept article offers systematic reviewers, guideline authors, and other users of evidence assistance in addressing randomized trial situations in which interventions or comparators differ from those in the target people, interventions, comparators, and outcomes. To clarify what GRADE considers under indirectness of interventions and comparators, we focus on a particular example: when comparator arm participants receive some or all aspects of the intervention management strategy (treatment switching).
An interdisciplinary panel of the GRADE working group members developed this concept article through an iterative review of examples in multiple teleconferences, small group sessions, and e-mail correspondence. After presentation at a GRADE working group meeting in November 2022, attendees approved the final concept paper, which we support with examples from systematic reviews and individual trials.
In the presence of safeguards against risk of bias, trials provide unbiased estimates of the effect of an intervention on the people as enrolled, the interventions as implemented, the comparators as implemented, and the outcomes as measured. Within the GRADE framework, differences in the people, interventions, comparators, and outcomes elements between the review or guideline recommendation targets and the trials as implemented constitute issues of indirectness. The intervention or comparator group management strategy as implemented, when it differs from the target comparator, constitutes one potential source of indirectness: Indirectness of interventions and comparators-comparator group receipt of the intervention constitutes a specific subcategory of said indirectness. The proportion of comparator arm participants that received the intervention and the apparent magnitude of effect bear on whether one should rate down, and if one does, to what extent.
Treatment switching and other differences between review or guideline recommendation target interventions and comparators vs. interventions and comparators as implemented in otherwise relevant trials are best considered issues of indirectness.

Carpal tunnel syndrome (CTS) is an entrapment neuropathy with a high level of morbidity if neglected. Boston Carpal Tunnel Questionnaire (BCTQ) was designed to track patients\' progress after diagnosis. However, few studies showed that this questionnaire might be applicable as a screening tool for CTS.
UNASSIGNED: This study aims to identify the ability of BCTQ to detect symptoms and functional limitations of CTS among the potential high-risk population.
UNASSIGNED: This study is a cross-sectional study involving 366 females, aged 30-60 years, residents of the West Bank, Palestine. Data was collected using BCTQ to assess participants\' symptoms severity and functional limitations.
UNASSIGNED: Symptoms were reported in 72.4% of participants, while functional limitations were reported in 64.2%. Very severe symptoms were found in 1.1% of the study population, and very severe functional limitations were reported in 1.4% only. BCTQ reliability testing via Cronbach alpha showed a score of 0.937 and 0.922 for symptom severity and functional limitations scales, respectively. The most common reported symptom was pain during the daytime, while the \'household chores\' was the most common functional limitation.
UNASSIGNED: This study showed that many participants reported symptoms and functional limitations of CTS without a prior diagnosis. The BCTQ can potentially be used as a screening tool for middle-aged females in the West Bank, Palestine, as it showed strong applicability. However, this study could not compute the actual prevalence of CTS due to the lack of access to clinical and electrophysiological confirmation.

BACKGROUND: Chronic cardiovascular diseases demand continuous care from general practitioners and medical specialists. Especially in fragmented healthcare systems, such as in Germany, a large body of research is devoted to the improvement of care continuity. Meanwhile, measuring continuity of care itself has been a challenge due to the absence of validated instruments. In 2011, the Dutch Nijmegen Continuity Questionnaire (NCQ) was developed and validated to measure continuity of care across care settings from the patients\' perspectives in the Netherlands. Its applicability in other countries and health systems, however, has rarely been tested. We therefore aimed at assessing the applicability of the Nijmegen Continuity Questionnaire to the German health care context.  METHODS: We translated and applied the original NCQ to an ambulatory cardiovascular care setting in Germany. Qualitative interview data and quantitative survey data on our adaptation were collected from patients in 27 general practices within the German states of Baden-Wuerttemberg and Rhineland-Palatinate. Qualitative data on understandability and clearness of the questionnaire was obtained using semi-structured telephone interviews and think aloud-protocols. Quantitative data was obtained through an anonymous written questionnaire containing the translated NCQ items to assess applicability of our translation. We performed confirmatory and exploratory factor analyses based on the original NCQ-structure mapped to general practitioners and an aggregated analysis of general practitioners and cardiologists combined.
RESULTS: A total of 6 patients participated in the interviews and a total of 435 patients participated in the written survey. The interviews showed that, overall, patients had little difficulties comprehending and answering to our translation of the NCQ. The confirmatory factor analyses then showed that the structure of the original NCQ with 12 items and 3 latent factors can also be found in the German context. However, a simpler 2-factor-structure would also fit well with the data.
CONCLUSIONS: A German translation of the NCQ yielded a factor structure comparable to the original version and proved to be understandable for patients.
BACKGROUND: The project underlying the study was registered on November 7, 2019 in the German Clinical Trials Register ( www.drks.de ) under ID: DRKS00019219.

BACKGROUND: Delirium is a common condition during hospitalisation that should be prevented and treated. Several recommendations have been established to date, whereas few studies have investigated their applicability in daily practice for medical and post-acute settings.
OBJECTIVE: The aim of this research exercise was to emerge the applicability of the interventions recommended by studies in the daily care of patients at risk or with delirium cared in medical and post-acute settings.
METHODS: The study was organised in three phases. A systematic literature review according to Centre for Reviews and Dissemination was conducted (January-February 2021). Cochrane Library, Pubmed, Scopus, Cumulative Index to Nursing and Allied Health Literature, Psychological Information Database, and the Joanna Briggs Institute databases were searched. Primary and secondary studies were evaluated in their methodological quality with the Standard Quality Assessment Criteria, the Critical Appraisal Skills Programme, and the Appraisal of Guidelines for Research & Evaluation. Then, the interventions identified were assessed in their applicability using the Nominal Group Technique who ranked their judgement on a four-point Likert scale from 1 (totally inapplicable) to 4 (totally applicable). Qualitative feedbacks were also considered, and a validation of the final list was performed by the Nominal Group.
RESULTS: A total of 12 studies were included producing a list of 96 interventions categorised into four macro-areas (prevention, non-pharmacological, communication and pharmacological management). The Nominal Group identified 51 interventions (average score > 3.5) as applicable in medical and post-acute settings. Then, through a process of re-reading, and revising according to the comments provided by the Nominal Group, a list of 35 interventions out of the initial 96 were judged as applicable.
CONCLUSIONS: Applicability should be assessed with experts in the field to understand the involved factors. One-third of interventions have been judged as applicable in the Italian context; the nurses\' expertise, the work environment features, and the time required for each intervention in a high workload setting may prevent the full applicability of the interventions recommended by the literature.